1. Recognizing fractures
Dr. Ahmed Refaey
FRCR

2. Definition
Fracture

3. Fracture A disruption in all or part of the cortex of a bone
All = complete
Part = incomplete

4. Incomplete fracture Greenstick fracture fracture through one cortex
Torus fracture
buckling of the cortex
( buckling fracture)

5. Torus fracture

6. Greenstick fracture

7. How fractures are described
By the direction of the fracture line
By the relationship of the fragments
By the number of fragments
By relation to the adjacent joint

8. By the direction of the fracture line
- transverse
- diagonal or oblique
- longitudinal
- spiral

9. Transverse
- perpendicular to the long axis of the bone
- caused by a force perpendicular to the bone shaft

11. Diagonal or oblique
- caused by a force usually applied in the same direction as the long axis of the bone

13. Longitudinal
- along the longitudinal axis of the bone

14. Spiral
- a twisting fracture caused by a torque injury such as planting the foot in a hole while running

15. How fractures are described
By the direction of the fracture line
By the relationship of the fragments
By the number of fragments
By relation to the adjacent joint

16. By the relationship of one fracture fragment to another
- displacement
- angulation
- shortening
- rotation
* Most fractures display more than one of these abnormalities of position

17. By convention, abnormalities of position describe the relationship of the distal fracture fragment relative to the proximal fragment

18. Displacement
The amount of offset of the distal fracture fragment relative to the proximal
There is lateral displacement of the distal femoral fracture fragment in this case

19. Angulation
The angle away from the normal that the distal fragment makes with the proximal
In this case the distal fragment is angulated medially from the position it would have were it not fractured

20. Shortening Overlapping of the ends of the fracture fragments
Shortening is usually described by the number of centimeters of overlap
There is also medial displacement here

21. Rotation Almost always involves long bones ( humerus and femur )
In this case, Knee joint is in AP position ( points forward) , but ankle points lateral

22. How fractures are described
By the direction of the fracture line
By the relationship of the fragments
By the number of fragments
By the relation to the adjacent joint

23. By the number of fracture fragments
- two fragments : simple
- more than two fragments : comminuted

24. By the relation to the adjacent joint
- intra-articular
- extra-articular

25. How fractures are described
By the direction of the fracture line
By the relationship of the fragments
By the number of fragments
By the relation with the adjacent joint

30. Salter-Harris fracture

31. Salter-Harris fracture
Fractures that involve the epiphyseal plate alone or in combination with an adjacent part of the bone
Why is the classification important ?
- prognostic value
- type I and II do well
- type IV and V can develop early fusion of epiphysis and shortening of that bone

32. Salter-Harris classification
Type I : epiphyseal plate alone
Type II : epiphyseal plate & metaphysis
Type III : epiphyseal plate & epiphysis
Type IV : epiphyseal plate & metaphysis & epiphysis
Type V : crush ( ruined ) fracture of the epiphyseal plate

36. SALTR S = Slipped growth plate A = Above (# above growth plate )
L = Low ( # lower than “below” growth plate)
T = Together ( # of metaphysis+growth plate + epiphysis)
R = Ruined

37. Salter-Harris classification
Type I
- fracture through the epiphyseal plate alone
- often difficult to detect without other side for comparison

39. Salter-Harris classification
Type II
- fracture of the epiphyseal plate and metaphysis
- most common type of Salter fracture
- “corner sign”- small metaphyseal fragment

41. Salter-Harris classification
Type III
- fracture of the epiphyseal plate and the epiphysis

42. Salter-Harris classification
Type IV :
- fracture through the metaphysis, epiphyseal plate and the epiphysis
- poorer prognosis
“ premature closure of epiphysis “

43. Common fracture eponymes
Colle’s fracture
Smith’s fracture
Barton’s fracture
Jone’s fracture
Boxer’s fracture
Lover’s fracture

44. Colle’s fracture
- Extra articular fracture of the distal radius with dorsal angulation

45. Smith’s fracture
- extra articular fracture of the distal radius with volar angulation

46. Smith’s fracture

47. Smith’s fracture ( reverse colle’s )

49. Barton’s fracture
- intra articular fracture of distal radius

51. Jone’s fracture
Fracture of base of 5th metatarsal bone
Avulsion type fracture frequently caused by pull of peroneus brevis tendon

52. Jone’s fracture
- fracture base of 5th metatarsal bone

53. Boxer’s fracture
- fracture head of 5th metacarpal with palmer angulation
- most often the result of punching a person or wall

55. “ Lover’s fracture “ “ Don joun fracture” Jumper’s fracture
fracture of the calcaneus and a dorso-lumbar spine fracture.
This is called a 'jumpers fracture' or a 'lover's fracture', because it is usually seen in people jumping out of a window to escape from the police or a jealous husband.

56. Easily missed fractures
Scaphoid fracture
Buckle fracture “ torus “
Radial head fracture
Supracondylar fracture in children

57. Scaphoid fracture
- common
- pain in anatomical snuff box
- fall in outstretched hand
- can lead to avascular necrosis

64. Buckle “ Torus “ fracture
- children
Look for angulation of the cortex
Heal quickly

65. Radial head fracture
Common
Fat pad sign

70. Supracondylar fractures in children
Fat bad sign
Posterior displacement of capitulum “ anterior humeral line “

71. Anterior humeral line

74. Quiz

81. Torus fracture

82. Greenstick fracture

83. Smith’s fracture

85. Salter-harris IV

89. Salter-Harris type IV

93. AVN of scaphoid

94. Salter-Harris fracture type I

98. Salter-Harris type III

101. Slipped capital femoral epiphysis “ Salter-Harris type I “

104. Salter-Harris type II

105. Salter-Harris type III

107. Lover’s ( Don joun) ( Jumper’s) fracture