Trauma, Upper & Lower Limb Fractures Lecture PDF

Trauma, Upper& Lower Limb Fractures  Table of contents 01 Radiological basics of fractures. 02 Upper Limb Fractures. 03 Lower Limb Fractures. Fractures -A fracture: is a discontinuity in a bone (or cartilage) resulting from mechanical forces which exceed the bon...

Trauma, Upper& Lower Limb Fractures  Table of contents 01 Radiological basics of fractures. 02 Upper Limb Fractures. 03 Lower Limb Fractures. Fractures -A fracture: is a discontinuity in a bone (or cartilage) resulting from mechanical forces which exceed the bone's ability to withstand them. - 4 anatomical classes of bone : "long, short, flat and irregular". Description of a bone fracture depends on the class of bone and the direction of the fracture line. Fractures  Fractures 'Irregular bone' fractures A fracture of a short, flat or irregular bone requires a description determined by its direction through the bone. Useful terms include - horizontal, vertical, coronal, sagittal and axial. Often a fracture can be seen to pass in more than one direction, in which case a more detailed description may be needed.  Fractures Comminuted fractures Results in more than 2 separate bone components. Some comminuted fractures have specific names such as 'butterfly fragment' or 'segmental fracture'. Fractures Fracture displacement -Abnormal position of the distal fracture fragment in relation to the proximal bone. Types of fracture displacement include - angulation, rotation, change of bone length, and loss of alignment. The severity and nature of displacement are key factors when considering fracture management.  Fractures Loss of alignment - 'displacement‘: -Loss of bone alignment along its long axis. -Usually accompanied by some degree of angulation, rotation or change in bone length. 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.  Fractures Angulation: -The direction of the distal bone and degree of angulation in relation to the proximal bone should be stated. -Medial angulation: varus. - Lateral angulation : valgus. Rotation internal or external.  Fractures Distraction and impaction Distraction (widening): A fracture resulting in increased overall bone length. Impacted: Shortening of bone without loss of alignment. Fractures Displacement combinations Most displaced fractures result in more than one type of displacement.  Fractures Incomplete fracture: does not cross the bone completely (usually in children) Bowing fracture: incomplete fractures of tubular long bones in pediatric patients (especially the radius and ulna) that often require no intervention and heal with remodeling.. Fractures Buckle fracture: the cortex is buckled, often in the distal radius Fractures Greenstick fracture: the cortex is broken, but only on one side. Pathology of fracture Three phases : 1. inflammatory 2. reparative 3. remodeling Inflammatory phase Immediately at the time of fracture. The space between fracture ends is filled with blood forming a hematoma. Hematoma stop additional bleeding. Hematoma gives structural and biochemical support. Soft-tissue callus is forment.(NB: It s non-mineralized and not readily visible on radiography ). Reparative phase Primary callus is transformed into a bony callus. Activation of osteoprogenitor cells. Stabilization of the fracture site. Remodling Phase It lasts many months, and even years. Gradual formation of compact cortical bone. Remodeling can result in almost perfect healing. In most instances, however, particularly if the alignment is not perfect, a residual deformity will remain. Upper limb fractures Clavicle fractures. Scapula fractures. Humerus fractures. Radius fractures. Ulna fractures. Carpal bones fractures. Metacarpal bone fractures. Phalanges fractures. Clavicle fractures o clavicular fracture. o acromio-clavicular dislocation. Scapula fractures o blade of scapula fracture. o glenoid fracture. o acromial fracture. o coracoid process fracture.  Humeral fractures o proximal humeral fracture. o humeral shaft fracture. o supracondylar fracture (extension). o supracondylar fracture (flexion). o internal epicondyle fracture. o external epicondylar fracture. Radius fractures o radial head fracture. o radial neck fracture. o Essex Lopresti fracture dislocation. o Galeazzi fracture dislocation. o Barton fracture. o Colles fracture. o Smith fracture. Ulna fractures o olecranon fracture. o coronoid process fracture. o Monteggia fracture-dislocation. o night stick fracture. o ulnar styloid fracture. o distal ulna fracture. Carpal bone fractures o scaphoid fracture. o perilunate fracture dislocation. o capitate fracture. o triquetral fracture. o pisiform fracture. o hamate fracture. o trapezoid fracture. o trapezium fracture.  Metacarpal bones fractures o Bennett fracture dislocation. o epibasal thumb fracture (pseudo Bennett's fracture dislocation). o Rolando fracture. o boxer's fracture.  Phalanges fractures. o Baseball (Mallet) finger. o jersey finger. Lower limb fractures Pelvic & femur fractures. Knee fractures. Ankle fractures. Knee fractures Segond fracture. patella fracture. ACL avulsion. PCL avulsion. tibial plateau fracture.  Ankle fractures triplanar fracture pilon fracture trimalleolar fracture Bosworth fracture Tillaux fracture Wagstaffe-Lefort fracture Maisonneuve fracture Weber fractures of the ankle Weber ankle fracture classification Foot injury avulsion of the 5th metatarsal. march fracture. Jones fracture. Lisfranc injury. tarsal fracture. o calcaneal fracture. o talar fractures. o navicular fracture. o cuboid fracture. o cuneiform fracture. Complications of fractures Compound fracture Joint involvement Other fractures Complications of fractures Compound fracture o A fracture that has extended through the skin ▪May be occult on an x-ray. ▪Compound at scene may be reduced by x-ray. ▪Look for gas bubbles and soft-tissue injury. Complications of fractures Joint involvement o Does a fracture extend to the joint? o Involvement of the joint makes prognosis worse. increased risk of joint osteoarthritis. ▪ Complications of fractures Other fractures o Is there another injury? ▪Paired structures, e.g. radius and ulnar. ▪Ring structures, e.g. pelvis, mandible.