1. University Hospitals Case Medical Center Department of Radiology

2.  Abrupt discontinuity of all or part of the cortex  +/- Acute angulation of normally smooth contour  Fracture lines are black and linear  Fracture lines are straight but acute in angulation - where fracture change course  Edges are jagged, rough, irregular  NOT well-corticated

4.  Direction of the fracture line  Relationship of the fracture fragments  Number of fragments  Communication of the fracture with the outside

5.  Transverse  Diagonal/Oblique  Longitudinal  Spiral

6.  Transverse  Perpendicular to the long axis of the bone  Diagonal/Oblique  Longitudinal  Spiral

7.  Transverse  Diagonal/Oblique  Force applied in the same direction as the long axis of the bone  Longitudinal  Spiral

8.  Transverse  Diagonal/Oblique  Longitudinal  Along the axis of the bone  Spiral

9.  Transverse  Diagonal/Oblique  Longitudinal  Spiral  Torque injury

10.  Displacement  Angulation  Shortening  Rotation

11.  Displacement  Amount by which the distal fragment is offset from the proximal fragment  Front-to-back, Side-to-side  Described by percent or fraction of shaft width  Angulation  Shortening  Rotation

12.  Displacement  Angulation  Angle between the distal and proximal fragments  Described by degrees and position  anterior/posterior or medial/lateral  Shortening  Rotation

13.  Displacement  Angulation  Shortening  If any, how much overlap between the fracture fragments  Described in cm  Rotation

14.  Displacement  Angulation  Shortening  Rotation  Involves long bones  Describes the orientation of one joint at one end relative to the orientation of the joint at the other end

15.  Simple Fracture  Two fragments  Comminuted Fracture  > Two fragments

16.  Closed  No communication to the atmosphere  Open  Communication with the atmosphere

17.  Closed  No communication to the atmosphere  Open  Communication with the atmosphere

19.  Epiphyseal Plate Fractures in Children  Growth Plate (Epiphyseal Plate) – most vulnerable in growing bone to shearing injury  30% of all childhood fractures  Classification System – I-V  Method of describing growth plate fractures  Implications for treatment  Predicts likelihood of complications

20.  Isolated epiphyseal plate injury  Good prognosis – heals well  Example: Slipped capital femoral epiphysis (SCFE)  Tall, heavier teenage boys, 25% bilateral  Line from the lateral femoral neck should intersect a portion of the femoral epiphysis

21.  Epiphyseal plate and metaphysis  Most common of Salter-Harris fractures  Good prognosis

22.  Epiphysis and Epiphyseal Plate  Intra-articular fracture  Fracture enters the joint space  Fracture of the articular cartilage  Long-term implications  Secondary osteoarthritis  Asymmetrical and premature fusion of the growth plate

23.  Epiphysis, Epiphyseal Plate, and Metaphysis  Intra-articular fracture  Poor prognosis  Premature, asymmetric closure of epiphyseal plate  Leg length discrepancy  Angular deformity  Secondary osteoarthritis

24.  Crush Injury of the Epiphyseal Plate  Damages growth plate by direct compression  Associated with vascular injury  Results in growth impairment  Rare

27.  Fracture of the distal radius  Dorsal angulation of the distal radial fragment  Fall on an outstreched hand  Association  Ulnar styloid fracture

28.  Fracture of the distal radius  Volar (palmer) angulation of the distal radial fragment  Fall on an flexed hand

29.  Fracture of the base of the 1 st metacarpal  Intra-articular fracture  Caused by axial load along the metacarpal in a partially flexed digit

30.  Fracture of the head of the fifth metacarpal  Volar (Palmar) angulation of the distal fracture fragment  Caused by punching a wall or person

31.  Avulsion of the anterolateral margin of the lateral tibial plateau  Caused by internal rotation and varus stress  Associations  ACL tear  Meniscal injuries

32.  Proximal fibular fracture  Associated - fracture of the medial malleolus  Disruption of the tibiofibular syndesmosis  Caused by ankle eversion injury  transmits force thru the interosseous memtrane

33.  Transverse, avulsion fracture of the base of the fifth metatarsal  At insertion of the peroneus brevis tendon  Caused by a combination of plantar flexion of the foot and inversion of the ankle

34.  Not an eponymous fracture but an easily missed fracture  Common  Pain in the anatomic snuff box  Caused by fall on an outstretched hand  Misdiagnosis can lead to avascular necrosis

35.  Questions?  Please read the supplemental article on bone tumors and tumor-like conditions  MSK quiz will be administered on Thursday at 11:30AM before conference