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Fractures
This document provides descriptions and information on many common bone fractures. It discusses fractures of the skull such as Jefferson fractures, fractures of the spine like Clay-Shoveler's fractures and Hangman's fractures, fractures of the shoulder and upper arm bones including clavicular, scapular, and humerus fractures. It also covers forearm fractures like Monteggia and radial head fractures, wrist fractures including Galeazzi and Colles' fractures, hand fractures such as Bennett's and Boxer's fractures, as well as hip fractures like intertrochanteric and femoral neck fractures. Additionally, it summarizes fractures of the lower leg, ankle, and foot bones such as tibial plateau, tibial p
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Fractures
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- 2. JEFFERSON FRACTURE Fracture ofC1 ring Axial loading injury with compression force to C1 Unilateral or bilateral fractures of anterior and posterior arches of C1
- 4. CLAY-SHOVELER’S FX Avulsion fractureof spinous process of C7 or T1 Sudden load on flexed spine
- 6. HANGMAN’S FRACTURE Bilateral pedicleor 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)
- 8. CLAVICULAR FRACTURE Extremely common Doesnot 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.
- 10. SCAPULAR FRACTURE Uncommon Scapular bodyfx 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
- 12. HUMERUS FRACTURE Proximal occurnear 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
- 14. HOLSTEIN-LEWIS FRACTURE Distal thirdhumeral 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
- 15. ULNAR FRACTURE Forearm isstruck by an object Nightstick Fracture Treatment of isolated ulnar fx: cast or brace; surgery if unstable
- 18. MONTEGGIA FRACTURE Giovanni Monteggia– 1814 Fracture of Ulna Dislocation of radial head within the elbow joint Treatment: Surgery
- 20. RADIAL HEAD Most commonpart broken in elbow fracture MC caused by fall onto outstretched hand +/- surgery depending on displacement
- 22. GALEAZZI FRACTURE Fracture ofRadius 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
- 24. NURSEMAID’S ELBOW Common inyoung 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
- 25. SMITH’S FRACTURE Fracture ofradius 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
- 27. COLLES’ FRACTURE Fracture ofradius Displaced posteriorly (behind normal position) MC after fall onto outstretched hand Treatment: Cast +/- surgery, depending on shortening and displacement of radius
- 29. SCAPHOID BONE FX Scaphoidsits 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
- 31. BOXER’S FRACTURE Classically atthe 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)
- 33. BENNETT’S FRACTURE Intra-articular fracture/dislocationof base of 1st metacarpal Small palmar fragment continues to articulate with trapezium Mechanism: forced abduction of thumb Treatment: open reduction and internal fixation
- 35. ROLANDO FRACTURE Fracture throughthumb metacarpal base Comminuted intraarticular fracture Prognosis is worse than Bennett’s Treatment: open reduction and internal fixation
- 37. INTERTROCHANTERIC HIP FX Occurslower than femoral neck fracture Bone blood flow is usually intact, so repair, not replacement is performed Treatment: Metal plate and screws
- 39. FEMORAL NECK FRACTURE Justbelow 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
- 41. FEMORAL SHAFT FX Severeinjury Treatment: Intramedullary rod (MC), plate and screws, or external fixator
- 43. SUPRACONDYLAR FEMUR FX Unusualinjury 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
- 44. PATELLAR FRACTURE Fall ontokneecap 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
- 46. TIBIAL PLATEAU FRACTURE Justbelow knee joint Involves the joint cartilage risk of arthritis Treatment: If non-displaced, may be treated without surgery. Surgery for displaced fractures
- 48. TIBIAL SHAFT FRACTURE Mostcommon type of tibial fracture Most can be treated by long leg cast May require plates, screws, external fixator, or intramedullary rod
- 51. TIBIAL PLAFOND FRACTURE “TibialPilon 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
- 53. POTT’S FRACTURE Fracture ofthe lower end of fibula with displacement of tibia Causes the foot to “turn out”
- 55. TALUS FRACTURE Complications: Ankle arthritis Subtalararthritis Foot deformity Avascular necrosis
- 57. CALCANEUS FRACTURE Fall fromheights 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)
- 59. 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
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- 62. TORUS FRACTURE “Buckle fracture” Compressionfracture 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
- 64. GREENSTICK FRACTURE Usually froma 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”
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Editor's Notes
- #20 Monteggia