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FRACTURES

By Mahima Charan
4th Year Medical Student
Key Points

I. Definition; A disruption in the continuity of


a bone.
II. Open Vs Closed
III.Location
IV. Simple/Comminuted
V. Types/Pattern
VI. Displacement/Angulation/Shortening
Open Vs Closed

Open ( “open to the


air”)
A fracture in which bone
penetrates through the
skin . Look out for an
open wound/soft tissue
laceration.
Closed
Fracture with intact
overlying skin.
Location

Can be described in many ways;


1. Segmental (long bones)
Epiphysis, Metaphysis, Diaphysis
2. Thirds (long bones)
Proximal 1/3, Middle 1/3, Distal 1/3
3. Anatomical landmarks
Head, Neck, Body, Condyle, Base
Neck of
Femur

e.g. anatomical
landmarks to describe
fractures
Simple Fracture; A fracture that consists of the bone breaking
into 2 fragments

The fracture passes at an angle oblique (> 30o) to


The fracture passes at right angles/<30o to the shaft of the long bone
the shaft of the long bone

Oblique
Transverse (Tibia) (Metartarsal)
Simple spiral Fracture
This fracture of the
tibia resulted from a
twisting injury.
The fracture line
spirals along the
shaft of the long
bone
Comminuted
A bone injury that results
in >2 separate components
is known as a commented
fracture. This is also
known as a multi-
fragmentary fracture.

Proximal humeral shaft


Fracture Displacement

Displacement of fractures is defined in terms of the abnormal position of


the distal fracture fragment in relation to the proximal bone.
Types of displacement include-
1. Angulation
2. Rotation
3. Shortening
4. Impaction and Distraction
Angulation and Rotation

To describe fracture angulation the direction of


the distal bone and degree of angulation in
relation to the proximal bone should be stated.
Medial angulation can be termed ‘varus’ and
lateral angulation ‘valgus’

Rotation of a long bone may be internal or


external
The fracture on the
left has resulted in
angulation of the distal
component.
The fracture on the
right has resulted in
rotation of the distal
component
Shortening

Proximal migration of the


distal fracture component
results in shortening of the
overall bone length.
An oblique fracture is more
readily shortened than a
transverse fracture, which
would need to be fully 'off-
ended' before it can shorten.

The fracture on the left is displaced


without shortening
The fracture on the right is both
displaced and shortened
Impaction and Distraction

A fracture resulting in increased


overall bone length, is due to
distraction (widening) of the bone
components.
If there is shortening of bone
without loss of alignment, the
fracture is impacted. The bone
substance of each component is
driven into the other.

The left image shows fracture


widening or distraction.
The right image shows a line of
increased density due to fracture
impaction.
Let’s have a look at some common fractures…..
Humeral
fracture
Elbow
The lateral image
shows the anterior fat
lad is raised way from
the humerus but does
not show a fracture.
Posterior fat pad
visible- ALWAYS
ABNORMAL
A fracture of the radial
head is visible on the
AP image
Monteggia vs Galeazzi

A Monteggia injury; fracture of the ulna shaft with dislocation of the


radial head at the elbow. The radiocapitellar line should pass through the
midline of the capitulum of the humerus.
A Galeazzi injury is a fracture of the radial shaft with dislocation of the
ulna from its articulation with the radius at the distal radio-ulnar joint.
Monteggia
Colles Fracture

Common injury in elderly people with low bone density.


njury comprises a transverse fracture of the distal radius with dorsal displacement and shorten
The fracture is often accompanied by a fracture of the ulnar styloid.
Classical presentation is “Fall on an outstretched hand”
Normal Hip Anatomy
If displaced, may present
with shortened and
externally rotated leg!
Tx- I/II Put in a screw
III/IV Austin Moore (
hemiarthroplasty)

Garden Classification for NOF Fractures


Avascular Necrosis (greater risk in intracapsular fractures and
scaphoid fractures ( tenderness in anatomical snuffbox)
Scaphoid Fracture
Principles of Management

I. First aid- If open ( clean wound, debride, tetanus injection)


Analgesia for pain associated with fracture
II. Immobilise (traction, splints, casts)
III. Reduction ( if displaced)
IV. Active Rehabilitation
DON’T FORGET YOU NEED 2 VIEWS ON AN XRAY!
Open Reduction Internal Fixation
Immobilise ( e.g. Kirschner wires
Fracture Complications

Soft tissue injury and neurovascular compromise


Malunion
Non-union
Avascular Necrosis
Osteopenia
Compartment Syndrome
Sudecks atrophy (Complex regional pain syndrome)
Thankyou very much!

Mahima Charan