Transcript Orthopaedic trauma - Home - Qassim College of Medicine

Prof Dr Osama Amin
Prof Of Orthopedics
Qassim University
ORTHOPAEDIC TRAUMA
Objectives
 ƒTo recognise common orthopaedic trauma
 ƒTo be able to describe the injury to a
 colleague/orthopaedic surgeon
What is a fracture?
 ƒA break, rupture or crack in bone or cartilage
How to describe a fracture
 Location
 Bone
 Position within the bone
 Proximal
 Mid
 Distal
Epiphysis
Epiphyseal plate (physis)
Metaphysis (proximal)
Diaphysis
Metaphysis (distal)
How to describe a fracture
 OPEN / CLOSED
 COMPLETE / INCOMPLETE
 SIMPLE / COMMINUTED
 DIRECTION OF FRACTURE LINE
 INTRA- OR EXTRA-ARTICULAR
 DESCRIPTION OF CHANGE IN ANATOMICAL
POSITION
How to describe a fracture
 OPEN/CLOSED
 Closed
 No break in the skin
 Open (Compound)
 Part of the bone protrudes
through the skin
How to describe a fracture
 OPEN/CLOSED
 Closed
 No break in the skin
 Open (Compound)
 Part of the bone protrudes
through the skin
How to describe a fracture
 COMPLETE/INCOMPLETE
 Complete
 All cortical surfaces
disrupted
 Incomplete
How to describe a fracture
 COMPLETE/INCOMPLETE
 Complete
 All cortical surfaces
disrupted
 Incomplete
Post-Fixation
How to describe a fracture
 COMPLETE/INCOMPLETE
 Complete
 Incomplete
 Greenstick
 Buckle
 Plastic bowing fracture
How to describe a fracture
 COMPLETE/INCOMPL
ETE
 Complete
 Incomplete
 Greenstick - break of one
cortical margin only due to
tension


How to describe a fracture
 COMPLETE/INCOMPL
ETE
 Complete
 Incomplete

 Buckle - buckling of cortex
due to compression

Cortical Buckle
How to describe a fracture
 COMPLETE/INCOMPL
ETE
 Complete
 Incomplete


 Plastic bowing fracture
 microfractures but no gross
visible fracture line
Bowing fracture
How to describe a fracture
 SIMPLE /
COMMINUTED
 Simple – single fracture
line resulting in two
bone fragments
 Comminuted
How to describe a fracture
 SIMPLE /
COMMINUTED

 Comminuted → more
than two fracture
fragments
How to describe a fracture
 SIMPLE /
COMMINUTED


Butterfly fragment – V
shaped fragment not
completely
circumscribed by cortex
How to describe a fracture
 DIRECTION
 Transverse
 Spiral
 Oblique
How to describe a fracture
 DIRECTION
 Transverse
 Break straight across the
bone


How to describe a fracture
 DIRECTION


 Spiral
 Break travels around the
bone

How to describe a fracture
 DIRECTION


 Spiral
 Break travels around the
bone

How to describe a fracture
 DIRECTION


 Oblique
 Break is diagonally across
the bone
How to describe a fracture
 DIRECTION


 Oblique
 Break is diagonally across
the bone
Post surgical follow-up
How to describe a fracture
 DIRECTION


 Oblique
 Break is diagonally across
the bone
How to describe a fracture
 INTRA / EXTRAARTICULAR
Intraarticular fracture
Comminuted
Intra-articular fracture
(Rolando fracture)
How to describe a fracture
Callus
Rolando fracture follow-up
How to describe a fracture
 CHANGE IN ANATOMICAL POSITION
 Length
 Distraction
 Shortening
 over-riding
 impacted
 Displacement
 Undisplaced
 Anterior, lateral etc
 Angulation/tilt
 Rotation
Distracted superior and inferior patellar poles
How to describe a fracture
 CHANGE IN ANATOMICAL POSITION
 Length
 Distraction
 Shortening
Over-riding fracture
fragments
 over-riding
 impacted
 Displacement
 Undisplaced
 Anterior, lateral etc
 Angulation/tilt
 Rotation
Rotated distal
fragment
How to describe a fracture
 CHANGE IN ANATOMICAL POSITION
 Length
 Distraction
 Shortening
 over-riding
 impacted
 Displacement
 Undisplaced
 Anterior, lateral etc
 Angulation/tilt
 Rotation
Impacted fracture of humeral neck
How to describe a fracture
 CHANGE IN ANATOMICAL POSITION
 Length
 Distraction
 Shortening
 over-riding
 impacted
 Displacement
 Undisplaced
Medial angulation
(at fracture apex)
Lateral displacement
(half a bone’s width)
 Anterior, lateral etc
 Angulation/tilt
 Rotation
Valgus deformity
Valgus and varus
 Describe direction of
movement in the
lateral plane of the
distal part of the bone
 Valgus = lateral/away
medial
lateral
from midline of the body
 Varus = medial/toward
the midline of the body
valgus
varus
Special types of fractures
 Pathological
 Stress
 Periprosthetic
 Salter-Harris
Special types of fractures
 Pathological fractures
 Occur in diseased bone
enchondroma
 Pre-existing pathology eg
 bone cyst,
 osteogenesis imperfecta
 Acquired lesion eg
 metastases, myeloma
fracture
Special types of fractures
 Stress fracture
 Abnormal stresses placed on normal bone
 eg runners, ballet dancers
 Can be difficult to identify on plain films
 More easily detected with MRI or bone scan
Special types of fractures
 Periprosthetic
Spiral periprosthetic fracture
with associated shortening
and rotation of the distal
fracture fragment
Post fixation
Special types of fractures
 Salter Harris fractures
 Special type of fracture involving the growth plate
in children
 May have consequences for later bone growth
I
II
III
IV
V
Special types of fractures
 Salter Harris fractures
 S – slipped (type I)
 A – above epiphyseal plate (type II)
 L – lower than epiphyseal plate (type III)
 T – through epiphyseal plate (type IV)
 R – “rammed” epiphyseal plate (type V)
I
II
III
IV
V
Special types of fractures
 Salter Harris fractures
 S – slipped (type I)
 A – above epiphyseal plate (type II)
 L – lower than epiphyseal plate (type III)
 T – through epiphyseal plate (type IV)
 R – “rammed” epiphyseal plate (type V)
I
II
III
IV
V
Special types of fractures
 Salter Harris fractures
 S – slipped (type I)
 A – above epiphyseal plate (type II)
 L – lower than epiphyseal plate (type III)
 T – through epiphyseal plate (type IV)
 R – “rammed” epiphyseal plate (type V)
I
II
III
IV
V
Special types of fractures
 Salter Harris fractures
 S – slipped (type I)
 A – above epiphyseal plate (type II)
 L – lower than epiphyseal plate (type III)
 T – through epiphyseal plate (type IV)
 R – “rammed” epiphyseal plate (type V)
I
II
III
IV
V