Rad.-Patho-Trauma-or-Fracture PDF

TRAUMA / FRACTURE  TRAUMA/FRACTURE ❖ A fracture is a discontinuity of bone caused by mechanical forces either applied to the bone or transmitted directly along the line of a bone. ❖ Trauma may injure a bone, resulting in fractures.  FRACTURE ❖ The choice of treat...

TRAUMA / FRACTURE  TRAUMA/FRACTURE ❖ A fracture is a discontinuity of bone caused by mechanical forces either applied to the bone or transmitted directly along the line of a bone. ❖ Trauma may injure a bone, resulting in fractures.  FRACTURE ❖ The choice of treatment usually depends on the classification and severity of the fracture. For closed and nondisplaced fractures, the most common treatment is splinting, casting, or both ❖ Closed reduction = requires that a local or general anesthetic be given to the patient for pain management. A splint or cast is then applied.  FRACTURE ❖ Open reduction = is required when orthopedic hardware is needed to maintain fracture reduction or when an open fracture needs to be irrigated. Generally, this is referred to as open reduction internal fixation (ORIF)  OPEN/COMPOUND FRACTURE ❖ An open or compound fracture occurs when the bone actually manages to pierce the skin. ❖ These fracture almost always require the surgical insertion of internal fixation devices.  SPIRAL FRACTURE ❖ A spiral fracture occurs when the bone has been twisted apart. ❖ It will have a similar appearance to a spiral staircase. ❖ This fracture is sometimes referred to as a torsion fracture. ❖ Spiral fractures in babies and children can be a warning sign of abuse. OBLIQUE AND SPIRAL FRACTURES Oblique fracture: the break has a slanted or sloped pattern Spiral Fracture: one part of the bone has been twisted at the break point.  TRANSVERSE FRACTURE ❖ A transverse fracture is characterized by a horizontal fracture in relation to the long axis of the bone.  COMMINUTED FRACTURE ❖ A comminuted fracture occurs when there are multiple bone fragments. ❖ This often occurs as the result of some type of crushing injury or as the result of gun shot wound. COMMINUTED FRACTURE Comminuted open distal tibial fracture secondary to GSW.  GREENSTICK FRACTURE ❖ A greenstick fracture is a type of partial fracture that is commonly associated with children. ❖ The analogy is between the pliable nature of their bones and the inability to cleanly break a green twig.  GREENSTICK FRACTURE ❖ These fractures are usually easily repaired and most often can be corrected with a closed reduction. ❖ Greenstick fractures are sometimes associated with rickets.  TORUS FRACTURE ❖ Torus comes from the Latin word tori which refers to a swelling or protuberance. ❖ The impact from a fall on an outstretched hand is usually the cause of this fracture. ❖ It commonly occurs in the distal forearm of young children and it is sometimes referred to as a “buckle” fracture.  TORUS FRACTURE ❖ It is characterized by a small buckle or protuberance on one side of the bone but not on the other. ❖ Treatment usually consists of a short cast for three weeks in order to prevent any further injury. TORUS FRACTURE A forearm radiograph of a 14-year-old girl who fell on her hand, resulting in a torus fracture of the distal radius  AVULSION FRACTURE ❖ An avulsion fracture occurs when there is trauma to where a ligament or tendon attaches to a bone. ❖ This type of fracture occurs when the tear causes a piece of bone to be pulled off.  AVULSION FRACTURE ❖ An avulsion fracture can be seen anywhere in the body but a common site is at the base of the 5th metatarsal. ❖ Most avulsion fractures are treated as a soft tissue injury and do not require surgical repair.  JONES FRACTURE ❖ A Jones fracture occurs on the shaft of the 5th metatarsal. ❖ It should not be confused with an avulsion fracture which often occurs at the base of the 5th metatarsal ❖ Most often a Jones fracture occurs without significant injury or impact.  JONES FRACTURE ❖ It is more difficult to heal than an avulsion fracture but usually only requires the wearing of a walking boot or cast for 4 to 8 weeks. ❖ However, in some instances, it may require the surgical insertion of a screw or bone graft in order to stimulate a healing response.  BOXER’S FRACTURE ❖ A boxer’s fracture occurs at the head of the 4th or 5th metacarpal of the hand. ❖ It almost always occurs as the result of striking a firm object with a closed fist. ❖ Most boxer’s fractures can heal with a cast but some severe cases may require surgical repair.  BLOW-OUT FRACTURE ❖ A blow-out fracture of the eye socket may involve the orbital floor, wall, or roof. ❖ The most common type of blow-out fracture involves the floor of the orbit and specifically the maxillary bone.  BLOW-OUT FRACTURE ❖ Following blunt trauma to the eye, the contents of the orbit compress and push down into the maxillary sinus. ❖ Surgery may be indicated in some instances in order to relieve the symptoms of double vision and/or muscle entrapment.  