Lecture 8 (Fractures & CT)

What does bone resorption look like?

• How long after fx is it first seen?

• Decreased Density (Darker)

  • Seen Within 1 Week

What fx type may disappear with time?

• How long would that take?

• Stress / March Fractures

  • Disappears 10 Days Post

What elements are examined for fractures?

“S DAT ASS”

• Site (Location)

• Direction (Angle + Path)

• Alignment (Can It Reform)

• Type (Complete vs Not)

• Associated Abnormalities (Dislocation)

• Special Fractures (Weird Ones)

• Special Types (Stress vs Disease)

What is Hills-Sachs vs Bankhart?

• H-S: Posterolateral Humeral Head

• Bankhart: Anteroinferior Glenoid

What is a Chauffeur’s Fracture?

• Distal Radial Fx + Ulnar Styloid Fx

What is the difference between a Bennet Fracture and a Boxer’s Fracture?

• Bennet: 1st Metacarpal

• Boxer’s: 4th / 5th Metacarpal

What is a Chance Fracture?

• Upper Lumbar Fracture (Normally L2)

What is used to assess Pediatric Fractures?

• What are the grades given?

• Salter-Harris Classification

  • I - Growth Plate Only

  • II - Growth Plate + Metaphysis

  • III - Growth Plate + Epiphysis

  • IV - Vertical (II + III Combined)

  • V - Crushed [Squished]

How long does bone typically take to heal?

• 1 - 3 Months

How long does cartilage typically take to heal?

• 2 Months - 2 Years

How long does tendinitis typically take to heal?

• 3 - 7 Weeks

How long does tendon laceration typically take to heal?

• 1 - 6 Months

How long does Grade III Muscle Injury & Grade II Ligamentous Injury take to heal?

• 1 - 6 Months

What are the stages of bone healing?

• When does each one occur?

• What processes are occurring?

• Inflammatory: 1 - 2 Weeks

  • Bone Resorption (1 Week)

  • 1st Cloudy Callus (2 Weeks)

• Reparative: 2 Weeks - 6 Months

  • Callus Increases (6-12 Weeks)

  • Callus Calcifies (3-6 Months)

• Remodeling: 6 - 12 Months

What is required for Primary Bone Healing?

“DONOR”

• Direct Contact Between Segments

• ORIF w/ Atraumatic Technique

• New Bone Grows Directly Over Old

• Osteoclastic Resorption → Osteoblastic Deposition

• Rigid Internal Fixation w/ No Movement

What is Secondary Bone Healing?

• Mineralization w/ Callus Formation

What terms are used for Primary vs Secondary bone healing?

• Primary: Stress Bearing

• Secondary: Stress Sharing

What is a Cortical Screw?

• What are some characteristics?

• For: Bone-Bone or Bone-Metal

  • Full Thread, Small Flutes

  • Non-Compressive

What is a Cancellous Screw?

• What are some characteristics?

• For: Bone-Bone Only

  • Half-Thread, Large Flutes

  • Compressive

What is a Canulated Screw?

• What are some characteristics?

• For: Guiding Larger Screws

  • Half-Thread, Hallow

What are Kirschner Wires?

• Fracture Stabilizers (For Hands & Feet)

What are Steinmann Pins?

• Fracture Stabilizers (For Pediatric Femurs)

What is a CT Scan best for?

“TITS”

• Trauma Detection

• Identifying Hemorrhages

• Tumor Diagnosis

• Spinal Alignment

What path does a CT Scan take?

• How big is a typical slice?

• Spiral (Around Patient)

  • 7 - 10 mm

What is a CT Scan Window?

• Settings That Adjust Visibility (Gray Scale Change)

  • This Also Specifies The Range Observed

How much more radiation dosage is in a chest CT (vs plain film)?

• How many years of background radiation is this equal to?

• 400x More (0.02 → 8.0)

  • Roughly 4 Years Radiation