Fractures ALI B ALHAILIY

Definition Fracture :a break in the continuity of a bone A fracture is present when there is loss of continuity in the substance of a bone. The term covers all bony disruptions, ranging from the situation when a bone is broken into one or many fragments

Causes of fracture Fractures are caused by the application of stresses which exceed the limits of strength of a bone. Violence is the commonest cause 1- direct violence, a bone may be fractured by being struck by a moving or falling object. 2- indirect violence. A twisting or bending stress is applied to a bone, and this results in its fracture at some distance from the application of the causal force.

Types of fracture 1-Pathological fracture Sometimes fracture may occur in an abnormal or diseased bone. That will reduce the strength of the bone then the force required to produce fracture is reduced. Bone cyst

2-Fatigue fractures (stress fractures) Stresses, repeated with excessive frequency to a bone, may result in fracture. It is hairline in pattern and are often not diagnosed with certainty until there is callus formation, or increased density at the fracture site. 3-6 weeks after the onset of symptoms Healed fatigue fracture through the second metatarsal bone

3- Open and closed fractures Closed fracture: (a) the bone is broken, but there is no external wound. A fracture not communicating with the external environment, the overlying skin are intact Open fracture: A fracture with break in the overlying skin and soft-tissues, leading to the fracture.

4- Simple transveres fractures Transverse fractures run either at right angles to the long axis of a bone (1), or with an obliquity of less than 30°. 5- Multifragmental fractures There are two fragments or more. 4 5

6- Avulsion fractures : produced by a sudden muscle contraction, the muscle pulling off the portion of bone to which it is attached. Common examples include: (1) Base of fifth metatarsal. (2) Tibial tuberosity (quadriceps). (3) Upper pole of patella (quadriceps). (4) Lesser trochanter (iliopsoas).

7-Fracture-dislocations present when a joint has dislocated and there is in addition a fracture of one of the bony components of the joint. fracture-dislocation of the shoulder, where there is an anterior dislocation with a fracture of the neck of the humerus. Injuries of this kind may be difficult to reduce and may be unstable. Stiffness and avascular necrosis are two common complications

Describing the level of a fracture The anatomical divisions of a long bone include the epiphysis (E), epiphyseal plate (EP), and diaphysis or shaft (D). Between the latter two is the metaphysis (M). A fracture may be described as lying within these divisions, or involving a distinct anatomical part, e.g. A = fracture of the tibial diaphysis; B = fracture of the femoral neck; C = fracture of the greater trochanter; F = supracondylar fracture of the femur.

Describing the level of a fracture For descriptive purposes a bone may be divided into thirds. In this way: A = fracture of the mid third of the femur; B = fracture of the femur in the distal third; C = fracture of the femur at the junction of the middle and distal thirds. D = fracture of the distal metaphysis of radial bone

X RAY FINDINGS Phalangeal dislocations Forced hyperextension of the thumb or finger joints is the usual cause for these injuries. Normally the distal segment is displaced posteriorly

Bennett’s fracture It is a fracture of the base of the first metacarpal bone which extends into the carpometacarpal (CMC) joint.[1] This intra-articular fracture is the most common type of fracture of the thumb A vertical lucent line is seen intersecting the proximal articular surface of the first metacarpal bone

Scaphoid Fracture

Scaphoid Fracture Usually fractures through the waist (middle) of the scaphoid bone Mechanism – fall on dorsiflexed outstretched hand May not be evident for up to 10 days post trauma Very well diagnosed clinically – pain and tenderness in anatomical snuff box Poor healing fracture due to complicated blood supply Most easily diagnosed via the PA ulnar deviation with angulation projection

Scaphoid fractures How many projections for scaphoid # ?

Or… PA OBL PA PA DEV LAT General setup of 24 x 30 cm cassette for patients who have defined trauma to scaphoid or follow up films or minimal injury

Colles’ fracture.

Colles’ Fracture # of the distal end of the radius (3cm from joint) +/- # of the styloid process of the ulnar Dorsal angulation of the distal fragment – ventral angulation of proximal radius Most common form of wrist fracture – females, middle aged and older Caused by fall on outstretched hand (FOOSH)

Smith’s Fracture Reverse Colles’ # Hyperflexion with fall on back of hand Fracture of the radius with ventral displacement of distal fragment and dorsal angulation of proximal radius

Galeazzi’s Fracture # of the mid shaft of the radius Dislocation of the distal radioulnar joint Fall on outstretched hand with elbow flexed High incidence of nonunion and a limitation on pronating or supinating the hand

Please read about Salter–Harris fractures ? Types with figures ? http://cal.vet.upenn.edu/projects/saortho/chapter_11/11mast.htm

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