Basic Principles of Fractures & Easily Missed Fractures Mr - - PowerPoint PPT Presentation

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Basic Principles of Fractures & Easily Missed Fractures Mr - - PowerPoint PPT Presentation

Jul 05, 2023 183 likes •957 views

Basic Principles of Fractures & Easily Missed Fractures Mr Irfan Merchant Trauma & Orthopaedic Registrar Bedford Hospital, East of England Objectives Types Fracture Patterns Fracture Healing Assessing a fracture

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Basic Principles of Fractures & Easily Missed Fractures

Mr Irfan Merchant Trauma & Orthopaedic Registrar Bedford Hospital, East of England

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Objectives

  • Types
  • Fracture Patterns
  • Fracture Healing
  • Assessing a fracture
  • Treatment Principles
  • Missed fractures – upper limb
  • Missed fractures – lower limb
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Definition

  • Break in continuity of bone
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Types

  • Simple/closed vs Compound/open
  • Incomplete vs complete
  • Displaced vs undisplaced
  • Traumatic vs pathological
  • Fracture pattern – Linear vs comminuted vs

segmental

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Something to consider

  • Greenstick – children
  • Stress fracture – athletes
  • Fatigue fracture – occupations – police
  • Pathological fracture - elderly
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Fracture healing

  • Begins to heal as soon as bone broken

provided conditions are favourable

  • Absolute vs relative stability
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Assessing a fracture

  • History
  • Age, sex, hand dominance, mechanism of

injury

  • Examination – Look/feel/move
  • Documentation
  • Investigation
  • Emergency management
  • Definitive management
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Rules in X-Ray

  • Better none than one view
  • X-ray is a shadow – conceals and distorts so

interpret with caution

  • Joint above and below
  • Read x-rays in anatomical position
  • Exposure should be adequate
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Treatment Principles

  • GOAL – restore anatomy back to normal or

near to normal as possible

  • Resuscitation
  • Reduction
  • Immobilisation/Fixation
  • Rehabilitation
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Reduction

  • Closed vs open
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Immobilisation

  • Conservative vs Surgical
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Importance of history

  • Mechanism of injury
  • Reverse force for reduction
  • Look at pattern and location to choose most

appropriate management

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Common Missed fracture – Upper Limb

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MALLET FINGER

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VOLAR PLATE FRACTURE

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BOXER’S FRACTURE

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Bennett’s Fracture

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Skier’s Thumb

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SCAPHOID FRCATURE

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TRIQUETRAL FRACTURE

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BUCKLE FRACTURE

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GREENSTICK FRACTURE

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RADIAL HEAD FRACTURE

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FAT PAD SIGN

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AVULSION OF THE MEDIAL EPICONDYLE

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Common Missed fracture – Lower Limb

Censored

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PUBIC RAMI FRACTURE

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Malgaigne Fracture

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Pubic Diastasis

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Acetabular fracture

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HOW MANY ABNORMALITIES?

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Bilateral superior and inferior pubic rami fractures and right sacral ala fracture. Normal SI joint and pubic symphysis alignment. Several sharp foreign bodies with appearance and density consistent with glass are projected near the left hip.

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Hip and Proximal femur

Look for:

  • A black line – a displaced fracture
  • A white line – impacted fracture
  • A fracture line through the subcapital region,

through the trochanteric region or through the subtrochanteric region Check:

  • If cortical margins of the femoral neck smooth

and continuous, or is there a slight step

  • Lateral radiograph
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Impacted fracture

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Intertrochanteric frcature

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CAN YOU SPOT THE FRACTURE

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Lateral view of the same patient

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Knee

AP view – look for:

  • The ‘intercondylar eminence’ (ie the tibial spines) of

the tibia and the condylar surfaces of the femur

  • The head and neck of the fibula
  • The tibial plateau – should be smooth, no steps, no

layering, no disruption

  • The subchondral bone should not show any focal

increase in density

  • The patella – look through the superimposed femur
  • Any small fragments of bone anywhere
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Knee

Lateral view – Look for

  • Joint effusion – present if the suprapatellar strip

exceeds 5mm

  • Fat-fluid level in the suprapatellar bursa –an

intra-articular fracture

  • Condylar surfaces of the femur – are they

smooth

  • The patella – is the articular surface smooth
  • The position of the patella
  • Small boney fragments
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Fat Fluid Level

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TIBIAL PLATEAU FRACTURE

AP of the same the patient

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CT Scan of Tibial Plateau fracture

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CT Scan of Tibial Plateau fracture

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PATELLA FRACTURE

NOTE: SKYLINE VIEW MIGHT BE NEEDED FOR PATELLA FRACTURES

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Head of fibula fracture

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Ankle

AP Mortice view – look for

  • Malleoli – fracture – medial, lateral
  • Talus – Dome - ?smooth
  • Joint width - ?talar shift
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DESCRIBE THE RADIOGRAPH

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  • Spiral fracture through the distal fibula.

Fracture line through the ankle joint in keeping with a Weber B, with slight lateral talar shift (widening of medial clear space).

  • Well-corticated ossicle distal to the medial

malleolus may be post-traumatic or congenital (i.e. an accessory ossicle).

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DESCRIBE THE RADIOGRAPH

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Insufficiency fracture

Fracture in the abnormal bone with normal stresses. Common site:

  • Vertebra,
  • Pelvis – Sacrum , Pubic bone
  • Neck of femur
  • Calcaneum
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Calcaneum fracture

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Stress fracture

Fatigue fracture

  • Normal bone with abnormal stresses
  • Common in lower limbs. Change in physical

activity

  • Not apparent on plain films. May take weeks

to appear on Plain radiographs

  • MRI shows them as bone oedema
  • Increased activity on the NM scan
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MRI of Stress Fracture

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Stress Fracture

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Radiograph and Bone scan of Stress Fracture

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Learning points

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Important points

When looking at the x-ray:

  • Look at all four corners
  • DO NOT be content if you have spotted one

fracture

  • Follow outline of all bones
  • Look at the soft tissue signs
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Thank You