1. Applied Anatomy Long bones and fractures

3. Basic Anatomy of Long Bones Physis Epiphysis Diaphysis Metaphysis

4. Long Bone Anatomy Physis Epiphysis Diaphysis metaphysis

5. Fracture terminology COMPOUND fracture COMMINUTED fracture INTRARTICULAR fracture AVULSION fracture

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

8. Comminuted Fracture Lots of little pieces

9. Intrarticular Fracture Fracture extends into the joint

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

11. SHOULDER

13. Shoulder Anatomy

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

15. Shoulder Separation Disruption of the AC joint

16. Shoulder Dislocation Disruption of the glenohumeral joint

18. 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

20. MRI Shoulder

21. 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

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

24. Y VIEW SHOULDER

25. 77 y.o. female fell at home complains of left shoulder pain. Pain and deformity left shoulder Unable to extend left wrist

27. Proximal humerus fracture with damage to the radial nerve

28. Elbow

29. Elbow Anatomy

30. 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

33. 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

34. 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

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

38. Anatomic Snuffbox

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

40. 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

42. 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

43. HIP and PELVIS

44. 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

46. 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

48. 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%

49. 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

50. PEDIATRIC FRACTURES Physis fractures Greenstick fractures Torus fractures

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

53. SALTER-HARRIS CALSSIFICATION

54. Which Salter- Harris type?

55. 5 y.o. girl fell on an outstretched arm Pain mid-forearm Moderate swelling mid-forearm

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

58. 4 y.o. girl fell onto an outstretched arm Pain distal forearm No swelling Refuses to use the arm

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

61. 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