JOSHUA CHERUKURI, MBBS contact : Gmail : joshuachowdarycherukuri@gmail.com

1. RADIOLOGY

2. Fracture
A fracture is a discontinuity in a bone(or cartilage)
resulting from mechanical forces, which exceed
bone’s ability to withstand them.

3. COMMON CAUSES OF
FRACTURES
 Fall from a height
 car accident
 Abnormal stresses (e.g. running)- Fatigue fractures
 Metabolic (e.g. osteoporosis) or less frequently
genetic abnormalities (e.g. osteogenesis imperfecta)
– Insufficiency fractures
 Pathology- the bone may have a lesion that focally
weakens a bone (e.g. metastasis, or bone cyst).

4. Signs or Symptoms of a
Fracture
• Pain and tenderness
• Loss of function
• A wound (with bone sticking out)
• Deformity
• Unnatural movement
• Shock
• Swelling and bruising

5. Describing a fracture
(an approach)
Describe the Radiograph
What type of fracture ?
Where is the fracture ?
Is it displaced ?
Is something else going on ?

6. 1. Describe The Radiograph
What radiograph we are looking at ?
Check Why, Whom, where and what we are
looking for ?

7. Description of location
Which One ?
Anatomic orientation ? Proximal, distal, medial,
lateral, anterior, posterior.
Anatomic landmarks ? Head, neck, body/shaft,
base, condyle.
Segment (long bones) ? Epiphysis, physis,
Metaphysis, diaphysis.

8. 2. What type OF fracture ?
Complete fracture : Transverse, oblique, spiral,
comminuted, impacted, segmental
Incomplete fracture : Bowing, buckle, greenstick,
torus, stress, compression
Salter-Harris

9. Complete fracture
Bone is completely broken into
2 or more fragments.
Eg:
Transverse fracture
Oblique fracture
Spiral fracture
Impacted fracture
Comminuted fracture
Segmental fracture
Bone is incompletely
divided and the periosteum
remains in continuity.
Eg:
Greenstick fracture
Torus fracture
Stress fracture
Compression fracture
Incomplete fracture

10. COMPLETE FRACTURE
A. Transverse fracture
• A fracture that occurs
at right angle to bone’s
axis (Perpendicular to
axis of the bone).
• Transverse fractures
are at risk of
displacements like any
other long bone
fracture.
Transverse fracture - Patella

11. B. Oblique fracture
Fractures that occur at a
plane oblique to long
axis of bone.
Eg : Oblique fracture of
Fibula.
COMPLETE FRACTURE

12. COMPLETE FRACTURE
C. Spiral fracture :
Fractures result from
rotational force applied to
the bone.
Usually the result of high
energy trauma and are
likely to be associated
with displacement.

13. D. Longitudinal fractures
:
Longitudinal fractures
are the fractures occur
along(or nearly along)
the axis of bone.
COMPLETE FRACTURE

14. E. Comminuted fracture :
A fracture in which the
bone breaks into more
than two fragments,
usually caused by
several forces or
followed by high-energy
traffic road accidents.
COMPLETE FRACTURE

15. F. Segmental fractures
:
Fracture composed
of atleast two
fracture lines that
together isolate a
segment of bone.
COMPLETE FRACTURE

16. A. Bowing fracture:
Bowing fractures are
incomplete fractures of
tubular long bones in
pediatric patients(especially
the radius and ulna).
It require no intervention and
heal with remodelling.
INCOMPLETE FRACTURE

17. B. Buckle fracture :
Also know as incomplete fractures.
Incomplete fractures of shaft of
long bone that is characterized by
bulging of cortex
Result from trabecular
compression from an Axial loading
force along long axis of bone.
Heals in 3-4 weeks, with simple
immobilization
INCOMPLETE FRACTURE

18. C. Greenstick fracture
An incomplete fracture of long
bones and are usually seen in
young children, bones are not
yet fully calcified and they
break line a green stick.
INCOMPLETE FRACTURE

20. OPEN OR COMPOUND
FRACTURE
An open fracture is a
broken bone that
penetrates the skin.
This is an important
distinction Because when a
broken bone penetrates
the skin, there is a News
for immediate treatment
and an operation is often
required to clean the area
of fracture.

21. PATHOLOGIC FRACTURE
Pathologic fracture is a
secondary result of another
illness or chronic condition that
weakens the bones of the
skeletal system.
X-ray to the left showing fracture,
secondary to giant non-ossifying
fibroma.

22. STRESS FRACTURE
Fracture without being visibly broken.
Due to mismatch of bone strength and
chronic mechanical stress placed
upon the bone.
Fractures Can be :
1. Fatigue - Abnormal stresses working
on normal bone
2. Insufficiency - Normal stresses on
abnormal bone

23. LOWER EXTREMITIES

24. FEMORAL FRACTURES
PROXIMAL END
A. Intracapsular :
1. Capital - Fracture of
head
2. Subcapital - below the
femoral head
3. Transcervical - across
the mid-femoral neck
4. Basicervical - across the
base of the femoral neck

25. FEMORAL FRACTURES
B. Extra capsular :
Interotrochanteric
Subtrochanteric
C. Shaft
D. Distal end :
Supracondylar
Condylar

27. SUBCAPITAL NOF

29. SEGOND FRACTURE
Segond fracture is an
avulsion fracture of knee
that involves lateral aspect
of tibial plateau and is very
frequently associated with
the anterior cruciate
ligament ligaMent.
May be referred to as
lateral capsular sign.
X-ray to right shows
segond fracture and bony
avulsion of ACL origin.

