Describing Fractures Basics

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Describing Fractures - Basics

• Garry W. K. Ho, M.D.
• VCU / Fairfax Family Practice
• April 2006

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Relevance

• Important to know how to describe fractures
• Documentation
• Communicate with other physicians
• Colleagues
• Specialists
• Ortho-speak

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Pre-reading Musculoskeletal Radiographs

• 1 Name, date, old films for
• comparison
• 2 What type of view(s)
• 3 Identify bone(s) joint(s)
• demonstrated
• 4 Skeletal maturity
• (physes growth plates)
• 5 Soft tissue swelling
• 6 Bones joints
• (fractures dislocations)

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What is a (bony) fracture?

• Disruption of a bones normal structure or
  wholeness
• Crack, break, or rupture in a bone
• There are many hows and whys to bony fractures
• Terms used to describe each are related

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Mnemonic OLD ACID

• O Open vs. closed
• L Location
• D Degree (complete vs. incomplete)
• A Articular extension
• C Comminution / Pattern
• I Intrinsic bone quality
• D Displacement, angulation, rotation

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O Open vs. Closed

• Open fracture
• AKA Compound fracture
• A fracture in which bone penetrates through skin
• Open to air
• Some define this as a fracture with any open
  wound or soft tissue laceration near the bony
  fracture
• Closed fracture
• Fracture with intact overlying skin

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L Location
Epiphysis

• Which bone?
• Thirds (long bones)
• Proximal, middle, distal third
• Anatomic orientation
• E.g. proximal, distal, medial, lateral, anterior,
  posterior
• Anatomic landmarks
• E.g. head, neck, body / shaft, base, condyle
• Segment (long bones)
• Epiphysis, physis, metaphysis, diaphysis

Physis
Metaphysis
Diaphysis (Shaft)
Articular Surface
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D Degree of Fracture

• Complete
• Complete cortical circumference involved
• Fragments are completely separated
• Incomplete
• Not fractured all the way through
• Only one cortex involved
• e.g Greenstick fracture

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A Articular Extension / Involvement

• Intra-articular fractures
• Involves the articular surface
• Dislocation
• Loss of joint surface / articular congruity
• Fracture-dislocation

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C Comminution / Pattern

• Transverse (Simple)
• Oblique (Simple)
• Spiral (Simple)
• Linear / longitudinal
• Segmental
• Comminuted
• Compression / impacted
• Buckle / Torus
• Distraction / avulsion

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C Comminution / Pattern

• Transverse (Simple)

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C Comminution / Pattern

• Oblique (Simple)
• Spiral (Simple)
• Oblique in 2 views

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C Comminution / Pattern

• Linear / longitudinal / split

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C Comminution / Pattern

• Segmental
• Bone broken in 2 separate places Fx lines do
  not connect

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C Comminution / Pattern

• Comminuted
• Broken, splintered, or crushed into gt3 pieces

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C Comminution / Pattern

• Compression
• Impacted
• (e.g. Buckle / Torus)

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C Comminution / Pattern

• Buckle / Torus

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C Comminution / Pattern

• Distracted
• Avulsion

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I Intrinsic Bone Quality

• Osteopenia
• Decrd density

• Normal

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I Intrinsic Bone Quality

• Osteopetrosis
• Incrd density

• Normal

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I Intrinsic Bone Quality

• Osteopoikilosis
• Focal areas of incrd density

• Normal

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D Displacement, Angulation, Rotation

• Displacement
• Extent to which Fx fragments are not axially
  aligned
• Fragments shifted in various directions relative
  to each other
• Convention describe displacement of distal
  fragment relative to proximal

• Oblique tibial shaft Fx b/w distal middle
  thirds laterally displaced

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D Displacement, Angulation, Rotation

• Angulation
• Extent to which Fx fragments are not anatomically
  aligned
• In a angular fashion
• Convention describe angulation as the direction
  the apex is pointing relative to anatomical long
  axis of the bone (e.g. apex medial, apex valgus)

• R Tibial shaft Fx b/w prox middle thirds,
  angulated apex lateral (apex varus)

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D Displacement, Angulation, Rotation

• Angulation

• Varus
• Apex lateral

• Valgus
• Apex medial

• Parallel
• No angulation

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D Displacement, Angulation, Rotation

• Rotation
• Extent to which Fx fragments are rotated relative
  to each other
• Convention describe which direction the distal
  fragment is rotated relative to the proximal
  portion of the bone

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D Displacement, Angulation, Rotation

• Rotation

• PA view of rotated hip Fx
• Greater trochanter perpendicular to film

• Normal PA view of hip
• Greater trochanter in profile

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Salter-Harris Fractures
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Other signs of fractures

• Callus / Osteosclerosis

• Periosteal reaction

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Other signs of fractures

• Fat pad sign / Sail sign

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Conclusions

• Know how to read X-rays
• (Patients expect this we order a lot of them)
• Communicate and share with your consultants
• (It affects patient outcomes)
• Pre-reading
• Describing fractures