Prof Dr Osama Amin Prof Of Orthopedics Qassim University

Objectives  ƒ To recognise common orthopaedic trauma  ƒ To be able to describe the injury to a  colleague/orthopaedic surgeon

What is a fracture?  ƒ A break, rupture or crack in bone or cartilage

How to describe a fracture  Location  Bone  Position within the bone  Proximal  Mid  Distal Epiphysis Epiphyseal plate (physis) Diaphysis Metaphysis (proximal) Metaphysis (distal)

HowtodescribeafractureHow to describe a fracture  OPEN / CLOSED  COMPLETE / INCOMPLETE  SIMPLE / COMMINUTED  DIRECTION OF FRACTURE LINE  INTRA- OR EXTRA-ARTICULAR  DESCRIPTION OF CHANGE IN ANATOMICAL POSITION

HowtodescribeafractureHow to describe a fracture  OPEN/CLOSED  Closed  No break in the skin  Open (Compound)  Part of the bone protrudes through the skin

HowtodescribeafractureHow to describe a fracture  OPEN/CLOSED  Closed  No break in the skin  Open (Compound)  Part of the bone protrudes through the skin

HowtodescribeafractureHow to describe a fracture  COMPLETE/INCOMPLETE  Complete  All cortical surfaces disrupted  Incomplete

HowtodescribeafractureHow to describe a fracture  COMPLETE/INCOMPLETE  Complete  All cortical surfaces disrupted  Incomplete Post-Fixation

HowtodescribeafractureHow to describe a fracture  COMPLETE/INCOMPLETE  Complete  Incomplete  Greenstick  Buckle  Plastic bowing fracture

HowtodescribeafractureHow to describe a fracture  COMPLETE/INCOMPL ETE  Complete  Incomplete  Greenstick - break of one cortical margin only due to tension  Buckle  Plastic bowing fracture

HowtodescribeafractureHow to describe a fracture  COMPLETE/INCOMPL ETE  Complete  Incomplete  Greenstick  Buckle - buckling of cortex due to compression  Plastic bowing fracture Cortical Buckle

HowtodescribeafractureHow to describe a fracture  COMPLETE/INCOMPL ETE  Complete  Incomplete  Greenstick  Buckle  Plastic bowing fracture  microfractures but no gross visible fracture line Bowing fracture

HowtodescribeafractureHow to describe a fracture  SIMPLE / COMMINUTED  Simple – single fracture line resulting in two bone fragments  Comminuted

HowtodescribeafractureHow to describe a fracture  SIMPLE / COMMINUTED  Simple – single fracture line resulting in two bone fragments  Comminuted → more than two fracture fragments

HowtodescribeafractureHow to describe a fracture  SIMPLE / COMMINUTED  Simple – single fracture line resulting in two bone fragments  Comminuted → more than two fracture fragments Butterfly fragment – V shaped fragment not completely circumscribed by cortex

HowtodescribeafractureHow to describe a fracture  DIRECTION  Transverse  Spiral  Oblique

HowtodescribeafractureHow to describe a fracture  DIRECTION  Transverse  Break straight across the bone  Spiral  Oblique

HowtodescribeafractureHow to describe a fracture  DIRECTION  Transverse  Break straight across the bone  Spiral  Break travels around the bone  Oblique

HowtodescribeafractureHow to describe a fracture  DIRECTION  Transverse  Break straight across the bone  Spiral  Break travels around the bone  Oblique

HowtodescribeafractureHow to describe a fracture  DIRECTION  Transverse  Spiral  Oblique  Break is diagonally across the bone

HowtodescribeafractureHow to describe a fracture  DIRECTION  Transverse  Spiral  Oblique  Break is diagonally across the bone Post surgical follow-up

HowtodescribeafractureHow to describe a fracture  DIRECTION  Transverse  Spiral  Oblique  Break is diagonally across the bone

HowtodescribeafractureHow to describe a fracture  INTRA / EXTRAARTICULAR Intraarticular fracture Comminuted Intra-articular fracture (Rolando fracture)

HowtodescribeafractureHow to describe a fracture Callus Rolando fracture follow-up

HowtodescribeafractureHow to describe a fracture  CHANGE IN ANATOMICAL POSITION  Length  Distraction  Shortening  over-riding  impacted  Displacement  Undisplaced  Anterior, lateral etc  Angulation/tilt  Rotation Distracted superior and inferior patellar poles

HowtodescribeafractureHow to describe a fracture  CHANGE IN ANATOMICAL POSITION  Length  Distraction  Shortening  over-riding  impacted  Displacement  Undisplaced  Anterior, lateral etc  Angulation/tilt  Rotation Over-riding fracture fragments Rotated distal fragment

HowtodescribeafractureHow to describe a fracture  CHANGE IN ANATOMICAL POSITION  Length  Distraction  Shortening  over-riding  impacted  Displacement  Undisplaced  Anterior, lateral etc  Angulation/tilt  Rotation Impacted fracture of humeral neck

HowtodescribeafractureHow to describe a fracture  CHANGE IN ANATOMICAL POSITION  Length  Distraction  Shortening  over-riding  impacted  Displacement  Undisplaced  Anterior, lateral etc  Angulation/tilt  Rotation Medial angulation (at fracture apex) Lateral displacement (half a bone’s width) Valgus deformity

Valgus and varusValgus and varus  Describe direction of movement in the lateral plane of the distal part of the bone  Valgus = lateral/away from midline of the body  Varus = medial/toward the midline of the body mediallateral valgus varus

Special types of fractures  Pathological  Stress  Periprosthetic  Salter-Harris

Special types of fractures  Pathological fractures  Occur in diseased bone  Pre-existing pathology eg  bone cyst,  osteogenesis imperfecta  Acquired lesion eg  metastases, myeloma enchondroma fracture

Special types of fractures  Stress fracture  Abnormal stresses placed on normal bone  eg runners, ballet dancers  Can be difficult to identify on plain films  More easily detected with MRI or bone scan

Special types of fractures  Periprosthetic Spiral periprosthetic fracture with associated shortening and rotation of the distal fracture fragment Post fixation

Special types of fractures  Salter Harris fractures  Special type of fracture involving the growth plate in children  May have consequences for later bone growth IIIIIIIVV

Special types of fractures  Salter Harris fractures  S – slipped (type I)  A – above epiphyseal plate (type II)  L – lower than epiphyseal plate (type III)  T – through epiphyseal plate (type IV)  R – “rammed” epiphyseal plate (type V) IIIIIIIVV

Special types of fractures  Salter Harris fractures  S – slipped (type I)  A – above epiphyseal plate (type II)  L – lower than epiphyseal plate (type III)  T – through epiphyseal plate (type IV)  R – “rammed” epiphyseal plate (type V) IIIIIIIVV

Special types of fractures  Salter Harris fractures  S – slipped (type I)  A – above epiphyseal plate (type II)  L – lower than epiphyseal plate (type III)  T – through epiphyseal plate (type IV)  R – “rammed” epiphyseal plate (type V) IIIIIIIVV

Special types of fractures  Salter Harris fractures  S – slipped (type I)  A – above epiphyseal plate (type II)  L – lower than epiphyseal plate (type III)  T – through epiphyseal plate (type IV)  R – “rammed” epiphyseal plate (type V) IIIIIIIVV