Applied Anatomy

Long bones and fractures

Basic Anatomy of Long Bones

• Physis

• Epiphysis

• Diaphysis

• Metaphysis

Long Bone Anatomy

• Physis• Epiphysis• Diaphysis• metaphysis

Fracture terminology

• COMPOUND fracture

• COMMINUTED fracture

• INTRARTICULAR fracture

• AVULSION fracture

Compound Fractures

• A fracture that punctures the skin. Also called an open fracture.

Comminuted Fracture

• Lots of little pieces

Intrarticular Fracture

• Fracture extends into the joint

Avulsion Fracture

• Fracture where a strong ligament or tendon pulls off a chunk of bone rather than rupturing

SHOULDER

Shoulder Anatomy

What is the difference between a shoulder separation and a

shoulder dislocation?

Shoulder Separation

• Disruption of the AC joint

Shoulder Dislocation

• Disruption of the glenohumeral joint

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

MRI Shoulder

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

Y VIEW SHOULDER

77 y.o. female fell at home complains of left shoulder pain.

• Pain and deformity left shoulder

• Unable to extend left wrist

Proximal humerus fracture with damage to the radial nerve

Elbow

Elbow Anatomy

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

Anatomic Snuffbox

Why do navicular wrist fractures have such a high rate of non-

union?

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

HIP and PELVIS

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

PEDIATRIC FRACTURES

• Physis fractures

• Greenstick fractures

• Torus fractures

• Pain and selling at the wrist

• Refuses to use the right hand

15 y.o. boy fell on an outstretched arm.

SALTER-HARRIS CALSSIFICATION

Which Salter-Harris type?

5 y.o. girl fell on an outstretched arm

• Pain mid-forearm

• Moderate swelling mid-forearm

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