FactsBone fracture, broken bone, bonecrack all mean he same thing. Thebone has been damaged such that.None of these terms indicate theseverity of the bone damage. Bonesare the bodys storage place forcalcium. Under hormone control,calcium content of bone is constantlyincreasing or decreasing.
Common Types and Locations of Fracturesgreenstick fracture,spiral fracture,comminuted fracture,transverse fracture,compound fracture,vertebral compression fracture,stress fracture,compression fracture,rib fracture, andskull fracture.wrist fracture (scaphoid fracture)
JEFFERSON FRACTUREFracture of C1 ringAxial loading injury with compressionforce to C1Unilateral or bilateral fractures of anteriorand posterior arches of C1
CLAY-SHOVELER’S FXAvulsion fracture of spinous process of C7or T1Sudden load on flexed spine
HANGMAN’S FRACTUREBilateral pedicle or pars fracturesinvolving C2 vertebral bodyA/w anterior subluxation or dislocation ofC2 vertebral bodySevere extension injury (MVC causinghead to hit dashboard, hanging)
CLAVICULAR FRACTUREExtremely commonDoes not completely ossify until late teensFall on outstretched hand, fall ontooutside of shoulder, direct hit to clavicleTreatment: “Figure-of-8” sling; Noactivities that exacerbate pain; fullrecovery in 12 weeks.
SCAPULAR FRACTUREUncommonScapular body fx are the MC typeCommonly (80-90%) associated withother injuries – lung and chestDon’t require surgeryGLENOID (cartilage) fracture – requiressurgery when unstable or fragments arefar out of alignment
HUMERUS FRACTUREProximal occur near the shoulder joint;treatment depends on rotator cuff tendonpositionMid-shaft – Injury to radial nerve causes wristdrop and numbness of the hand dorsumDistal are uncommon in adults; often requiresurgeryMost heal without surgeryOver 90% with nerve injury have completerecovery of nerve in 3-4 months
HOLSTEIN-LEWIS FRACTUREDistal third humeral fracture18% are associated with radial nerve palsy,particularly if break is between middle anddistal thirds of humerusDue to direct blow or torsion injuryCompetitors in throwing events
ULNAR FRACTUREForearm is struck by an objectNightstick FractureTreatment of isolated ulnar fx: cast orbrace; surgery if unstable
MONTEGGIA FRACTUREGiovanni Monteggia – 1814Fracture of UlnaDislocation of radial head within the elbowjointTreatment: Surgery
RADIAL HEADMost common part broken in elbowfractureMC caused by fall onto outstretched hand+/- surgery depending on displacement
GALEAZZI FRACTUREFracture of RadiusInjury of the distal radio-ulnar joint ofwrist (shortening and dislocation of distalulna)Mechanism: fall on outstretched handwith elbow flexedTreatment: Surgery to repair radius, theninspection of distal radio-ulnar joint
NURSEMAID’S ELBOWCommon in young children (< 5 yo)Subluxation of radius at elbow joint --bone has slid out of proper positionClassically a sudden pull on child’s armPresent with arm flexed a/g bodyIf treated (replaced) quickly,immobilization is not necessaryFor multiple subluxations, cast to allowligaments to heal
SMITH’S FRACTUREFracture of radius near the wrist jointDisplaced anteriorly (in front of normalposition)MC found after falling on to the back of thehandTreatment: Requires fixation
COLLES’ FRACTUREFracture of radiusDisplaced posteriorly (behind normalposition)MC after fall onto outstretched handTreatment: Cast +/- surgery, dependingon shortening and displacement of radius
SCAPHOID BONE FXScaphoid sits below the thumb; shapedlike a kidney beanRetrograde blood supplyMany are misdiagnosed as sprainMay not show up on xray until healingbegins (may immobilize empirically andrepeat xray in 1-2 wks)May cast for trial period with routine xraysTotal healing time of 10-12 weeks
BOXER’S FRACTUREClassically at the base of 5th metacarpal(metacarpal neck)Seen after punching person or objectCommonly a bump over the back of palmjust below the small finger knuckle; maynot go away even with treatmentTreatment: casting or surgery (pins)
BENNETT’S FRACTUREIntra-articular fracture/dislocation of baseof 1st metacarpalSmall palmar fragment continues toarticulate with trapeziumMechanism: forced abduction of thumbTreatment: open reduction and internalfixation
ROLANDO FRACTUREFracture through thumb metacarpal baseComminuted intraarticular fracturePrognosis is worse than Bennett’sTreatment: open reduction and internalfixation
INTERTROCHANTERIC HIP FXOccurs lower than femoral neck fractureBone blood flow is usually intact, so repair,not replacement is performedTreatment: Metal plate and screws
FEMORAL NECK FRACTUREJust below the ball of the ball-and-sockethip jointThe ball is disconnected from rest of thefemurBlood supply is often disrupted, so there’sa high risk of non-healingTreatment: Often with partial hipreplacement, esp if > 65 yo
