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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