applied anatomy long bones and fractures. basic anatomy of long bones physis epiphysis diaphysis...
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Fracture terminology
• COMPOUND fracture
• COMMINUTED fracture
• INTRARTICULAR fracture
• AVULSION fracture
Avulsion Fracture
• Fracture where a strong ligament or tendon pulls off a chunk of bone rather than rupturing
55 y.o. female is being assisted up and embankment; she falls
while still holding the hand of her assistant.
• Immediate pain left shoulder
• Unable to left arm above her head to brush her hair
• Pain is worst at night
Rotator Cuff Tear
• Acute are usually traumatic
• Chronic are usually degenerative
• Pain or weakness with abduction of the arm
• MRI is diagnostic test of choice
Roatator Cuff Tear
• Treatment depends on:– Age of patient– Type of tear (traumatic vs. degenerative)– Time since tear– Patient’s activities
77 y.o. female fell at home complains of left shoulder pain.
• Pain and deformity left shoulder
• Unable to extend left wrist
30 y.o. man who fell on a outstretched arm
• Pain at the elbow
• Unable to flex or extend the elbow due to pain
• Elbow is swollen
Elbow Fractures
• Notorious for not showing up on x-ray
• BEWARE the swollen elbow! --- fractured until proven otherwise
• Look for the “SAIL SIGN”--- indicative of joint swelling and strongly suggests fracture
16 y.o. male who fell on an outstretched hand while
snowboarding
• Pain left wrist at the anatomic snuffbox
• No obvious swelling
• Able to flex and extend the wrist
NAVICULAR WRIST FRACTURE
• Notorious for not showing up on x-ray
• High rate of non-union
• Pain in anatomic snuffbox suggests navicular fracture
23 y.o. male who fell onto an outstretched arm while skiing
• Pain at the base of the thumb
• No significant swelling
• Injury occurred in his dominent hand
GAMEKEEPER’S THUMB
• Tear of the ulnar collateral ligament of the thumb (or avulsion fx)
• Laxity at the base of the thumb leads to weakness long term
• Must fix close to the time of injury
83 y.o. female fell on left hip. Complains of pain in left hip.
• Known h/o osteoporosis
• Left leg is foreshortened and externally rotated
• Unable to bear weight
83 y.o. female fell on right hip. Complains of pain in the right
hip.• Known h/o osteoporosis
• Right leg is foreshortened and externally rotated
• Unable to bear weight
Hip Fractures in General
• Usually (>90%) the hip breaks and then they fall.• In the absence of MAJOR trauma, hip fracture is
pathognomonic for osteoporosis• Mortality rate at 1 year approaches 50%
Femoral Neck vs. Intertrochanteric
• Femoral neck fx are within the joint capsule• Femoral neck fx have higher rates of
complication• Clinical presentations are the same
• Pain and selling at the wrist
• Refuses to use the right hand
15 y.o. boy fell on an outstretched arm.
GREENSTICK FRACTURES
• Incomplete fracture seen in young children
• Heal quickly• Note the bend in the
ulna --- this is referred to as a bend “fracture”
4 y.o. girl fell onto an outstretched arm
• Pain distal forearm
• No swelling
• Refuses to use the arm
TORUS FRACTURE
• Also called “buckle fracture”
• Seen in young children with soft, plastic bones
• Cortex simply wrinkles
• Heals quickly
SUMMERY
• Basic anatomy
• Types of fractures
• Pediatric fractures
• Relationship of structures not seen on an x-ray film (nerves, tendons, blood vessels) to outcome of fracture
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