MENGENALI FRAKTUR

TULANG

Penyegaran dan Pendalamn Radiologi

17-18 Maret 2013

Definitions

Fracture

Dislocation

Subluxation

Fracture

A disruption in all
or part of the
cortex of a bone
All = complete
Part = incomplete =
children
Complete fracture of the surgical
neck of the humerus

Dislocation

The bony
components of a joint
no longer are in
contact with each
other
There is complete
disruption of the joint
R3

Dislocation of the metacarpalphalyngeal joint of the thumb

Subluxation

The bony
components of a
joint are partially in
contact with each
other
There is partial
disruption of the
joint
R3

Incomplete Fractures

Greenstick
fracture
through one
cortex
Torus
buckling of
the cortex
Also called Buckle fx
Greenstick Fractures

Buckle Fractures

How Fractures Are Described

By the direction of the fracture line

By the relationship of the fragments

By the number of fragments

By communication with the atmosphere

How Fractures Are Described

By the direction of the fracture line

Transverse

Diagonal or oblique

Longitudinal

Spiral

How Fractures Are Described

By the direction of
the fracture line

Transverse
perpendicular to the
long axis of the bone
Caused by a force
perpendicular to shaft

How Fractures Are Described

By the direction of the

fracture line

Diagonal or oblique
caused by a force
usually applied in the
same direction as the
long axis of the bone

How Fractures Are Described

By the direction of the

fracture line

Longitudinal along the

long axis of the bone

R3

How Fractures Are Described

By the direction of the

fracture line

Spiral a twisting
fracture caused by a
torque injury such as
planting the foot in a
hole while running

How Fractures Are Described

By the relationship of one fracture

fragment to another

Displacement

Angulation

Shortening

Rotation

Most fractures display more than one of

these abnormalities of position

How Fractures Are Described

By convention, abnormalities of position

describe the relationship of the distal
fracture fragment relative to the proximal
fragment

Displacement

The amount of off-set of

the distal fracture
fragment relative to the
proximal
There is lateral
displacement of the
distal femoral fracture
fragment in this case
Lateral

Medial

Angulation

The angle away from the

normal that the distal
fragment makes with the
proximal
In this case the distal
fragment is angulated
medially from the
position it would have
were it not fractured
Medial

Lateral

Shortening

Overlapping of the
ends of the fracture
fragments
Shortening is usually
described by the
number of centimeters
of overlap

There is also medial displacement here

Medial

Lateral

Rotation

Almost always involves

long bones (humerus
and femur)
Knee joint is in AP
position (points
forward) but ankle
points lateral, in this
case

Anteroposterior
at knee

Lateral at
ankle

How Fractures Are Described

By the number of
fracture
fragments

Two fragments Simple

More than two
fragments Comminuted

2
1

4
2

Simple

Comminuted

How Fractures Are Described

By the relationship
of the fracture to the
atmosphere

Closed

Open or compound

Best evaluated
clinically
Open or compound fracture of the tibia
communicates with outside air

Salter-Harris Fractures

Fractures that involve the epiphyseal

plate alone or in combination with an
adjacent part of the bone
Why is the classification important?

Prognostic value

Type Is and IIs do well

Type IVs and Vs can develop early fusion of
epiphysis and shortening of that bone

Salter-Harris Classification

Type I Epiphyseal plate alone

Type II Epiphyseal plate and metaphysis

Type III Epiphyseal plate and epiphysis

Type IV Epiphyseal plate, metaphysis

and epiphysis
Type V crush fracture of epiphyseal plate

Salter-Harris Classification

Type I
Fracture through
the epiphyseal
plate alone
Often difficult to
detect without
other side for
comparison
R3

Salter-Harris Classification

Type II fracture of the

metaphysis and the
epiphyseal plate
Most common type of
Salter fracture
Corner-sign small
metaphyseal fragment
R3

Salter-Harris Classification
Type III Fracture
of the epiphyseal
plate and the
epiphysis

R3

Salter-Harris Classification

Type IV Fracture
through the
metaphysis,
epiphyseal plate and
the epiphysis
Poorer prognosis
i.e. premature closure
of epiphysis
R3

Common Fracture Eponyms

Colles fracture

Smiths fracture

Jones fracture

Boxers fracture

Common Fracture Eponyms

Colles
fracture
fracture of
the distal
radius with
dorsal
angulation

R3

Common Fracture Eponyms

Smiths fracture
fracture of the
distal radius with
palmar
angulation
Fall on a flexed
hand
R3

Common Fracture Eponyms

Jones fracture fx base 5th metatarsal

Common Fracture Eponyms

Boxers fracture fx
head 5th metacarpal
with palmar
angulation
Most often the
result of punching a
person or wall
R3

Easily Missed Fractures

Scaphoid fractures

Buckle fractures of radius/ulna

Radial head fracture

Supracondylar fractures in children

Posterior dislocation of the shoulder

Hip fractures

Easily Missed Fractures

Scaphoid fractures
common
Pain in anatomical
snuff box
Fall on
outstretched hand
Can lead to
avascular necrosis
R3

Easily Missed Fractures

Buckle fractures of
radius/ulna
Children
Look for angulation
of cortex
Heal quickly
R3

Easily Missed Fractures

Radial head
fracture
Common
May require
multiple views
to see it

Easily Missed Fractures

Supracondyla
r fractures in
children

Supracondylar fractures can be difficult

especially in children (this is an adult)

R3

Easily Missed Fractures

Posterior
dislocation of the
shoulder
Humeral head
looks like
lightbulb
Usually need
another view like
axillary or Y view
R3

Easily Missed Fractures

Hip fractures
May be very subtle
and require bone
scan or MRI for
diagnosis
In this case, white
zone of sclerosis
is an impacted
subcapital fracture
R3

Easily Missed Fractures

Jones fracture
fracture of the base
of the 5th metatarsal
Avulsion type
fracture frequently
caused by pull of
peroneus brevis
tendon

Fracture Healing

Indistinctness of fracture line

Bony callous production

Bridging of fracture

Obliteration of fracture line

Remodeling of bone

Series of images shows indistinctness of fracture line with bony callous

formation and, finally, obliteration of the fracture line. There are metallic rods
transfixing the fracture.

R3