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