30. PATELLA FRACTURE
Patella fracture is one of
the common knee injuries
usually post direct trauma
to the patella or sudden
forceful contraction of the
quadriceps muscles in the
context of a sports injury.
1% all fractures, and are
most common in those
aged 20-50 years.

31. ANTERIOR CRUCIATE LIGAMENT
AVULSION FRACTURE
Anterior cruciate ligament
(ACL) avulsion fracture or
tibial eminence avulsion
fracture is a type of avulsion
fracture of the knee.
This typically involves
separation of the tibial
attachment of the ACL to
variable degrees.
X-RAY to the right shows
ACL avulsion fracture

32. Meyers and McKeevers
classification
Under the Meyers and
McKeever system, injuries are
classified into four main types:
type 1: minimally/nondisplaced
fragment
type 2: anterior elevation of the
fragment

33. type 3: complete separation
of the fragment
type 3a: involves small
portion of eminence
type 3b: involves the majority
of the eminence
type 4: comminuted avulsion
or a rotation of the fracture
fragment
MEYERS AND MCKEEVERS
CLASSIFICATION

34. POSTERIOR CRUCIATE LIGAMENT
AVULSION FRACTURES
Posterior cruciate ligament
(PCL) avulsion fractures
are a type of avulsion
fracture of the knee that
represent the most
common isolated PCL
lesion.
This typically involves
separation of the posterior
tibial insertion of the PCL
to variable degrees.

35. TIBIAL PLATEAU
FRACTURES
Tibial plateau fractures were
originally termed a bumper or
fender fracture but only 25% of
tibial plateau fractures result from
impact with automobile bumpers.
common mechanism of injury
involves axial loading, e.g. fall
from a significant height.
In younger patients, the most
common pattern of fracture is
splitting, while older, more
osteoporotic patients, depression
fractures typically are sustained.

36. TRIPLANE FRACTURE
Triplane or triplanar fractures are of the distal tibia
only occurring in adolescents. As the physiological
closure of the physeal plate begins medially, the
lateral (open) physis is prone to this type of fracture.
It comprises of:
a vertical fracture through the epiphysis
a horizontal fracture through the physis
an oblique fracture through the metaphysis

37. TRIPLANE FRACTURE

38. PILON FRACTURE
A pilon fracture is a type of
fracture involving the distal
tibia. These are considered
to represent 1-10% of all
lower limb fractures.
Typically occurs as a result
of an axial loading injury
which drives the talus into
the tibial plafond.

39. TRIMALLEOLAR FRACTURES
Trimalleolar fractures refer
to a three-part fracture of
the ankle. The fractures
involve the medial
malleolus, the posterior
aspect of the tibial plafond
(referred to as the posterior
malleolus) and the lateral
malleolus.

40. Maisonneuve fracture
Maisonneuve fracture refers to a combination of a fracture of the
proximal fibula together with an unstable ankle injury (widening of the
ankle mortise on x-ray), often comprising ligamentous injury (distal
tibiofibular syndesmosis, deltoid ligament) and/or fracture of the
medial malleolus.
It is caused by pronation external-rotation mechanism.

41. AVULSION FRACTURE IF 5TH
METATARSAL STYLOID
Avulsion fracture of the 5th
metatarsal styloid, also
known as a pseudo-Jones
fracture or a dancer
fracture, is one of the more
common foot avulsion
injuries and accounts for
over 90% of fractures of
the base of the 5th
metatarsal.

42. JONES FRACTURE
A Jones fracture is an
extra-articular fracture at
the base of the fifth
metatarsal bone.
The fracture is believed to
occur as a result of
significant adduction force
to the forefoot with the
ankle in plantar flexion

44. MARCH FRACTURES
March fractures are a
name subtype of
fatigue/stress fracture.
They occur due to
repeated concentrated
trauma to a normal bone,
classically the 2nd
metatarsal of the foot but
can occur in other weight-
bearing bones of the lower
limb and pelvis.

45. LISFRANC FRACTURE-
DISLOCATIONS
Lisfranc injuries, also
called Lisfranc fracture-
dislocations, are the most
common type of dislocation
involving the foot and
correspond to the
dislocation of the
articulation of the tarsus
with the metatarsal bases.

46. CALCANEAL
FRACTURES
Calcaneal fractures are the most common tarsal
fracture and can occur in a variety of settings.
The calcaneus is the most commonly fractured tarsal
bone and accounts for about 2% of all fractures and
~60% of all tarsal fractures
Calcaneal fractures can be divided broadly into two
types depending on whether there is articular
involvement of the subtalar joint

47. CALCANEAL FRACTURES
1. Extra-articular: 25-30%
anterior calcaneal process
fracture
calcaneal tuberosity avulsion
fracture
extra-articular body fracture
2. Intra-articular: 70-75%
intra-articular body fracture

48. CALCANEAL FRACTURES
1. Extra-articular: 25-30%
anterior calcaneal process
fracture
calcaneal tuberosity avulsion
fracture
extra-articular body fracture
2. Intra-articular: 70-75%
intra-articular body fracture

49. Displacement
The relationship between fracture
fragments can be described using the
following terms.
Fracture translation : (a.k.a.
translocation or displacement)
direction: usually of the distal part
relative to the proximal part
amount: measurement or % width

50. Displacement
Fracture angulation :
direction: usually of the
distal part relative to the
proximal part
amount: in degrees

51. Displacement
Fracture rotation
direction: terminology will depend on the location
amount: in degrees
Fracture length
distraction/impaction/shortening

52. EXAMPLES
Spiral fracture of
the proximal 3rd
of right femoral
shaft.

53. Examples
Oblique fracture of
distal 3rd of fibula

54. Fractures of lower extremity

62. FOOT