The Language Of Fractures - Rush - Msk

Front 1

Greenstick fracture

Back 1

-incomplete fracture causing bowing of bone
-break occurs on outer surface of the CONVEX side of the fracture

Front 2

What two fractures only occur in children?

Back 2

-Greenstick and torus (due to inc water content in bones)
-*unless they have some condition like Osteogenesis Imperfect

Front 3

How would one describe an open fracture such as a car accident where a bone pushes from inside out?

Back 3

-Open from within

Front 4

How would one describe an open fracture such as a bullet wound which pushes bone from outside in?

Back 4

-Open from Without

Front 5

What are 2 types of communicated fractures?

Back 5

1. Butterfly - wedge shaped frag of bone making up one of the frags
*if transverse portion is shorter, more likely superior portion will fall
2. Segmental- fracture divides the long bone into several frags

Front 6

Intraarticular

Back 6

-fracture that extends into and involves an articular surface
-may lead to traumatic arthritis

Front 7

Distraction

Back 7

-when opposing ends of the fracture frags are kept apart from each other resulting from muscle pull, excessive traction on fracture or due to interposed tissue

Front 8

Impaction

Back 8

-when one frag of bone is forcibly driven into the adjacent frag
-this occurs in cancellous bone b/c it is softer (can be stable fracture)
***Remember: impacted NOT compacted

Front 9

Avulsion

Back 9

-frag is pulled away from its original position by active contraction of a muscle or by passive resist of a lig against a force in the opp direction
-the lig instead of tearing pulls the bony attachment off
***will commonly stay distracted*

Front 10

Depression

Back 10

-hard surface of one bone is driven into the softer of the adjacen bone (articular surf) and the outer surf is pushed into the softer cancellous bone (commonly at the tibial plateau)

Front 11

Tibial Plateau

Back 11

-the smooth bony surface of either the lateral or medial condyle of the tibia that articulates w/ the corresponding condylar surface of the femur

Front 12

Compression

Back 12

-in VERTEBRAL BODIES
-sup & inf surfs are driven toward each other prod a wedge shape
-extent in terms of % loss of height as compared to adj bone

Front 13

Where are compression fractures commonly seen?

Back 13

- in elderly w/ osteoporosis
-affected vertebral body becomes wedged, MC anteriorly so doesnt affect SC posteriorly

Front 14

What is the first way to describe angulation?

Back 14

-the angle of the distal fracture frag makes in relation to the prox frag

-ex) a fracture of the distal radius w/ 30 degrees dorsal angulation of the distal fracture frag

Front 15

What is the other way to describe angulation?

Back 15

-the direction of the apex of the angulation formed by the fracture fragments and expressed in number of degrees (apex = where point portion points)

Front 16

Subluxation

Back 16

-partial loss of continuity between 2 opposing joint surfaces
-CAN'T be mid-shaft

Front 17

Diastasis

Back 17

-separation of normally joined parts
ex. pubic symphysis (in childbirth) and syndesmotic ligament (btwn tibia and fibula or radius and ulna)

Front 18

Delayed union

Back 18

failure of fracture to unite in time usually required for union to occur
-expect fracture to eventually heal

Front 19

Nonunion

Back 19

-failure of the fracture fragments and the process of bone repair has ceased (ends of bones appear rounded and ahve white bony sclerosis)

Front 20

Pseudoarthrosis

Back 20

-false joint of dense fibrous or fribrocartilaginous tissue which forms between 2 fracture frags

Front 21

Malunion

Back 21

-union to the fracture w/ angulation or rotation deformity

Front 22

What is a fracture of the hip capsule?

Back 22

-often in older individuals w/ osteoporosis, hip capsule tightens but femur continues to rotate and femoral neck brakes

Front 23

***Blood supply to femoral head vs shaft

Back 23

-different
-blood is on outside of femoral head so if displace, blood supply then is cut off
-OLD person - replace hip
-You person - leave own femur in as long as possible

Front 24

What are 3 mechanisms that produce hip fracture?

Back 24

1. a fall or direct blow over the greater trochanter
2. Lateral rot of the extrem firmly fixes the ant caps & the ligs as the neck rotates posteriorly
3. Cyclical loading causing microfractures (stress fracture)

Front 25

What are the 3 anatomical classifications of hip fractures

Back 25

1. Subcapital
2. Transcervical (femoral neck)
3. Basi-cervical (base of femoral neck)

Front 26

What is the Garden Classification of Hip Fractures?

Back 26

1. Valgus impacted
2. Complete fracture w/out displacement
3. Complete fract w/ partial displacement
4. Complete fracture w/ total displacement

Front 27

Garden Classification I

Valgus impacted

Back 27

-incomplete fract - more stable since fem head jammed on shaft
a. pts may complain of only sligh pain in groin or referred along medial side of knee
b. no clinical deformity
c. X-rays appear neg (MRI is gold standard w/in 4-6 hrs)

Front 28

Angle associations of the femoral head w/ the pelvis

Back 28

1. Normal = 135 deg +/- 5
2. Valgus (straight line) ~180
3. Varus (bull rider- round) ~90

Front 29

What is a Closed Tx for hip fracture?

Back 29

1. Short hip spica cast
2. bed rest followed by ambulation NWB (non-weight bearing) - 4 m
3. Prob w/ pt compliance
4. Risk of displacement
5. Risk of aseptic necrosis (13-45%)

Front 30

What is open tx for hip fractures?

Back 30

-stabilize fracture and allow body to heal itself

Front 31

Tx for Garden I and II?

Back 31

-internal fixation w/ cannulated screw or compression screw

Front 32

Tx for Garden III and IV?

Back 32

-closed reduction on the fracture table
-*Hemiarthroplasty

Front 33

What is a hemiarthroplasty?

Back 33

-surgical procedure which replaces one half of the joint w/ an artificial surface and leaves the other part in its natural pre op state

Front 34

Advantages/Indications of Hemiarthroplasty?

Back 34

1. allows immediate mobilization
2. Eliminates aseptic necrosis, nonunion fixation and failure
3. Good for Parkinsons, Pagets, porosis (3 P's)
4. AVOID in young pts

Front 35

What are Intertrochanteric Fractures?

Back 35

-occurs along a line btwn the greater and lesser trochanters
-totally extracapsular
-lots of blood loss at fract site
-high healing ratio due to good blood supply

Front 36

Intertrochanteric Fractures

Diagnosis

Back 36

1. history of fall
2. limb markedly shortened and externally rotated
3. swelling, pain ecchymosis over greater trochanter 12-24 hrs later

Front 37

Intertrochanteric Fractures

Non-operative tx

Back 37

1. simple cast
2. cast
3. Traction - Buck's, skeletal

Front 38

Intertrochanteric Fractures

Operative Tx

Back 38

-urgent vs non urgent
-closed red w/ internal fixation
-stable reduction, not necessarily anatomical reduction

Front 39

Subtrochanteric Fracture

Back 39

-at prox 1/3 of femur
-between the lesser trochanter and a point 5 cm distally
-young adults w/ high energy injuries
-very elderly simple falls

Front 40

Subtrochanteric Fracture

Tx

Back 40

1. Fixed angle blade plate
2. AO blade plate
3. Sliding compression hip screww
4. Intramedullary device

Front 41

Subtrochanteric Fracture

Problems w/ tx

Back 41

1. malunion
2. delayed or non-union
3. implant failure