Msk - Dr. Rush: Language Of Fxs

Front 1

complete

Back 1

both cortices of bone have broken

Front 2

incomplete

2 types?

Back 2

only 1 cortex has been broken

1. greenstick
2. torus

Front 3

incomplete: greenstick?

Back 3

incomplete fx causing bowing of bone

break occurs on outer convex side of fx

Front 4

incomplete: torus?

Back 4

incomplete fx w/ buckling of cortex

caused by compression fx

Front 5

what age do greenstick/torus fx occur?

Back 5

children

Front 6

comminuted fx

Back 6

> 2 fx fragments exist

Front 7

closed

Back 7

skin & soft tissue overlying the fx are intact

there is no communication to outside

Front 8

open

Back 8

fx site communicates w/ outside environment

may be from a small pin hole to massive skin loss

Front 9

open: open from within

Back 9

bone pushes from inside out ("cleaner" wound)

Front 10

open: open from without

Back 10

outside gets pushed into bone (bullet wound)

Front 11

once _____ is _______, any fx that is exposed to the outside environment is an _____ fx

Back 11

skin; broken; open

Front 12

directions of fx lines?

Back 12

1. transverse
2. oblique
3. spiral
4. comminuted

Front 13

transverse

Back 13

fx line runs at R angle to cortices or long axis of bone

Front 14

oblique

Back 14

fx line runs obliquely to long axis of bone

Front 15

spiral

Back 15

torsional (twisting) fx - like spiral

spans greater area & encircles shaft of long bone

Front 16

comminuted

2 types?

Back 16

> 2 fragments of bone

1. butterfly pattern
2. segmental pattern

Front 17

comminuted: butterfly

Back 17

wedge shaped fragment of bone making up one of the fragments

Front 18

comminuted: segmental

Back 18

fx divides long bone into several fragments or segments

Front 19

other things that occur at fx

Back 19

1. intraarticular
2. distraction
3. impaction
4. avulsion
5. depression
6. compression

Front 20

intraarticular

Back 20

fx that extends into & involves an articular surface

Front 21

distraction

3 reasons for it?

Back 21

when opposing ends of fx fragments are kept apart from each other due to:

mm pull
excessive traction on the fx
interposed tissue

Front 22

impaction

where does it occur? why?

Back 22

when 1 fragment of bone is forcibly driven into adjacent fragment

occurs in cancellous bone since it is softer

can be a very stable fx

Front 23

fx are _____ NOT ______

garbage is _______

Back 23

impacted; compacted

compacted

Front 24

avulsion

causes?

Back 24

fragment of bone pulled away from original position by:

1. active contraction of mm
2. passive resistance of a ligament against a force in the opposite direction

Front 25

what does a ligament do in an avulsion fx?

Back 25

instead of tearing, pulls bony attachment off

Front 26

avulsion v distraction

Back 26

an avulsion fx will commonly stay distracted

Front 27

depression fx

commonly occurs where?

Back 27

hard surface of 1 bone is driven into softer surface of adjacent bone (articular surface) & outer surface is pushed into softer cancellous bone

tibial plateau

Front 28

compression fx

Back 28

in **vertebral bodies** where superior & inf. surfaces driven towards each other producing wedge shape of varying degrees

Front 29

how is extent of compression fx described?

Back 29

in terms of % of loss of height as compared to adjacent vertebrae

Front 30

location of fx

Back 30

reference points must be established to be able to give location

Front 31

location of fx:

long bone is divided into:

Back 31

3rds:
proximal
middle
distal

Front 32

location of fx:

if fx occurs at junction pt or pts of overlap?

Back 32

described as:

junction of mid to distal third
junction of proximal to mid third

Front 33

location of fx:

if fx occurs in middle?

Back 33

midshaft

Front 34

location of fx:

what if location at specific bone or area?

ex

Back 34

can be described by specific locations

medial malleolus, femoral neck, intertrochanteric, superior/inferior pubic ramus

Front 35

other anatomical descriptions (2)

define

Back 35

supracondylar - above level of condyles and epicondyles

transcondylar - transversely across condyles

Front 36

position

Back 36

relationship of fragments to nL anatomic structure

Front 37

alignment

Back 37

relationship of long axis of 1 fragment to another

Front 38

what is misalignment the result of?

Back 38

angulation

Front 39

displacement

Back 39

loss of position - may result from loss of apposition, overriding, or rotation of fragments

Front 40

apposition

Back 40

extent of contact of dents of bone fragments

Front 41

describe angulation by 1.

Back 41

angle the distal fx fragment makes in relation to proximal fragment

Front 42

describe angulation by 2.

