FRACTURESBy Mahima Charan

4th Year Medical Student

Key Points

I. Definition; A disruption in the continuity of a bone.II. Open Vs ClosedIII.Location IV. Simple/ComminutedV. Types/PatternVI. Displacement/Angulation/Shortening

Open Vs Closed

Open ( “open to the air”)A fracture in which bone penetrates through the skin . Look out for an open wound/soft tissue laceration.

Closed Fracture with intact overlying skin.

Location

Can be described in many ways;1. Segmental (long bones)Epiphysis, Metaphysis, Diaphysis2. Thirds (long bones)Proximal 1/3, Middle 1/3, Distal 1/33. Anatomical landmarks Head, Neck, Body, Condyle, Base

Neck of Femur

e.g. anatomical landmarks to

describe fractures

Simple Fracture; A fracture that consists of the bone breaking into 2 fragments

Oblique (Metartarsal)Transverse (Tibia)

The fracture passes at an angle oblique (> 30o) to the shaft of the long bone

The fracture passes at right angles/<30o to the shaft of the long

bone

Simple spiral FractureThis fracture of

the tibia resulted from a twisting

injury.The fracture line spirals along the shaft of the long

bone

Comminuted

A bone injury that results in >2 separate components is known

as a commented fracture. This is also

known as a multi-fragmentary fracture.

Proximal humeral shaft

Fracture Displacement

Displacement of fractures is defined in terms of the abnormal position of the distal fracture fragment in relation to the proximal bone.Types of displacement include-1. Angulation2. Rotation3. Shortening4. Impaction and Distraction

Angulation and Rotation

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 ‘valgus’

Rotation of a long bone may be internal or external

The fracture on the left has resulted in angulation of the distal component.

The fracture on the right has resulted in rotation of the distal component

ShorteningProximal 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.The fracture on the left is displaced without shorteningThe fracture on the right is both displaced and shortened

Impaction and Distraction

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.

The left image shows fracture widening or distraction.The right image shows a line of increased density due to fracture impaction.

Let’s have a look at some common fractures…..

Humeral fracture

ElbowThe lateral image shows the anterior

fat lad is raised way from the

humerus but does not show a fracture.

Posterior fat pad visible- ALWAYS

ABNORMALA fracture of the

radial head is visible on the AP

image

Monteggia vs Galeazzi

A Monteggia injury; fracture of the ulna shaft with dislocation of the radial head at the elbow. The radiocapitellar line should pass through the midline of the capitulum of the

humerus.

A Galeazzi injury is a fracture of the radial shaft with dislocation of the ulna from its articulation with the radius at

the distal radio-ulnar joint.

Monteggia

Colles Fracture

Common injury in elderly people with low bone density.Classically the injury comprises a transverse fracture of the distal radius with dorsal displacement and shortening of the wrist.

The fracture is often accompanied by a fracture of the ulnar styloid.Classical presentation is “Fall on an outstretched hand”

Normal Hip Anatomy

Garden Classification for NOF Fractures

If displaced, may present with shortened and

externally rotated leg!

Tx- I/II Put in a screwIII/IV Austin Moore ( hemiarthroplasty)

Avascular Necrosis (greater risk in intracapsular fractures

and scaphoid fractures ( tenderness in anatomical snuffbox)

Scaphoid Fracture

Principles of Management

I. First aid- If open ( clean wound, debride, tetanus injection)Analgesia for pain associated with fracture

II. Immobilise (traction, splints, casts)III. Reduction ( if displaced)

IV. Active Rehabilitation

DON’T FORGET YOU NEED 2 VIEWS ON AN XRAY!

Open Reduction Internal Fixation

Immobilise ( e.g. Kirschner wires

Fracture Complications

Soft tissue injury and neurovascular compromiseMalunionNon-union

Avascular NecrosisOsteopenia

Compartment SyndromeSudecks atrophy (Complex regional pain syndrome)

Thankyou very much!

Mahima Charan