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Fractures
- 1. FRACTURES AND DISLOCATIONS Dr VARUN SHARMA RESIDENT IN ORTHOPAEDICS AND TRAUMATOLOGY OSMANIA GENERAL HOSPITAL
- 2. Definition of trauma: Injuries which are caused by external force or violence. They may range from minor to major, obvious to not apparent, single injury to multiple.
- 3. When a bone fractures, there is usually damage to the surrounding area which may include: • Damage to muscles • Tearing of blood & lymph vessels • Severing of nerves • Damage to nearby organs • Laceration of the skin
- 4. Signs of fracture: • limited or no movement of a limb • swelling at the site of injury • pain at, or distal to, the injury • bruising at injury site • deformity of a limb • no pulse distal to the injury • loss of feeling at, and distal to, the injury
- 5. Deformity of a limb Clinical indication of dislocation
- 6. Fracture Healing Healing begins when swelling occurs. Blood, lymph, & tissue fluids form a fibrin clot around the fracture. Soon fibroblasts appear & begin granulation. Granulation process helps stabilize the fracture…….. (continued)
- 7. Healing (continued) Calcium is deposited around the fracture forming a callus. *The callus is the first phase of healing which can be demonstrated radiographically. Calcified area may be large at first, but will reduce with use. Fracture site may be stronger than before!
- 8. Factors affecting healing: • Patient age • general health • nutrition • circulation at site of injury
- 9. Terminology A/A or MVA Fracture abrasion hematoma amputation sprain concussion luxation crepitus subluxation dislocation
- 12. General types of fractures • Complete vs. Incomplete Entire cross section of the bone fractures vs. not broken into separate pieces.
- 13. General fracture types (cont.) • Closed (simple) vs. compound Bone does not pierce through the skin vs. bone is through the skin
- 14. Closed vs compound fractures
- 15. General types of fractures (cont.) • Direct vs Indirect fracture occurs at the site of trauma vs away from the impact point
- 16. Fracture Alignment Displacement or apposition = misalignment of a fracture (see note) Other terms denoting misalignment: • Varus • Valgus • Bayonet
- 17. OUCH!
- 18. Varus or Valgus?
- 19. ANOTHER OUCH !
- 20. Overlapping fx.
- 21. Specific types of fractures LINEAR - straight lines
- 22. Transverse fx
- 23. Transverse fx.
- 25. Oblique fx (also an oblique fx because of the direction of the fracture line)
- 26. Spiral fx Fracture line rotates around the bone, usually from a twisting force
- 27. Spiral fx.
- 28. Comminuted fx 2 or more fracture lines = 3 or more fragments
- 29. Crush fx Severe communited !
- 30. Impacted fx Fractured ends get pushed Typical of a front seat into one passenger in a car another crash !
- 31. Impacted fx.
- 32. Splinter fx Fracture ends are thin shards or splinters like wood. (gunshot wounds)
- 33. Stellate fx Specific to the patella- fracture lines radiate out from a center point in a star-like pattern.
- 34. Compression fx Specific to the vertebrae - vertebral body collapses, anterior aspect is reduced in height. From trauma or demineralization of bone (old age).
- 35. Burst fx C1 ring is C - 1 (atlas) broken, fragments move outward. Football injuries, heavy object dropped on head.
- 36. Blowout fx Orbital floor collapses from direct blow to eyeball (fist, baseball)
- 37. Depressed fx Section of bone pushed into center of an area (skull, sternum)
- 38. Complicated fx Fractured bone causes damage to an internal organ. Ex. - rib pierces lung
- 39. Avulsion fx (chip fx) Caused by stress to a joint, ligament, or tendon. Small piece of bone is torn away. Often seen with dislocations.(see note)
- 40. NON-TRAUMA FRACTURES 1. Pathologic - bone is weakened by disease, spontaneous fx’s (cancer, osteomalacia, osteomyelitis, Pagets) 2. Stress - caused by prolonged running or marching - metatarsals fracture. Difficult to visualize.
- 41. Pediatric fractures 1. Greenstick (torus) - incomplete fx, bones more flexible, bends & fractures only outer edge. 2. Epiphyseal - fractures located at the site of an epiphysis. Sometimes with associated dislocation (slipped epiphysis)
- 42. THE END !!
Editor's Notes
- A typical injury encountered by the radiologic technologist is a patient with a fractured hip. The clinical indications (sign) of this pathology is a completely externally rotated foot. If a patient comes to the radiology department with his/her foot lying outward on it’s side, and cannot move the foot without assistance, then the hip is most likely fractured. PROCEED WITH THE UTMOST CAUTION. A AP projection should be taken and checked before moving the patient. (see note)
- OUCH!.
- A/A = automobile accident MVA = motor vehicle accident (either of these abbreviations may be used at your clinical site) The rest of the terminology you need to look up in a medical dictionary!
- Look up the three new terms. Pictures and a radiograph demonstrating them are to follow.
- Linear fractures can occur in virtually any bone of the body. (see note)
- Note the way the fracture line wraps around the bone, not straight across. In fact you can see that the anterior aspect of the fracture is inferior to the posterior segment, where it forms a point.
- This type of fracture is common after a fall where the patient lands on the outstretched hand!
- Although some sports coaches or participants may wish to pop a dislocated bone back into place, it is strongly recommended that all dislocations be radiographed first to rule out the presence of avulsion fractures and other pathologies that can occur with the dislocation.