Applied Anatomy Long bones and fractures

Basic Anatomy of Long Bones Physis Epiphysis Diaphysis Metaphysis

Long Bone Anatomy Physis Epiphysis Diaphysis metaphysis

Fracture terminology COMPOUND fracture COMMINUTED fracture INTRARTICULAR fracture AVULSION fracture

Compound Fractures A fracture that punctures the skin. Also called an open fracture.

Comminuted Fracture Lots of little pieces

Intrarticular Fracture Fracture extends into the joint

Avulsion Fracture Fracture where a strong ligament or tendon pulls off a chunk of bone rather than rupturing

SHOULDER

Shoulder Anatomy

What is the difference between a shoulder separation and a shoulder dislocation?

Shoulder Separation Disruption of the AC joint

Shoulder Dislocation Disruption of the glenohumeral joint

55 y.o. female is being assisted up and embankment; she falls while still holding the hand of her assistant. Immediate pain left shoulder Unable to left arm above her head to brush her hair Pain is worst at night

MRI Shoulder

Rotator Cuff Tear Acute are usually traumatic Chronic are usually degenerative Pain or weakness with abduction of the arm MRI is diagnostic test of choice

Roatator Cuff Tear Treatment depends on: –Age of patient –Type of tear (traumatic vs. degenerative) –Time since tear –Patient’s activities

Y VIEW SHOULDER

77 y.o. female fell at home complains of left shoulder pain. Pain and deformity left shoulder Unable to extend left wrist

Proximal humerus fracture with damage to the radial nerve

Elbow

Elbow Anatomy

30 y.o. man who fell on a outstretched arm Pain at the elbow Unable to flex or extend the elbow due to pain Elbow is swollen

Elbow Fractures Notorious for not showing up on x-ray BEWARE the swollen elbow! --- fractured until proven otherwise Look for the “SAIL SIGN”--- indicative of joint swelling and strongly suggests fracture

16 y.o. male who fell on an outstretched hand while snowboarding Pain left wrist at the anatomic snuffbox No obvious swelling Able to flex and extend the wrist

NAVICULAR WRIST FRACTURE Notorious for not showing up on x-ray High rate of non- union Pain in anatomic snuffbox suggests navicular fracture

Anatomic Snuffbox

Why do navicular wrist fractures have such a high rate of non- union?

23 y.o. male who fell onto an outstretched arm while skiing Pain at the base of the thumb No significant swelling Injury occurred in his dominent hand

GAMEKEEPER’S THUMB Tear of the ulnar collateral ligament of the thumb (or avulsion fx) Laxity at the base of the thumb leads to weakness long term Must fix close to the time of injury

HIP and PELVIS

83 y.o. female fell on left hip. Complains of pain in left hip. Known h/o osteoporosis Left leg is foreshortened and externally rotated Unable to bear weight

83 y.o. female fell on right hip. Complains of pain in the right hip. Known h/o osteoporosis Right leg is foreshortened and externally rotated Unable to bear weight

Hip Fractures in General Usually (>90%) the hip breaks and then they fall. In the absence of MAJOR trauma, hip fracture is pathognomonic for osteoporosis Mortality rate at 1 year approaches 50%

Femoral Neck vs. Intertrochanteric Femoral neck fx are within the joint capsule Femoral neck fx have higher rates of complication Clinical presentations are the same

PEDIATRIC FRACTURES Physis fractures Greenstick fractures Torus fractures

Pain and selling at the wrist Refuses to use the right hand 15 y.o. boy fell on an outstretched arm.

SALTER-HARRIS CALSSIFICATION

Which Salter- Harris type?

5 y.o. girl fell on an outstretched arm Pain mid-forearm Moderate swelling mid-forearm

GREENSTICK FRACTURES Incomplete fracture seen in young children Heal quickly Note the bend in the ulna --- this is referred to as a bend “fracture”

4 y.o. girl fell onto an outstretched arm Pain distal forearm No swelling Refuses to use the arm

TORUS FRACTURE Also called “buckle fracture” Seen in young children with soft, plastic bones Cortex simply wrinkles Heals quickly

SUMMERY Basic anatomy Types of fractures Pediatric fractures Relationship of structures not seen on an x-ray film (nerves, tendons, blood vessels) to outcome of fracture