Back 42

direction of apex of angulation formed by fx fragments & expressed in # of degrees

Front 43

ex of angulation description 2

Back 43

fx at distal radius w/ 30* dorsal angulation of the distal fx fragment

fx at distal radius w/ 30* angulation w/ apex volar

Front 44

direction of angulation

Back 44

you must give your point of reference when describing a fx

Front 45

ex of what can happens if point of reference not given when describing angulation of fx

Back 45

colles' fx may become a smith's fx

Front 46

displacement & angulation: a fx may be (5 pts)

Back 46

1. good position & alignment (no displacement or angulation)
2. angulated or misaligned w/ no displacement
3. completely displaced and still be in good alignment (Bayonet apposition)
4. completely displaced and angulated
5. good alignment but w/ no rotational displacement

Front 47

bayonet apposition

Back 47

completely displaced & still be in good alignment

Front 48

sublaxation

Back 48

partial loss of continuity b/w 2 opposing joint surfaces

Front 49

dislocation

Back 49

complete loss of continuity b/tw 2 opposing joint surfaces

Front 50

diastasis

ex:

Back 50

seperation of nLly joined parts

pubic symphysis or syndesmotic ligament

Front 51

stress fx

Back 51

fatigue fx resulting from repeated trivial trauma

may be complete or incomplete

Front 52

fx union

Back 52

delayed union
nonunion
psuedoarthrosis
malunion
avascular necrosis

Front 53

delayed union

Back 53

- failure of fx to unite in time usually required for union to occur

- expect fx to eventually heal

Front 54

non-union

Back 54

failure of fx fragments & process of bone repair has ceased

Front 55

psuedoarthrosis

Back 55

false jt of dense fibrous or fibrocartilaginous tissue which forms b/w 2 fx fragments

Front 56

malunion

Back 56

union to fx w/ angulation or rotation deformity

Front 57

avascular necrosis

Back 57

death of bone due to interruption of blood supply to a bone or segment of bone

Front 58

anatomical growth regions (4) & definitions

Back 58

diaphysis - main or mid section (shaft) of long bone
metaphysis - area b/w the physis and diaphysis (gen. flared region)
physis - growth plate
epiphysis - ossification center

Front 59

apophysis

ex?

Back 59

a traction epiphysis

tibial tuberosity, greater trochanter

Front 60

5 types of salter-harris classifications

Back 60

I. epiphysis completely seperated from metaphysis w/o evidence of metaphysis fragment
II. fx transversely across physis before exiting THROUGH metaphysis
III. fx transversely across physis before exiting THROUGH epiphysis
IV. vertical splitting injury crossing both epi & metaphyseal regions
V. severe crushing injury to physis

Front 61

3 types of fx of hip

Back 61

1. neck of femur
2. intertrochanteric fx
3. subtrochanteric fx

Front 62

vascular anatomy of hip

Back 62

1. obturator artery supplies foveal artery
2. femoral artery supplies:
- lateral femoral circumflex
- medial femoral circumflex
3. intracapsular cervical vesses that cross marrow space

Front 63

hip fx 1st or fall 1st?

Back 63

minor or trival trauma

Front 64

3 mechanisms produce fx (hip)

Back 64

1. fall or direct blow over greater troch
2. lat rotation of ext. firmly fixes the ant capsule & ligaments as neck rotates posteriorly
3. cyclical loading causing microfx

Front 65

why do we classify fx?

Back 65

-possibility of stabilization & anatomical fx reduction

-allow for surgical planning

-allow surgeon to predict outcome & 2* loss of reduction

Front 66

classification of hip fx based upon:

Back 66

1. anatomical location
2. direction of fx
3. displacement of fx fragments

Front 67

anatomical class. of hip fx

Back 67

subcapital
transcervical
bassi-cervical

Front 68

garden classification I-IV

Back 68

I. valgus impacted - incomp. fx
II. complete fx w/o displacement
III. complete fx w/ partial displacement
IV. complete fx w/ total displacement

Front 69

garden I hip fx

Back 69

pt w/ garden I fx may complain of only slight pain in groin or referred p along medial side of knee

no clinical deformity

XR may appear (-)
- if p persists do bone scan or MRI

Front 70

closed tx of garden I & II

Back 70

- short hip spica cast
- bedrest followed by ambulation NWB for 4 mos
- problem w/ pt cooperation
- risk of displacemnt
- risk of aseptic necrosis (13-45%)

Front 71

garden I & II open tx

Back 71

internal fixation w/ cannulated screw or compression screw

Front 72

garden III or IV closed tx

Back 72

closed reduction of fx table

Front 73

garden III or IV open tx

Back 73

hemiarthroplasty:
- allows immediate mobilization
- eliminates: aseptic necrosis; nonunion & fixation; failure
- Good w/ Parkinsons, Paget's, Porosis (3 Ps)
- avoid in young pts

Front 74

intertrochanteric fx

Back 74

-occurs along line b/w greater & lesser trochanter
-totally extracapsular
-excellent blood supply - will have high blood loss at time of fx
-high healing ratio due to good blood supply

Front 75

dx of intertrochanteric fx

Back 75

-fx of fall
-limb markedly shortened & externally rotated
-swelling
-pain
0ecchymosis over greater trochanter

Front 76

non-operative tx of intertroch fx

Back 76

-simple support
-cast
-traction - Buck's, skeletal

Front 77

operative tx of intertroch fx

Back 77

- urgent vs. emergent
- closed reduction w/ internal fixation
- stable reduction
---not necessarily anatomical reduction

Front 78

subtroch fx

Back 78

fx of the proximal 1/3 of femur
--> occurs b/w lesser troch and pt 5 cm distally

Front 79

tx of subtroch fx

Back 79

- fixed angle blade plate
- AO blade plate
- sliding compression hip screw
- intramedullary device

Front 80

problem w/ tx of subtroch fx

Back 80

- malunion
- delayed or non-union
- implant failure

Front 81

subtroch fx occurs in

Back 81

-young adults as a result of high energy injuries
-very elderly as a result of simple falls