FEMORAL SHAFT FXSevere injuryTreatment: Intramedullary rod (MC),plate and screws, or external fixator
SUPRACONDYLAR FEMUR FXUnusual injury just above knee jointHigh risk of knee arthritis laterMore common in pts with severeosteoporosis and those with previous kneereplacement surgeryTreatment: Cast, brace, external fixator,plate, screws, intramedullary rod
PATELLAR FRACTUREFall onto kneecap or when quadriceps iscontracting, but knee joint is straightening(“eccentric contraction”)Attempt “straight leg raise” yes? Non-operative treatment may be possible no? surgery – combo of pins, screws, and wires
TIBIAL PLATEAU FRACTUREJust below knee jointInvolves the joint cartilage risk ofarthritisTreatment: If non-displaced, may betreated without surgery. Surgery fordisplaced fractures
TIBIAL SHAFT FRACTUREMost common type of tibial fractureMost can be treated by long leg castMay require plates, screws, externalfixator, or intramedullary rod
TIBIAL PLAFOND FRACTURE“Tibial Pilon Fracture”End of shin bone and involves ankleSoft-tissue around ankle may beproblematic if very swollen – makessurgery difficultTreatment: casting, external fixation,limited internal fixation, internal fixation,ankle fusion
POTT’S FRACTUREFracture of the lower end of fibula withdisplacement of tibiaCauses the foot to “turn out”
CALCANEUS FRACTUREFall from heights or MVCLike an orange if you stand on it, thecalcaneus widens and squashes flatInversion and eversion are affected(subtalar joint – b/w talus and calcaneus)
FRACTURES OF 5th METATARSALAvulsion: “Dancer’s fracture;” tiny flecksof bone are pulled off by attached tendon;heal well in castJones: occurs at proximal end (inmidportion of foot); cast for 6-8 wks
TORUS FRACTURE“Buckle fracture”Compression fracture of a long bone,mostly in children; usually occurs nearmetaphysisBetter seen on lateral filmsDistal radius is most common siteTreatment: well-fitting immobilizing castfor 2-4 weeks
GREENSTICK FRACTUREUsually from a quick twisting motionoccompanied by axial compression such asa fall backwards on the outstretched handSupinated twist palmar angulationPronated twist dorsal angulationNo disruption of cortex; may havebuckling on opposite side of bone from thebreak; “incomplete break”
How is a fracture diagnosed?PainSwellingBruisingDiscolored skin around the affected areaAngulation - the affected area may be bent at anunusual angleThe patient is unable to put weight on the injuredareaThe patient cannot move the affected areaThe affected bone or joint may have a gratingsensationIf it is an open fracture there may be bleeding
When a large bone is affected, such as the pelvis or femur The sufferer may look pale and clammy There may be dizziness (feeling faint).. ..as well as a feeling of sickness and nauseaIf possible, do not move a person with abroken bone until a health care professionalis present and can assess the situation and,if required, apply a splint.
What are the treatment options for a bone fracture?Fracture treatment is usually aimed atmaking sure there is the best possiblefunction of the injured part after healing.Treatment also focuses on providing theinjured bone with the best circumstances foroptimum healing (immobilization).For the natural healing process to begin, theends of the broken bone need to be lined up- this is known as reducing the fracture.
ImmobilizationPlaster casts or plastic functional braces -these hold the bone in position until it hashealed.Metal plates and screws - current proceduresuse minimally invasive techniques.Intra-medullary nails - Internal steel rods areplaced down the center of long bones. Flexiblewires may be used in children.External fixators - these may be made of metalor carbon fiber; they have steel pins that go intothe bone directly through the skin. They are atype of scaffolding outside the body.
What are the possible complications of a bone fracture?Heals in the wrong position - this is known as a malunion; eitherthe fracture heals in the wrong position or it shifts (the fracture itselfshifts).Disruption of bone growth - if a childhood bone fracture affectsboth ends of bones, there is a risk that the normal development ofthat bone may be affected, raising the risk of a subsequentdeformity.Persistent bone or bone marrow infection - if there is a break inthe skin, as may happen with a compound fracture, bacteria can getin and infect the bone or bone marrow, which can become aosteomyelitis. Patients may need to be hospitalized and treated withantibiotics.Bone death (avascular necrosis) - if the bone loses its essentialsupply of blood it may die.