FR Presented by Dina Metwaly AC T URE S

FRACTURE A few of the reasons fractures occur are because of: Trauma Osteoporosis Osteogenesis Imperfecta (brittle bone disease) Fracture is defined as a break in the bone or cartilage

TYPES OF FRACTURES 1.Avulsion-boxer- Blowout fractures 2. closed, comminuted, compound, compression, 3.greenstick, impacted, pathologic, spiral, stress and transverse. 4.Salter-haris fractures 5.Colles’- smith of the wrist 6.Elbow fracture- hip fracture There are many types of fractures. Some are:

Avulsion Fracture An avulsion fracture occurs when there is trauma to where a ligament or tendon attaches to a born. This type of fracture occurs when the tear causes a piece of bone to be pulled off. An avulsion fracture can be seen anywhere in the body but a common site is at the base of the 5th metatarsal.

Boxer’s Fracture A boxer’s fracture occurs at the head of the 4th or 5th metacarpal of the hand. It almost always occurs as the result of striking a firm object with a closed fist. Most boxer’s fractures can heal with a cast but some severe cases may require surgical repair.

Blow-out Fracture A blow-out fracture of the eye socket may involve the orbital floor, wall, or roof. The most common type of blow-out fracture involves the floor of the orbit and specifically the maxillary bone. Following blunt trauma to the eye, the contents of the orbit compress and push down into the maxillary sinus.

Open or Compound Fracture: An open or compound fracture occurs when the bone actually manages to pierce the skin. These fracture almost always require the surgical insertion of internal fixation devices. This patient fell and broke her humerus at the distal portion of her prosthesis. This resulted in a compound fracture.

Compression Fracture A compression fracture occurs when a vertebral body is crushed and collapses down upon itself. It can be the result of trauma, cancer, or osteoporosis.

Comminuted Fracture A comminuted fracture occurs when there are multiple bone fragments. This often occurs as the result of some type of crushing injury or as the result of gun shot wound.

TRANSVERSE FRACTURE Is a complete fracture that goes straight across the bone The fracture is at a right angle to the long axis of the bone

GREENSTICK FRACTURE Is a fracture with an incomplete break. One side is broken and the other is bent. Found in children because they have a softer and more pliable bone structure than adults.

Spiral Fracture A spiral fracture occurs when the bone has been twisted apart. It will have a similar appearance to a spiral staircase. This fracture is sometimes referred to as a torsion fracture. Spiral fractures in babies and children can be a warning sign of abuse.

Colles’ Fracture A Colles’ fracture is most often caused when an individual falls backwards onto a hard surface and braces themselves with an open out stretched hand. It consists of a fracture of the distal radius with posterior and lateral displacement of the distal fragment.

Smith's fracture A Smith's fracture, also sometimes known as a reverse Colles' fracture it is a fracture of the distal radius. It is caused by a direct blow to the dorsal forearm or falling onto flexed wrists. Smith's fractures are less common than Colles' fractures. The distal fracture fragment is displaced volarly (ventrally), as opposed to a Colles' fracture which the fragment is displaced dorsally.

Colle’s vs Smith fracture

Salter-Harris Fractures Salter-Fractures involve fractures of the growth plate in children. There are five categories of this fracture: 1.Type I: The epiphysis is completely dislocated from the metaphysis (shaft) of the bone. This type usually only requires a cast for treatment. 2.Type II: This is the most common type. It involves a partial dislocation of the epiphysis and a fracture of the metaphysis. 3.Type III: This one involves a partial dislocation and a fracture of the epiphysis. 4.Type IV: This type is the result of a fracture of both the epiphysis and the metaphysis. 5.Type V: This one involves the impaction of the epiphysis into the metaphysis.

A Salter-Harris Type II fractureis the most common type of growth plate fracture. A Salter-Harris Type III fractureis a relatively rare type of growth plate fracture.

Elbow Fracture: Fat Pad Sign A subtle fracture to the elbow in the area of the distal humerus can be very difficult to visualize radiographically. The best position to view is the lateral. On the anterior surface of the elbow, there is a fat pad that is normally visualized as a small radiolucency. There is also a fat pad located on the posterior surface of the distal humerus however, it is normally not demonstrated. If there is trauma to the elbow with an underlying fracture to the distal humerus, this posterior fat pad will be displaced and it will be visualized as a radiolucent density.

Elbow Fracture: Fat Pad Sign This is a normal lateral elbow that has no injury to the distal humerus. The arrow is pointing to the area that would exhibit a fat pad signif there was an injury. This lateral elbow did experience trauma to the distal humerus. The arrow is pointing to a radiolucent area that is indicative of a positive fat pad sign.

Hip Fractures A hip fracture occurs on the proximal end of the femur and is usually the result of a fall from an elderly patient with osteoporosis. There are four classifications of hip fractures: 1.Femoral Head Fracture: This is often the result of a high energy impact and is often combined with a dislocation. 2.Femoral Neck or Transcervical Fracture: The blood supply to the femoral head is almost always disrupted with this type of fracture. 3.Intertrochanteric Fracture: These fractures usually do not damage the blood supply the to hip and can often be reduced with the surgical insertion of a metal plate and screws. 4.Subtrochanteric Fracture:This fracture occurs just below the level of the intertrochanteric crest.It is actually physically located on the shaft of the femur and may extend down the femur.

The femoral neck(arrow) on this patient has been fractured and this is sometimes referred to as a transcervical fracture. The blood supply to the femoral head is almost always disrupted with this type of fracture and as a result, there is always a risk that these fracture may not heal. Therefore, many are treated with a total hip replacement.

Hip Fracture: Intertrochanteric This hip fracture occurred through the intertrochanteric crest(arrows). These fractures are usually do not damage the blood supply to the hip like femoral neck fracturesdo and can therefore be reduced with a metal plate and screws as opposed to the more invasive total hip replacement usually required for neck fractures.

TREATMENT OF FRACTURES The treatment of fractures could include the following procedures: 1.Immobilization of fractured body part 2.A splint to immobilize the fracture and the joints surrounding it may be the next step in treatment 3.After a few days then a cast may be applied. It usually takes a few days to cast the area because of the swelling around the fracture would build too much pressure under the cast 4.Finally depending on the severity, surgery may be required