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  • Monteggia
  • Fractures

    1. 1. FRACTURES
    2. 2. JEFFERSON FRACTURE Fracture of C1 ring Axial loading injury with compression force to C1 Unilateral or bilateral fractures of anterior and posterior arches of C1
    3. 3. CLAY-SHOVELER’S FX Avulsion fracture of spinous process of C7 or T1 Sudden load on flexed spine
    4. 4. HANGMAN’S FRACTURE Bilateral pedicle or pars fractures involving C2 vertebral body A/w anterior subluxation or dislocation of C2 vertebral body Severe extension injury (MVC causing head to hit dashboard, hanging)
    5. 5. CLAVICULAR FRACTURE Extremely common Does not completely ossify until late teens Fall on outstretched hand, fall onto outside of shoulder, direct hit to clavicle Treatment: “Figure-of-8” sling; No activities that exacerbate pain; full recovery in 12 weeks.
    6. 6. SCAPULAR FRACTURE Uncommon Scapular body fx are the MC type Commonly (80-90%) associated with other injuries – lung and chest Don’t require surgery GLENOID (cartilage) fracture – requires surgery when unstable or fragments are far out of alignment
    7. 7. HUMERUS FRACTURE Proximal occur near the shoulder joint; treatment depends on rotator cuff tendon position Mid-shaft – Injury to radial nerve causes wrist drop and numbness of the hand dorsum Distal are uncommon in adults; often require surgery Most heal without surgery Over 90% with nerve injury have complete recovery of nerve in 3-4 months
    8. 8. HOLSTEIN-LEWIS FRACTURE Distal third humeral fracture 18% are associated with radial nerve palsy, particularly if break is between middle and distal thirds of humerus Due to direct blow or torsion injury Competitors in throwing events
    9. 9. ULNAR FRACTURE Forearm is struck by an object Nightstick Fracture Treatment of isolated ulnar fx: cast or brace; surgery if unstable
    10. 10. MONTEGGIA FRACTURE Giovanni Monteggia – 1814 Fracture of Ulna Dislocation of radial head within the elbow joint Treatment: Surgery
    11. 11. RADIAL HEAD Most common part broken in elbow fracture MC caused by fall onto outstretched hand +/- surgery depending on displacement
    12. 12. GALEAZZI FRACTURE Fracture of Radius Injury of the distal radio-ulnar joint of wrist (shortening and dislocation of distal ulna) Mechanism: fall on outstretched hand with elbow flexed Treatment: Surgery to repair radius, then inspection of distal radio-ulnar joint
    13. 13. NURSEMAID’S ELBOW Common in young children (< 5 yo) Subluxation of radius at elbow joint --bone has slid out of proper position Classically a sudden pull on child’s arm Present with arm flexed a/g body If treated (replaced) quickly, immobilization is not necessary For multiple subluxations, cast to allow ligaments to heal
    14. 14. SMITH’S FRACTURE Fracture of radius near the wrist joint Displaced anteriorly (in front of normal position) MC found after falling on to the back of the hand Treatment: Requires fixation
    15. 15. COLLES’ FRACTURE Fracture of radius Displaced posteriorly (behind normal position) MC after fall onto outstretched hand Treatment: Cast +/- surgery, depending on shortening and displacement of radius
    16. 16. SCAPHOID BONE FX Scaphoid sits below the thumb; shaped like a kidney bean Retrograde blood supply Many are misdiagnosed as sprain May not show up on xray until healing begins (may immobilize empirically and repeat xray in 1-2 wks) May cast for trial period with routine xrays Total healing time of 10-12 weeks
    17. 17. BOXER’S FRACTURE Classically at the base of 5th metacarpal (metacarpal neck) Seen after punching person or object Commonly a bump over the back of palm just below the small finger knuckle; may not go away even with treatment Treatment: casting or surgery (pins)
    18. 18. BENNETT’S FRACTURE Intra-articular fracture/dislocation of base of 1st metacarpal Small palmar fragment continues to articulate with trapezium Mechanism: forced abduction of thumb Treatment: open reduction and internal fixation
    19. 19. ROLANDO FRACTURE Fracture through thumb metacarpal base Comminuted intraarticular fracture Prognosis is worse than Bennett’s Treatment: open reduction and internal fixation
    20. 20. INTERTROCHANTERIC HIP FX Occurs lower than femoral neck fracture Bone blood flow is usually intact, so repair, not replacement is performed Treatment: Metal plate and screws
    21. 21. FEMORAL NECK FRACTURE Just below the ball of the ball-and-socket hip joint The ball is disconnected from rest of the femur Blood supply is often disrupted, so there’s a high risk of non-healing Treatment: Often with partial hip replacement, esp if > 65 yo
    22. 22. FEMORAL SHAFT FX Severe injury Treatment: Intramedullary rod (MC), plate and screws, or external fixator
    23. 23. SUPRACONDYLAR FEMUR FX Unusual injury just above knee joint High risk of knee arthritis later More common in pts with severe osteoporosis and those with previous knee replacement surgery Treatment: Cast, brace, external fixator, plate, screws, intramedullary rod
    24. 24. PATELLAR FRACTURE Fall onto kneecap or when quadriceps is contracting, 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
    25. 25. TIBIAL PLATEAU FRACTURE Just below knee joint Involves the joint cartilage  risk of arthritis Treatment: If non-displaced, may be treated without surgery. Surgery for displaced fractures
    26. 26. TIBIAL SHAFT FRACTURE Most common type of tibial fracture Most can be treated by long leg cast May require plates, screws, external fixator, or intramedullary rod
    27. 27. TIBIAL PLAFOND FRACTURE “Tibial Pilon Fracture” End of shin bone and involves ankle Soft-tissue around ankle may be problematic if very swollen – makes surgery difficult Treatment: casting, external fixation, limited internal fixation, internal fixation, ankle fusion
    28. 28. POTT’S FRACTURE Fracture of the lower end of fibula with displacement of tibia Causes the foot to “turn out”
    29. 29. TALUS FRACTURE Complications: Ankle arthritis Subtalar arthritis Foot deformity Avascular necrosis
    30. 30. CALCANEUS FRACTURE Fall from heights or MVC Like an orange if you stand on it, the calcaneus widens and squashes flat Inversion and eversion are affected (subtalar joint – b/w talus and calcaneus)
    31. 31. FRACTURES OF 5th METATARSAL Avulsion: “Dancer’s fracture;” tiny flecks of bone are pulled off by attached tendon; heal well in cast Jones: occurs at proximal end (in midportion of foot); cast for 6-8 wks
    32. 32. Avulsion (Dancer’s)
    33. 33. Jones’ fracture
    34. 34. TORUS FRACTURE “Buckle fracture” Compression fracture of a long bone, mostly in children; usually occurs near metaphysis Better seen on lateral films Distal radius is most common site Treatment: well-fitting immobilizing cast for 2-4 weeks
    35. 35. GREENSTICK FRACTURE Usually from a quick twisting motion occompanied by axial compression such as a fall backwards on the outstretched hand Supinated twist  palmar angulation Pronated twist  dorsal angulation No disruption of cortex; may have buckling on opposite side of bone from the break; “incomplete break”
    36. 36. THE END (FINALLY!!!!)