1. Fractures

2. 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

3. Open vs Closed

4. Location

5. Degree

6. Articular involvement

7. 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'.

8. Comminuted fracture

9. Butterfly fragment

10. Segmental fracture

12. Transverse fracture

14. Oblique fracture

16. Spiral fracture

18. Longitudinal fracture

19. 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.

21. 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.

22. 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.

23. 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'.

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

25. 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.

26. Soft tissue injury

27. Quiz

28. 1) Describe this fracture

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

30. 3) Describe this fracture

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

32. 5)

33. Answers

34. 1) Describe this fracture

35. 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.

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

37. 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.

38. 3) Describe this fracture

39. 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.

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

41. 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.

42. 5)

43. 5)