Fractures ALI B ALHAILIY
Fractures
ALI B ALHAILIY
Definition
• Fracture :a break in the• continuity of a bone • A fracture is present when
there is loss of continuity in the substance of a bone.
• The term covers all bony disruptions, ranging
• from the situation when a bone is broken into one or many fragments
Causes of fracture• Fractures are caused by the• application of stresses which• exceed the limits of strength of• a bone.• Violence is the commonest cause• 1- direct violence, a• bone may be fractured by being• struck by a moving or falling• object.• 2- indirect violence. A• twisting or bending stress is• applied to a bone, and this• results in its fracture at some• distance from the application of• the causal force.
Types of fracture
• 1-Pathological fracture • Sometimes fracture may
occur in an abnormal or diseased bone. That will
• reduce the strength of the bone then the force required to produce fracture is reduced.
Bone cyst
2-Fatigue fractures (stress fractures)
• Stresses, repeated• with excessive frequency to a• bone, may result in fracture.• It is hairline in pattern and are
often not diagnosed with certainty
• until there is callus formation, or increased density at the fracture site.
• 3-6 weeks after the onset of symptoms Healed fatigue fracture
through the secondmetatarsal bone
3- Open and closed fractures• Closed fracture: (a) the bone is• broken, but there is no external• wound. A fracture not• communicating with the
external environment, the overlying skin are intact
• Open fracture: A fracture with break in
• the overlying skin and soft-tissues,
• leading to the fracture.
4- Simple transveres fractures
• Transverse fractures run either at right angles to the long axis of a bone (1), or with an obliquity of less than 30°.
• 5- Multifragmental fractures
• There are two fragments or more.
4
5
6- Avulsion fractures : produced by a sudden muscle
contraction,• the muscle pulling off the portion
of bone to which it is attached.• Common examples include:• (1) Base of fifth metatarsal.• (2) Tibial tuberosity (quadriceps).• (3) Upper pole of patella
(quadriceps).• (4) Lesser trochanter (iliopsoas).
7-Fracture-dislocations• present when a joint has
dislocated and there is in addition a fracture of one of the bony components of the joint.
• fracture-dislocation of the shoulder, where there is an anterior dislocation with a fracture of the neck of the humerus.
• Injuries of this kind may be difficult to reduce and may be
• unstable. Stiffness and avascular necrosis
• are two common complications
Describing the level of a fracture• The anatomical divisions of a long bone
include• the epiphysis (E), epiphyseal plate (EP),
and diaphysis or shaft (D). Between the latter two is the metaphysis (M).
• A fracture may be described as lying within these divisions, or involving a distinct anatomical part, e.g.
• A = fracture of the tibial diaphysis;• B = fracture of the femoral neck;• C = fracture of the greater trochanter;• F = supracondylar fracture of the femur.
Describing the level of a fracture• For descriptive purposes a bone
may be divided into thirds. In this way:
• A = fracture of the mid third of the femur;
• B = fracture of the femur in the distal third;
• C = fracture of the femur at the junction of the
• middle and distal thirds.• D = fracture of the distal
metaphysis of radial bone
X RAY FINDINGS
Phalangeal dislocationsForced hyperextension of the thumb or finger joints is the usual cause for these injuries. Normally the distal segment is displaced posteriorly
Bennett’s fracture
• It is a fracture of the base of the first metacarpal bone which extends into the carpometacarpal (CMC) joint.[1] This intra-articular fracture is the most common type of fracture of the thumb
• A vertical lucent line is seen intersecting the proximal articular surface of the first metacarpal bone
Scaphoid Fracture
Scaphoid Fracture
• Usually fractures through the waist (middle) of the scaphoid bone
• Mechanism – fall on dorsiflexed outstretched hand• May not be evident for up to 10 days post trauma• Very well diagnosed clinically – pain and tenderness in
anatomical snuff box• Poor healing fracture due to complicated blood supply• Most easily diagnosed via the PA ulnar deviation with
angulation projection
Scaphoid fractures
• How many projections for scaphoid # ?
Or…
General setup of 24 x 30 cm cassette for patients who have defined trauma to scaphoid or follow up films or minimal injury
PAPA
OBL
LATPA
DEV
Colles’ fracture.
Colles’ Fracture
• # of the distal end of the radius (3cm from joint) +/- # of the styloid process of the ulnar
• Dorsal angulation of the distal fragment – ventral angulation of proximal radius
• Most common form of wrist fracture – females, middle aged and older
• Caused by fall on outstretched hand (FOOSH)
Smith’s Fracture
• Reverse Colles’ #• Hyperflexion with fall on back of hand• Fracture of the radius with ventral
displacement of distal fragment and dorsal angulation of proximal radius
Galeazzi’s Fracture
• # of the mid shaft of the radius• Dislocation of the distal radioulnar joint• Fall on outstretched hand with elbow flexed• High incidence of nonunion and a limitation on
pronating or supinating the hand
Please read about
• Salter–Harris fractures ?• Types with figures ?• http://cal.vet.upenn.edu/projects/saortho/
chapter_11/11mast.htm
Thank You