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Fractures

Fractures. Normal Bone and Normal Ossification Bone Terms. Epiphysis Epiphyseal Plate ( physis ) Metaphysis Diaphysis. Longitudinal Transverse Oblique Spiral Incomplete “T” fracture. Impacted, compressed Comminuted Pathological Closed fracture Open fracture Avulsion fracture.

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Fractures

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  1. Fractures

  2. Normal Bone and Normal OssificationBone Terms Epiphysis Epiphyseal Plate (physis) Metaphysis Diaphysis

  3. Longitudinal Transverse Oblique Spiral Incomplete “T” fracture Impacted, compressed Comminuted Pathological Closed fracture Open fracture Avulsion fracture Fracture Classifications

  4. Fracture Classifications

  5. Fracture PositionDistal Relationship to Proximal • Displacement • Angulation • Shortening • Rotation • Dislocation (complete loss of continuity at a joint) • Subluxation (partial loss of continuity at a joint) • Fracture-dislocation (same bone with a fracture and a dislocation)

  6. Fracture Evaluation • X-ray films should be taken in at least 2 projections usually AP and lateral view • X-ray films should be large enough to include one end of joint and adjacent soft tissue

  7. Fracture Evaluation • In a child, the healthy opposite side occasionally is examined for comparison • For special questions, some special studies • Oblique view • Stress film • Flexion and extension views • Delayed films

  8. Lower Leg Fracture • Frontal view • Oblique fracture tibia • Angulation convex lateral at fracture • Slight medial displacement distal fragment • Comminuted fracture of fibula • Lateral displacement • Angulation convex lateral at fracture

  9. Lower Leg Fracture Lateral View • Posterior displacement of tibia fracture • Slight angulation convex anteriorly at the fracture site • Inadequate films with fibular fracture not included

  10. Forearm Fracture • No angulation • Transverse slightly impacted fracture radius • Associated ulnar fracture evident

  11. T Type Fracture • Vertical component somewhat lucent • Horizontal component slight impaction with increased density

  12. Impaction Fracture Radius

  13. Tibia Fracture • Oblique, almost spiral fracture line • Barely visible on the frontal study

  14. Comminuted Fracture • Comminuted fracture of distal radius • Anterior angulation • Extension into the joint space

  15. Scaphoid Fracture • Undisplaced fracture • Only lucent line identified

  16. Scaphoid Fracture Old * *

  17. Scaphoid Fracture • Sclerosis of proximal portion • Avascular necrosis of the proximal portion * • Blood supply distal to proximal *

  18. Radial Head Fracture • Small joint effusion with small anterior and posterior fat pads • Minimally depressed radial head fracture

  19. Pathologic Scaphoid Fracture • Small cystic zone in scaphoid • Fracture through the cyst

  20. Salter I Facture • Posteriolateral displacement of epiphysis

  21. Humerus Fracture • Shoulder trauma • Surgical neck involvement • Somewhat comminuted

  22. Olecranon Fracture • Joint effusion, anterior and posterior fat pads • Displaced fracture of the olecranon

  23. Monteggia’s Fracture • Ulnar fracture • Radial dislocation • Paired bones – almost always both involved

  24. Tibial Stress Fracture • Femur, tibia, metatarsals common locations • Bone scan and MRI useful • Plain film negative many cases • Linear fracture with some callus in this case

  25. Healing Stress Fracture • Periosteal reaction • Resorption along the fracture line • Early healing

  26. Distal Femoral Stress Fracture • Stress fracture distal posterior cortex • Periosteal elevation restricted to area of injury

  27. Femoral neck fracture(traumatic s/p fall) • Recent fall • Disruption of femoral neck

  28. Hip Dislocation – Acetabular Fracture

  29. Posterior Hip Dislocation

  30. Tibial Plateau Fracture • Transverse tibial plateau fracture through growth plate • Edema medial femoral condyle, tibial plateau

  31. C-3 Fracture/ dislocation

  32. C-2 Fracture • C2 Fracture • Anterior subluxation • “hangman’s” fracture

  33. Post Op – Halo placement • C2 Fracture – minimal displacement • Post-Op placement of a halo device

  34. Cervical Dislocation C4-5 • Anterior dislocation C4-5 • Facet joint dislocation

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