Fractures (main): Difference between revisions
 
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==Describing Fractures==
==Describing Fractures<ref>Wolfson, A. B., Cloutier, R. L., Hendey, G. W., Ling, L., & Schaider, J. (n.d.). Approach to Musculoskeletal Injuries. In Harwood-Nuss' clinical practice of emergency medicine (6th ed.). LWW.</ref>==
*Open versus Closed
[[File:Types of fracture.jpg|thumb|Types of fractures]]
*Location
[[File:Fracture Naming Construct.png|thumb|Fracture naming construct]]
**Intra-articular versus articular
A systematic approach for the description of fractures should be used to aid in clear communication with radiologists and consulting specialists.
**Mid-shaft, proximal 1/3, or distal 1/3
*'''Laterality'''
**Supracondylar
*'''[[Open fracture|Open]] vs. Closed'''
**Intertrochanteric, subtrochanteric, femoral neck, or subcapital
*'''Affected Bone'''
*Orientation of the fracture line
*'''Location'''
**Intra-articular vs. extra-articular
**Portion of long-bone (proximal, middle, distal)
**Anatomic site (ex. [[supracondylar]], [[Intertrochanteric femur fracture|intertrochanteric]], [[Subtrochanteric femur fracture|subtrochanteric]], [[Femoral neck fracture|femoral neck]])
*'''Direction''' (orientation of fracture line relative to long-axis)
**Transverse
**Transverse
**Oblique
**Oblique
**Spiral
**Spiral
**Comminuted
**Impacted
**Segmental
**Torus / [[Greenstick Fracture|Greenstick]] (Peds)
**Torus / Greenstick (Peds)
*'''Alignment'''
*Displacement
**Displacement (distal relative to proximal fragment)
**Extent to which fracture fragments are offset from each other
***State in terms of direct measurement (e.g. 4mm) or %width of bones (50% displacement)
***State in terms of direct measurement (e.g. 4mm) or %width of bones (50% displacement)
**Direction of displacement is based on position of distal fragment relative to proximal
**Angulation
*Separation
***Deviation from longitudinal axis, described in degrees and direction
**Distance the two fragments have been pulled apart (but not offset from each other)
***Direction of apex of angle formed from redrawn longitudinal axes of fracture fragments
*Shortening
***Valgus angulation is lateral
**Amount by which a bone's length has been reduced (expressed in mm or cm)
***Varus angulation is medial
**May occur by impaction or by overriding
**Rotation
*Angulation
***Twisting around longitudinal axis (distal relative to proximal fragment)
**Described in terms of degree and direction
***Described as medial or lateral rotation (towards or away from midline respectively)
***Degree
**Separation
****Calculate amount of "unbending" needed to make fx fragments parallel
***Distance two fragments have been pulled apart (but not offset from each other)
***Direction
**Shortening
****Described by direction of the apex of the angle formed by the two fragments OR
***Amount by which a bone's length has been reduced (expressed in mm or cm)
****Described by direction the terminal fragment is deviated
***May occur by impaction or by overriding
****Examples: anterior or posterior, lateral or medial, radial or ulnar, dorsal or volar
**Other
*Rotational Deformity
***Incomplete: Only one side of cortex disrupted
**Usually apparent on physical exam, not on radiographs
***Stress: Caused by repetitive low-force trauma/impact
*Fracture-Dislocation
***Pathologic: Caused by trivial trauma or biomechanically routine force, suggestive of abnormal bone.
**Be careful not to describe these injuries as fractures with displacement
***Fracture-Dislocation: Be careful not to describe these injuries as fractures with displacement
*[[Salter Harris]]
*'''Fragmentation'''
**Segmental (>2 fragments, with one segment not connected to either end)
**Comminuted (>3 fragments)
 
*'''[[Salter Harris]]'''
 
==Anatomic Terms==
*'''Diaphysis''' - shaft
*'''Metaphysis''' - widened ends of the bones adjacent to the physis
*'''Physis''' - radiolucent growth plate between metaphysis and epiphysis
*'''Epiphysis''' - secondary ossification center at the end of the bones
*'''Apophysis''' - secondary ossification center at site of tendon or ligament attachment


