FRACTURES

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FRACTURES

• (On Which We Will Likely Be Pimped)
• Lindsay Gould July 2006

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JEFFERSON FRACTURE

• Fracture of C1 ring
• Axial loading injury with compression force to C1
• Unilateral or bilateral fractures of anterior and
  posterior arches of C1

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CLAY-SHOVELERS FX

• Avulsion fracture of spinous process of C7 or T1
• Sudden load on flexed spine

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HANGMANS FRACTURE

• Bilateral pedicle or 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)

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CLAVICULAR FRACTURE

• Extremely common
• Does not 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.

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SCAPULAR FRACTURE

• Uncommon
• Scapular body fx are the MC type
• Commonly (80-90) associated with other injuries
  lung and chest
• Dont require surgery
• GLENOID (cartilage) fracture requires surgery
  when unstable or fragments are far out of
  alignment

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HUMERUS FRACTURE

• Proximal occur near 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

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HOLSTEIN-LEWIS FRACTURE

• Distal third humeral 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

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ULNAR FRACTURE

• Forearm is struck by an object
• Nightstick Fracture
• Treatment of isolated ulnar fx cast or brace
  surgery if unstable

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MONTEGGIA FRACTURE

• Giovanni Monteggia 1814
• Fracture of Ulna
• Dislocation of radial head within the elbow joint
• Treatment Surgery

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RADIAL HEAD

• Most common part broken in elbow fracture
• MC caused by fall onto outstretched hand
• /- surgery depending on displacement

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GALEAZZI FRACTURE

• Fracture of Radius
• 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

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NURSEMAIDS ELBOW

• Common in young children (lt 5 yo)
• Subluxation of radius at elbow joint --bone has
  slid out of proper position
• Classically a sudden pull on childs 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

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SMITHS FRACTURE

• Fracture of radius 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

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COLLES FRACTURE

• Fracture of radius
• Displaced posteriorly (behind normal position)
• MC after fall onto outstretched hand
• Treatment Cast /- surgery, depending on
  shortening and displacement of radius

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SCAPHOID BONE FX

• Scaphoid sits 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

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BOXERS FRACTURE

• Classically at the 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)

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BENNETTS FRACTURE

• Intra-articular fracture/dislocation of base of
  1st metacarpal
• Small palmar fragment continues to articulate
  with trapezium
• Mechanism forced abduction of thumb
• Treatment open reduction and internal fixation

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ROLANDO FRACTURE

• Fracture through thumb metacarpal base
• Comminuted intraarticular fracture
• Prognosis is worse than Bennetts
• Treatment open reduction and internal fixation

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INTERTROCHANTERIC HIP FX

• Occurs lower than femoral neck fracture
• Bone blood flow is usually intact, so repair, not
  replacement is performed
• Treatment Metal plate and screws

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FEMORAL NECK FRACTURE

• Just below the ball of the ball-and-socket hip
  joint
• The ball is disconnected from rest of the femur
• Blood supply is often disrupted, so theres a
  high risk of non-healing
• Treatment Often with partial hip replacement,
  esp if gt 65 yo

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FEMORAL SHAFT FX

• Severe injury
• Treatment Intramedullary rod (MC), plate and
  screws, or external fixator

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SUPRACONDYLAR FEMUR FX

• Unusual injury 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

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PATELLAR FRACTURE

• Fall onto kneecap 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

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TIBIAL PLATEAU FRACTURE

• Just below knee joint
• Involves the joint cartilage ? risk of arthritis
• Treatment If non-displaced, may be treated
  without surgery. Surgery for displaced fractures

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TIBIAL SHAFT FRACTURE

• Most common type of tibial fracture
• Most can be treated by long leg cast
• May require plates, screws, external fixator, or
  intramedullary rod

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TIBIAL PLAFOND FRACTURE

• Tibial Pilon 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

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POTTS FRACTURE

• Fracture of the lower end of fibula with
  displacement of tibia
• Causes the foot to turn out

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TALUS FRACTURE

• Complications
• Ankle arthritis
• Subtalar arthritis
• Foot deformity
• Avascular necrosis

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CALCANEUS FRACTURE

• Fall from heights 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)

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FRACTURES OF 5th METATARSAL

• Avulsion Dancers 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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Avulsion (Dancers)
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Jones fracture
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TORUS FRACTURE

• Buckle fracture
• Compression fracture 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

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GREENSTICK FRACTURE

• Usually from a 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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THE END

• (FINALLY!!!!)