DefinitionDefinition

• Fracture Fracture

FractureFracture

A disruption in all or A disruption in all or part of the cortex part of the cortex of a boneof a bone

AllAll = complete= completePart Part = incomplete= incomplete

Incomplete fractureIncomplete fracture

• Greenstick fractureGreenstick fracture fracture through fracture through

one cortexone cortex

• Torus fractureTorus fracture buckling of the buckling of the

cortexcortex ( ( buckling fracturebuckling fracture))

Torus fractureTorus fracture

Greenstick fractureGreenstick fracture

How fractures are describedHow fractures are described• By the direction of the fracture lineBy the direction of the fracture line• By the relationship of the fragmentsBy the relationship of the fragments• By the number of fragmentsBy the number of fragments• By relation to the adjacent joint By relation to the adjacent joint

• By the direction of the fracture lineBy the direction of the fracture line

- transverse - transverse - diagonal or oblique- diagonal or oblique - longitudinal- longitudinal - spiral- spiral

• Transverse Transverse

- perpendicular to - perpendicular to the long axis of the the long axis of the bonebone

- caused by a force - caused by a force perpendicular to the perpendicular to the bone shaftbone shaft

• Diagonal or Diagonal or obliqueoblique

- caused by a force - caused by a force usually applied in usually applied in the same direction the same direction as the long axis of as the long axis of the bone the bone

• LongitudinalLongitudinal

- along the - along the longitudinal axis of longitudinal axis of the bone the bone

• SpiralSpiral

- a twisting fracture - a twisting fracture caused by a torque caused by a torque injury such as injury such as planting the foot in planting the foot in a hole while a hole while runningrunning

How fractures are describedHow fractures are described• By the direction of the fracture lineBy the direction of the fracture line• By the relationship of the fragmentsBy the relationship of the fragments• By the number of fragmentsBy the number of fragments• By relation to the adjacent jointBy relation to the adjacent joint

• By the relationship of one fracture By the relationship of one fracture fragment to anotherfragment to another

- displacement- displacement - angulation- angulation - shortening- shortening - rotation- rotation

* * Most fractures display more than one of Most fractures display more than one of these abnormalities of positionthese abnormalities of position

• By convention, abnormalities of By convention, abnormalities of position describe the relationship of position describe the relationship of the distal fracture fragment relative the distal fracture fragment relative to the proximal fragmentto the proximal fragment

DisplacementDisplacement

• The amount of offset The amount of offset of the distal fracture of the distal fracture fragment relative to fragment relative to the proximal the proximal

• There is lateral There is lateral displacement of the displacement of the distal femoral distal femoral fracture fragment in fracture fragment in this casethis case

AngulationAngulation

• The angle away from The angle away from the normal that the the normal that the distal fragment distal fragment makes with the makes with the proximal proximal

• In this case the distal In this case the distal fragment is angulated fragment is angulated medially from the medially from the position it would have position it would have were it not fracturedwere it not fractured

ShorteningShortening

• Overlapping of the ends Overlapping of the ends of the fracture of the fracture fragmentsfragments

• Shortening is usually Shortening is usually described by the described by the number of centimeters number of centimeters of overlapof overlap

• There is also medial There is also medial displacement heredisplacement here

RotationRotation

• Almost always Almost always involves long bones involves long bones ( humerus and ( humerus and femur )femur )

• In this case, Knee In this case, Knee joint is in AP position joint is in AP position ( points forward) , but ( points forward) , but ankle points lateralankle points lateral

How fractures are describedHow fractures are described• By the direction of the fracture lineBy the direction of the fracture line• By the relationship of the fragmentsBy the relationship of the fragments• By the number of fragmentsBy the number of fragments• By the relation to the adjacent jointBy the relation to the adjacent joint

• By the number of By the number of fracture fracture fragmentsfragments

- two fragments : - two fragments : simplesimple

- more than two - more than two fragments : fragments : comminutedcomminuted

• By the relation to the By the relation to the adjacent jointadjacent joint

- intra-articular- intra-articular - - extra-articularextra-articular

How fractures are describedHow fractures are described• By the direction of the fracture lineBy the direction of the fracture line• By the relationship of the fragmentsBy the relationship of the fragments• By the number of fragmentsBy the number of fragments• By the relation with the adjacent By the relation with the adjacent

jointjoint

Salter-Harris Salter-Harris fracturefracture

Salter-Harris fractureSalter-Harris fracture

• Fractures that involve the epiphyseal plate Fractures that involve the epiphyseal plate alone or in combination with an adjacent alone or in combination with an adjacent part of the bonepart of the bone

• Why is the classification important ?Why is the classification important ? - prognostic value- prognostic value - type I and II do well- type I and II do well - type IV and V can develop early fusion of - type IV and V can develop early fusion of

epiphysis and shortening of that boneepiphysis and shortening of that bone

Salter-Harris classificationSalter-Harris classification• Type IType I : : epiphyseal plate aloneepiphyseal plate alone• Type IIType II : : epiphyseal plate & metaphysisepiphyseal plate & metaphysis• Type IIIType III : : epiphyseal plate & epiphysisepiphyseal plate & epiphysis• Type IVType IV : : epiphyseal plate & metaphysis &epiphyseal plate & metaphysis &

epiphysisepiphysis• Type VType V : : crush ( ruined ) fracture of thecrush ( ruined ) fracture of the epiphysealepiphyseal

plateplate

SALTRSALTR• SS = = SSlipped growth lipped growth

plateplate• AA = = AAbove (# above bove (# above

growth plate )growth plate )• LL = = LLow ( # lower ow ( # lower

thanthan ““belowbelow”” growth growth plate)plate)