COLLES’ FRACTURE ❖ A Colles’ fracture is most often caused when an individual falls backwards onto a hard surface and braces themselves with an open hand. ❖ It consists of a fracture of the distal radius with posterior and lateral displacement of the distal fragment.  COLLES’ FRACTURE ❖ It can most often be treated with a closed reduction and a cast. ❖ Some severe fractures may require the surgical insertion of an internal fixation device  COMPRESSION FRACTURE ❖ A compression fracture occurs when a vertebral body is crushed and collapses down upon itself. ❖ It can be the result of trauma, cancer, or osteoporosis.  COMPRESSION FRACTURE ❖ Treatment may include the any of the following depending on the severity of the fracture and its potential impact on the spinal cord: ✓ A back brace to stabilize the fracture while it heals. The surgical insertion of internal fixation devices.  COMPRESSION FRACTURE ❖ Treatment may include the any of the following depending on the severity of the fracture and its potential impact on the spinal cord: ✓ A vertebroplasty may be performed. ▪ This requires the injection of bone cement (polymethylmethacrylate) into the vertebral body by an interventional radiologist as a means to prevent further collapse of the vertebral body COMPRESSION FRACTURE A lateral lumbar radiograph demonstrating compression fractures of the second and fourth lumbar vertebral bodies with no apparent fracture of the posterior elements of the spine.  ELBOW FRACTURE: FAT PAD SIGN ❖ A subtle fracture to the elbow in the area of the distal humerus can be very difficult to visualize radiographically ❖ The best position to view is the lateral. ❖ On the anterior surface of the elbow, there is a fat pad that is normally visualized as a small radiolucency.  ELBOW FRACTURE: FAT PAD SIGN ❖ There is also a fat pad located on the posterior surface of the distal humerus however, it is normally not demonstrated. ❖ If there is trauma to the elbow with an underlying fracture to the distal humerus, this posterior fat pad will be displaced and it will be visualized as a radiolucent density  HIP FRACTURES ❖ A hip fracture occurs on the proximal end of the femur and is usually the result of a fall from an elderly patient with osteoporosis. ❖ There are four classifications of hip fractures: 1. Femoral Head Fracture 2. Femoral Neck or Transcervical Fracture 3. Intertrochanteric Fracture 4. Subtrochanteric Fracture  HIP FRACTURES ❖ Femoral Head Fracture This is often the result of a high energy impact and is often combined with a dislocation. ❖ Femoral Neck or Transcervical Fracture The blood supply to the femoral head is almost always disrupted with this type of fracture. As a result, many are treated with a total hip replacement.  HIP FRACTURES ❖ Intertrochanteric Fracture These fractures usually do not damage the blood supply the to hip and can often be reduced with the surgical insertion of a metal plate and screws. ❖ Subtrochanteric Fracture This fracture occurs just below the level of the intertrochanteric crest. It is actually physically located on the shaft of the femur and may extend down the femur.  MONTEGGIA FRACTURE ❖ A Monteggia fracture is usually the result of a fall on an outstretched arm. ❖ It involves a fracture of the proximal third of the ulna combined with a dislocation of the radial head within the elbow joint.  MONTEGGIA FRACTURE ❖ These are very unstable injuries that usually require surgical repair. The ulna will require an internal fixation device and once this will usually reduce the radial head dislocation. GALEAZZI FRACTURE Occurs at the radial shaft with concomitant dislocation of the distal radioulnar joint (DRUJ)  SALTER-HARRIS FRACTURES ❖ Salter-Fractures involve fractures of the growth plate in children. ❖ There are five categories of this fracture: 1. Type I The epiphysis is completely dislocated from the metaphysis (shaft) of the bone. This type usually only requires a cast for treatment.  SALTER-HARRIS FRACTURES 2. Type II This is the most common type. It involves a partial dislocation of the epiphysis and a fracture of the metaphysis. 3. Type III This one involves a partial dislocation and a fracture of the epiphysis.  SALTER-HARRIS FRACTURES 4. Type IV This type is the result of a fracture of both the epiphysis and the metaphysis. 3. Type V This one involves the impaction of the epiphysis into the metaphysis.  TRIPOD FRACTURE ❖ The malar or zygomatic bone articulates with the frontal bone, temporal bone, and the maxillary bone. ❖ Trauma directly to the malar bone may cause a fracture at each of these articulations. ❖ Treatment of this type of fracture usually requires a surgical reduction of the fracture sites. TRIPOD FRACTURE A computed tomography image demonstrating a tripod fracture of the right zygomatic bone. THE END Thank you!