Fractures

Fracture description mnemonic OLD ACIDS; O – open or closed L - Location D – Degree (complete vs incomplete) A – Articular invlovement C – communited/type I – Intrinsic bone quality D – Displacement, angulation, rotation S – Soft tissue injury

Open vs Closed

Location

Degree

Articular involvement

Comminuted/type A bone injury that results in more than 2 separate bone components is known as a comminuted fracture. Some comminuted fractures have specific names such as 'butterfly fragment' or 'segmental fracture'.

Comminuted fracture

Butterfly fragment

Segmental fracture

Transverse fracture

Oblique fracture

Spiral fracture

Longitudinal fracture

Intrinsic bone quality Osteoporosis is the commonest cause of pathological fractures. Pathological fractures may also occur in bone weakened by benign or malignant, primary or secondary bone tumours.

Displacement/Angulation/Rotation Displacement of fractures is defined in terms of the abnormal position of the distal fracture fragment in relation to the proximal bone. Types of fracture displacement include - angulation, rotation, change of bone length, and loss of alignment.

Displacement and shortening Proximal migration of the distal fracture component results in shortening of the overall bone length. An oblique fracture is more readily shortened than a transverse fracture, which would need to be fully 'off-ended' before it can shorten.

Angulation To describe fracture angulation the direction of the distal bone and degree of angulation in relation to the proximal bone should be stated. Medial angulation can be termed 'varus', and lateral angulation can be termed 'valgus'.

Rotation Rotation of a long bone fracture may be internal or external.

Distraction and impaction A fracture resulting in increased overall bone length, is due to distraction (widening) of the bone components. If there is shortening of bone without loss of alignment, the fracture is impacted. The bone substance of each component is driven into the other.

Soft tissue injury

Quiz

1) Describe this fracture

2) Describe this fracture (patient’s left humerus) Posterior Anterior NB What do you notice about the bone density?

3) Describe this fracture

4) Describe the fracture (patient’s right elbow) Lat. view AP view

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Answers

1) Describe this fracture

1) A closed, complete fracture of the humerus neck on the left side 1) A closed, complete fracture of the humerus neck on the left side. It is a transverse, extra-articular and posteriorly displaced fracture. There is no evidence of bone disease or soft tissue damage.

2) Describe this fracture (patient’s left humerus) Posterior Anterior NB What do you notice about the bone density?

2) A closed, complete fracture of the humeral diaphysis on the left side. It is a transverse, extra-articular fracture with anterior displacement and angulation. There is evidence of bone disease. The bone appears 'moth-eaten' This is multiple myeloma.

3) Describe this fracture

3) A closed, complete fracture of the distal third of the right clavicle. The fracture is extra-articular, oblique and inferiorly displaced with no evidence of bone disease and no soft tissue injury. The unfused growth plates of the proximal humerus and the acromial apophysis should not to be mistaken for fractures.

4) Describe the fracture (patient’s right elbow) Lat. view AP view

4) A closed, incomplete fracture of the right radial head 4) A closed, incomplete fracture of the right radial head. The fracture is extra-articular with buckling of the radial head cortex anteriorly. No evidence of bone disease but there is an effusion around the joint.

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