Trauma Radiography (Chapter 15: Part II)

What is the goal of the emergency room?

• To stabilize the pt’s condition by treating the acute problem and discharging or transferring the pt

• Provide timely, compassionate, & high-quality care

What is an acute illness/injury?

Abnormal body condition with sudden, rapid onset

What is the emergency team composed of?

• MDs, PAs, NPs, Dos, PharmDs, anesthesiologist

  • orthro, neuro, general surgery, pediatrics

• RNs, Respiratory Therapists, Radiographers

• Social workers

In the trauma room, the patient is everyone’s ______.

priority

In the trauma room, ______ is essential.

communication

In the trauma room, always wear your ______.

lead

In the trauma room, _____ when you are going to expose.

announce

ER pts present with various symptoms and even more varied _____.

abilities

The pt’s experience includes ______ and ______ they interact with while in our care.

everyone, everything

Be mindful of pt privacy and always uphold ______.

HIPAA

It is our duty to provide the pt with ____, ______, and ____-_____ care.

timely, compassionate, high-quality

We should avoid _____ the pt too much.

moving

If the pt cannot move, we must manipulate our ___ and ___ to get the desired images.

CR, IR

We should ____ force a pt into position.

NEVER

Define a fracture.

A disruption of bone caused by mechanical forces either applied directly to the bone or transmitted along the shaft of the bone

For a fracture, we should always use ______.

caution

• NEVER force a limb or body part into position

What is apposition?

How fragmented ends of the bone make contact with one an other

• Anatomic apposition

• Lack of apposition (distraction)

• Bayonet apposition

What apposition is this?

Anatomic

What apposition is this?

Lack of apposition (distraction)

What apposition is this?

Bayonet apposition

What is angulation?

Extent to which fracture fragment aligned

• Apex angulation

• Varus deformity (inversion)

• Valgus (eversion) deformity

What is apex angulation?

• Describes the direction or angle of the apex, whether it points medially or laterally

What angulation is this?

Varus deformity (inversion)

• distal fragment towards midline apex angles away (lateral)

What angulation is this?

Valgus (eversion) deformity

• distal fragment away from midline/apex towards (medial)

Since the fx is NOT aligned… the apex angle will always be ______ the distal fragment angle

opposite

What are the main 2 types of fractures?

Simple And Compound open

What is a simple fracture?

Fx where bone does not break through the skin

What is a compound fracture?

Portion of the bone protrudes through the skin

What is an incomplete fracture?

Fracture does not transverse through the entire bone (bone is not broken into 2 pieces)

1. Torus

2. Greenstick

What type of fracture are these?

Torus, greenstick (incomplete)

What is a complete fracture?

Break is complete, bone is broken into 2 pieces

1. Transverse

2. Oblique

3. Spiral

What fracture is this?

Oblique - complete

What fracture is this?

Spiral - complete

What fracture is this?

Transverse - complete

What is a comminuted fracture?

Bone is splintered or crushed at site of impact resulting in two or more fragments

1. Segmental

2. Butterfly

3. Splintered

What type of fracture is this?

Butterfly -comminuted

What type of fracture is this?

Segmental - comminuted

What is an impacted fracture?

One fragment is driven into the other, quite common with fall on outstretched hand (FOSH)

What type of fracture is this?

Avulsion

What is an avulsion fracture?

Fragment of bone is pulled away an attached tendon or ligament

What type of fracture is this?

Chip

What is a chip fracture?

Isolated bone fragment NOT caused by tendon or ligament

What type of fracture is this?

Compression

What is a compression fracture?

Vertebral fracture displays as decreased vertical dimension of anterior vertebral body

• Lower t-spine usually

What fracture is this?

Depressed (Ping-pong)

Describe a depressed (ping-pong) fracture?

Skull fx where the fragment is depressed in like a ping pong ball

What fracture is this?

Epiphyseal

What is an epiphyseal fracture?

Fracture through the epiphyseal plate in children

What fracture is this?

Pathologic fracture

What is a pathologic fracture?

Fracture due to disease process

What type of fracture is this?

Stellate

What is a stellate fracture?

Fracture radiates in a star like pattern from central point of injury

What type of fracture is this?

Stress

What is a stress fracture?

Caused by a repeated stress on the bone (marchers or runners)

What type of fracture is this?

Trimalleolar

What is a trimalleolar fracture?

Fracture of ankle joint involving medial and lateral malleoli and posterior lip of distal tibia

What type of fracture is this?

Tuft/Burst

What is a tuft/burst fracture?

Caused by crushing blow to distal finger or thumb (slamming in a door/hammer)

What type of fracture is this?

Blowout/tripod fracture

What is a blowout/tripod fracture?

Direct blow to the orbit and maxilla or zygoma causing fractures to orbital floor and lateral orbital margin

What type of fracture is this?

Colles - special fracture

What is a colles fracture?

• Special

• Fracture of the wrist in which distal radius is fractures with distal fragment displaced posteriorly

What type of fracture is this?

Smith (reverse colles) - special

What is a smith (reverse colles) fracture?

Special

• Fracture of the wrist with a distal fragment of the radius displaced anteriorly

• Results from backward fall on outstretched hand (FOSH)

What type of fracture is this?

Barton fracture - special

What type of fracture is this?

Barton

What is a barton fracture?

Intra-articular fracture of the distal radius that often involves subluxation or dislocation of the radiocarpal joint anterior or posterior

What fracture is this?

Bennett

What is a Bennett fracture?

Longitudinal fracture at base at first metacarpal with fracture line entering the CMP joint

What is this fracture?

Boxer

What is boxer fracture?

• Fracture of distal fifth metacarpal

• Results from punching someone or something

What type of fracture is this?

Hangman fracture

What is a hangman fracture?

Fracture through pedicles of axis (C2)

What fracture is this?

Hutchinson (Chauffeur)

What is a Hutchinson (Chauffer) fracture?

• Special

• Fx of radial styloid process (blow to lateral side of distal forearm)

What type of fracture is this?

Monteggia

What is a monteggia fracture?

• Fx of proximal half of ulna with dislocation of radial head

• May happen if raise arms to block blows to the head

What type of fracture is this?

Pott

What is a pott fracture?

Complete fracture of distal fibula, may involve ligament damage and fracture of medial malleolus and distal tibia

What is a closed reduction?

• Fracture fragments are realigned by manipulation and immobilized by cast or splint

• This is a NON-SURGICAL procedure but may use fluoroscopy

What is an open reduction?

• Surgery using screws, plates, or rods to maintain alignment of parts while bone regrowth takes place

• Also called Open Reduction with Internal Fixation (ORIF)

Scenario review slides 27-40