• TT = = TTogether ( # of ogether ( # of metaphysis+growth metaphysis+growth plate +plate + epiphysis)epiphysis)

• RR = = RRuineduined

Salter-Harris classificationSalter-Harris classification• Type I Type I

- fracture through - fracture through the epiphyseal plate the epiphyseal plate alonealone

- often difficult to - often difficult to detect without other detect without other side for comparisonside for comparison

Salter-Harris classificationSalter-Harris classification• Type IIType II

- fracture of the epiphyseal - fracture of the epiphyseal plate and metaphysisplate and metaphysis

- most common type of - most common type of Salter fractureSalter fracture

- - ““corner signcorner sign””- small - small metaphyseal fragmentmetaphyseal fragment

Salter-Harris classificationSalter-Harris classification• Type IIIType III

- fracture of the - fracture of the epiphyseal plate epiphyseal plate and the epiphysisand the epiphysis

Salter-Harris classificationSalter-Harris classification• Type IVType IV : :

- fracture through the - fracture through the metaphysis, metaphysis, epiphyseal plate and epiphyseal plate and the epiphysisthe epiphysis

- poorer prognosis- poorer prognosis ““ premature closure of premature closure of

epiphysis epiphysis ““

Common fracture Common fracture eponymeseponymes• ColleColle’’s fractures fracture• SmithSmith’’s fractures fracture• BartonBarton’’s fractures fracture• JoneJone’’s fractures fracture• BoxerBoxer’’s fractures fracture• LoverLover’’s fractures fracture

• ColleColle’’s fractures fracture

- Extra articular fracture of the - Extra articular fracture of the distal radius with dorsal distal radius with dorsal angulationangulation

• SmithSmith’’s fractures fracture

- extra articular fracture of the distal - extra articular fracture of the distal radius with volar angulation radius with volar angulation

SmithSmith’’s fractures fracture

SmithSmith’’s fracture ( reverse s fracture ( reverse collecolle’’s )s )

• BartonBarton’’s fractures fracture - intra articular fracture of distal - intra articular fracture of distal

radiusradius

• JoneJone’’s fractures fracture

- Fracture of base of Fracture of base of 55thth metatarsal bone metatarsal bone

- Avulsion type Avulsion type fracture frequently fracture frequently caused by pull of caused by pull of peroneus brevis peroneus brevis tendontendon

• JoneJone’’s fractures fracture - fracture base of 5- fracture base of 5thth metatarsal bone metatarsal bone

• BoxerBoxer’’s fractures fracture - fracture head of 5- fracture head of 5thth

metacarpal with metacarpal with palmer angulationpalmer angulation

- most often the - most often the result of punching result of punching a person or wall a person or wall

• ““ LoverLover’’s fracture s fracture ““

• ““ Don joun fractureDon joun fracture””• JumperJumper’’s fractures fracture

• fracture of the calcaneus and a fracture of the calcaneus and a dorso-lumbar spine fracture.dorso-lumbar spine fracture.

•This is called a 'jumpers fracture' This is called a 'jumpers fracture' or a 'lover's fracture', because it or a 'lover's fracture', because it is usually seen in people jumping is usually seen in people jumping out of a window to escape from out of a window to escape from the police or a jealous husband.the police or a jealous husband.

Easily missed fracturesEasily missed fractures

• Scaphoid fractureScaphoid fracture• Buckle fracture Buckle fracture ““ torus torus ““• Radial head fractureRadial head fracture• Supracondylar fracture in childrenSupracondylar fracture in children

• Scaphoid fractureScaphoid fracture

- common- common - pain in anatomical - pain in anatomical

snuff boxsnuff box - fall in outstretched - fall in outstretched

handhand - can lead to - can lead to

avascular necrosisavascular necrosis

• Buckle Buckle ““ Torus Torus ““ fracture fracture

- children- children- Look for angulation of the Look for angulation of the

cortexcortex- Heal quicklyHeal quickly

• Radial head Radial head fracturefracture

- CommonCommon- Fat pad signFat pad sign

Supracondylar fractures in Supracondylar fractures in childrenchildren• Fat bad signFat bad sign

• Posterior Posterior displacement of displacement of capitulum capitulum ““ anterior humeral anterior humeral line line ““

Anterior humeral lineAnterior humeral line

QuizQuiz

Torus fractureTorus fracture

Greenstick fractureGreenstick fracture

SmithSmith’’s fractures fracture

Salter-harris IVSalter-harris IV

Salter-Harris type IVSalter-Harris type IV

AVN of scaphoidAVN of scaphoid

Salter-Harris fracture type ISalter-Harris fracture type I

Salter-Harris type IIISalter-Harris type III

Slipped capital femoral Slipped capital femoral epiphysisepiphysis

““ Salter-Harris type I Salter-Harris type I ““

Salter-Harris type IISalter-Harris type II

Salter-Harris type IIISalter-Harris type III

LoverLover’’s ( Don joun) ( Jumpers ( Don joun) ( Jumper’’s) s) fracturefracture