IMAGING LECTURE 2A: FRACTURES (EXAM I)

_____ are a break in continuity of bone, epiphyseal plate or cartilaginous joint surface

Fractures

4 categories of fractures:

- traumatic

- stress/fatigue

- insufficiency

- pathologic

_____ fractures occur with sudden impact (macrotrauma)

Traumatic

Reasons for _____ fracture:

- fall

- direct blow

- deceleration

- ligamentous instability

Traumatic

With fractures, an irregular area of _____ is seen on imaging

Radiodensity

____/____ fracture is caused by bones inability to withstand repeated stresses (microtrauma)

Stress/fatigue

Stress fractures are more common in ____

LE

____-____% of stress/fatigue fractures occur in the LE

80-90%

the ____ is the most common bone to get a stress fracture

Tibia

There is a tendency for non union or delayed union with ____/____ fractures

Stress/fatigue

Places that are of high risk for a ___/____ fracture:

- anterior tibial diaphysis

- lateral femoral neck

- patella

- medial malleolus

- navicular

- base of 5th MT

- talus

- femoral head

Stress/fatigue

An _____ fracture results from a normal stress or force acting on an abnormal bone

Insufficiency

Reasons for ____ fractures:

- effects of radiation

- post menopausal osteoporosis

- corticosteroid induces osteoporosis

Insufficiency

A _____ fracture is one that occurs in bone rendered abnormally fragile by neoplastic or other disease conditions

Pathologic

_____ fractures can be considered a subset of pathologic fractures

Insufficiency

____ ____ of fractures:

- trauma (MVA, falls, assault/abuse)

- advanced age

- decreased BMD

- low BMI

- gender (women more than men)

- smoking

- radiation treatment

- repetitive stress

- low physical function (slow gait speed/use of assistive device)

- impaired cognition/dementia

- medications

- disease conditions (osteoporosis)

Risk factors

_____ & ____ of fracture:

- history of fall/direct blow/twisting injury/accident

- localized pain aggravated by movement and/or weight bearing

- muscle guarding with passive movement

- swelling

- deformity

- sharp, localized tenderness at the site

Signs & symptoms

3 stages of healing:

- inflammatory

- reparative

- remodeling

It can take ____-____ weeks to heal from a fracture in adults

3-12

____ ____ usually occurs before clinical union

Radiographic union

____ ____ occurs when progressively increasing stiffness and strength provided by mineralization process

Clinical union

_____ _____ makes the fracture site stable & pain free

Clinical union

____ ____ is when plain x-rays show calcified bone crossing the fracture site

Radiographic union

_____ _____ of fractures depend on:

- age (children heal quicker)

- location/type of fracture

- displaced vs. non-displaced

- treatment required

- blood supply to fragments

- nutritional status

- smoker

- NSAID use (may prolong healing)

- degree of local trauma

Healing time

_____ is when the fracture heals in unsatisfactory position resulting in bone deformity

Malunion

Malunion may result in loss of ___

Function

___ _____ is when the fracture takes longer than normal to heal

Delayed union

Healing beyond ____-____ weeks is typically considered delayed

16-20

____ ____ is when the fracture fails to unite with a bony union

Non union

Elements of ____ ____:

- anatomical site & event

- type (complete or incomplete)

- alignment of fragments

- relationship to the environment (open or closed)

- fracture configuration

- special features

- associated abnormalities

Fracture description

____ is the shaft of bone

Diaphysis

____ is the 2 ends of the bone

Metaphysis

____ is the enlarged wide end of the bone

Epiphysis

Parts of the _____:

- proximal

- middle

- distal

Diaphysis

___ ____ is when the fracture is in the shaft of the bone

Extra articular

____ ____ is when the fracture extends into the joint space

Intra articular

Standard ____ ____ for fractures:

- surgical neck

- intertrochanteric

- supracondylar

anatomical landmarks

_____ fractures are stable and will remain so as long as no stresses are applied to them

Incomplete

____ fractures are seen in shorter, flatter and irregularly shaped bones

Incomplete

____ is loss of position

Displacement

Displacement is named by position of the ____ ____

Distal fragment

____ is when the bone is pulled apart

Distraction

_____ is when the bone is not lined up

Overriding

_____ is when the bone is twisted in opposite directions

Rotation

____ fractures will have some content that stays intact

Nondisplaced

The ____ the segment of a bone is displaced the more assistance it may need to get into place and heal properly (reduction or surgery)

Further

_____ is the longitudinal axis relationship

Alignment

_____ is deviation in alignment

Angulation

_____ position & ____ alignment:

- good healing

Good; good

____ position & ____ alignment; ____ position & ____ alignment:

- may need reduction

- still heals well

Good & deviated; deviated & good

_____ position & ____ alignment:

- surgical intervention needed

- delayed healing

Displaced; displaced

____ is when bone protrudes under the skin

Tinting

____ & ____ fractures appear similar on radiographs

Spiral & oblique

_____ fractures heal better than oblique fractures because the fracture fits back together better

Spiral

A comminuted fracture is a fracture with more than ____ fragments

2

______ fracture is a result of a bending force

Transverse

_____ fracture is straight across the bone

Transverse

____ fracture is the result of combined forces

Oblique

______ fracture is a diagonally oriented fracture

Oblique

_____ fracture is the result of torsional force

Spiral

_____ fracture is spiraled along the long axis

Spiral

_____ fracture results in multiple pieces

Comminuted

_____ fracture is the result of high energy load (crush from MVA)

Comminuted

_____ fracture is a type of comminuted fracture

Segmental

______ fracture is when the bone is driven into itself

Impacted

_____ is when a compressive force is related to an axial load

Impacted

_____ fracture is an impaction fracture that results in a pulling of the cortex & is commonly seen in children

Torus (buckle)

_____ fracture matches the appearance of an incomplete fracture and is common in children

Greenstick

____ fracture is the result of tensile loading of a bone

Avulsed

____ ____ is when a dislocation results in tearing of the labrum of the glenoid

Bankart lesion

___ ____ ____ is a fracture that occurs secondary to anterior shoulder dislocation

Hill Sachs lesion

Children have _____ injury patterns

Unique

Fractures in ____ are difficult to assess due to:

- growth plates

- dense growth lines

- secondary centers of ossification

- cartilage model is not evident on radiograph

Children

_______ fractures in children:

- greenstick fracture

- torus (buckle) fracture

Incomplete

A greenstick fracture is a fracture on the ____ side

Tension

A greenstick fracture has an intact cortex on the _____ side

Compressed

A torus (buckle) fracture is an ____ fracture with _____ of the cortex

Impaction; buckling

Type ___-____ fractures in children require surgical intervention

3-5

Children have an increased incidence of fractures during _____

Puberty

______ experience fractures more than ____

Boys; girls

____-___% of all fractures in children involve the growth plate

15-20%

Grade ___ fracture in children:

- fracture through the physis only

1

Grade ____ fracture in children:

- fracture thought the physis and metaphysis

2

Grade ____ fracture in children:

- fracture through the physis & epiphysis

3

Grade ____ fracture in children:

- fracture through the physis, Metaphysis & epiphysis

4

Grade ____ fracture in children:

= crush/compression injury to the physis

5

A grade ___ fracture is the most common in children

2

SALTR mnemonic for remembering grades of fractures in children:

- S: same/straight across (fracture of cartilage of physis)

- A: above (fracture lies above the physis in the metaphysis)

- L: lower (fracture is below the physis in the epiphysis)

- T: through (fracture is through metaphysis, physis, and epiphysis)

- R: rammed (physis has been crushed)