==Head and Neck==
==Head and Neck==
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{{Cervical spine injuries}}
{{Cervical spine injuries}}


== Upper Extremity ==
==Upper Extremity==
{{Proximal arm fracture DDX}}
{{Proximal arm fracture DDX}}


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**[[Olecranon fracture]]
**[[Olecranon fracture]]
**[[Elbow dislocation]]
**[[Elbow dislocation]]
**[[Capitellum fracture]]
*Pediatric
*Pediatric
**[[Nursemaid's elbow]]
**[[Nursemaid's elbow]]
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*[[Scapula fracture]]
*[[Scapula fracture]]
*[[Rib fracture]]
*[[Rib fracture]]
**[[Flail chest]]
*[[Sternum fracture]]
*[[Sternum fracture]]


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==Other==
==Other==
*[[Salter-Harris fractures]]
*[[Salter-Harris fractures]]
==Management==
{{General Fracture Management}}


==See Also==
==See Also==
*[[Fracture management overview]]
*[[Splinting]]
*[[Splinting]]
*[[Diagnoses by Body Part (Main)]]
*[[Diagnoses by Body Part (Main)]]
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*[[Joint dislocations (main)]]
*[[Joint dislocations (main)]]


[[Category:Ortho]]
==References==
<references/>
 
[[Category:Orthopedics]]

Latest revision as of 18:00, 13 June 2020

Describing Fractures[1]

Types of fractures
Fracture naming construct

A systematic approach for the description of fractures should be used to aid in clear communication with radiologists and consulting specialists.

  • Laterality
  • Open vs. Closed
  • Affected Bone
  • Location
  • Direction (orientation of fracture line relative to long-axis)
    • Transverse
    • Oblique
    • Spiral
    • Impacted
    • Torus / Greenstick (Peds)
  • Alignment
    • Displacement (distal relative to proximal fragment)
      • State in terms of direct measurement (e.g. 4mm) or %width of bones (50% displacement)
    • Angulation
      • Deviation from longitudinal axis, described in degrees and direction
      • Direction of apex of angle formed from redrawn longitudinal axes of fracture fragments
      • Valgus angulation is lateral
      • Varus angulation is medial
    • Rotation
      • Twisting around longitudinal axis (distal relative to proximal fragment)
      • Described as medial or lateral rotation (towards or away from midline respectively)
    • Separation
      • Distance two fragments have been pulled apart (but not offset from each other)
    • Shortening
      • Amount by which a bone's length has been reduced (expressed in mm or cm)
      • May occur by impaction or by overriding
    • Other
      • Incomplete: Only one side of cortex disrupted
      • Stress: Caused by repetitive low-force trauma/impact
      • Pathologic: Caused by trivial trauma or biomechanically routine force, suggestive of abnormal bone.
      • Fracture-Dislocation: Be careful not to describe these injuries as fractures with displacement
  • Fragmentation
    • Segmental (>2 fragments, with one segment not connected to either end)
    • Comminuted (>3 fragments)

Anatomic Terms

  • Diaphysis - shaft
  • Metaphysis - widened ends of the bones adjacent to the physis
  • Physis - radiolucent growth plate between metaphysis and epiphysis
  • Epiphysis - secondary ossification center at the end of the bones
  • Apophysis - secondary ossification center at site of tendon or ligament attachment

Head and Neck

Maxillofacial Trauma

Vertebral fractures and dislocations types

Vertebral anatomy.
Numbering order of vertebrae.

Upper Extremity

Humerus Fracture Types

Humeral anatomy

Elbow

Forearm Fracture Types

Carpal fractures

AP view

Hand and Finger Fracture Types

Torso

Chest

Abdomen

Spine

Lower Extremity

Proximal Leg

Distal Leg Fracture Types

Foot and Toe Fracture Types

Hindfoot

Midfoot

Forefoot

Other

Management

General Fracture Management

See Also

References

  1. ↑ Wolfson, A. B., Cloutier, R. L., Hendey, G. W., Ling, L., & Schaider, J. (n.d.). Approach to Musculoskeletal Injuries. In Harwood-Nuss' clinical practice of emergency medicine (6th ed.). LWW.
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