TRAMUA

Complete or incomplete disruption in continuity and structure of the bone and/or cartilage. Creates an insult to bone marrow, periosteum and soft tissues

Fracture

Bones are __________ meaning unequal in strength, and therefore can withstand mechanical forces differently

Anisotrophic

____________ bone is stronger on compression and less resilient to distraction, most vulnerable to shearing forces

Cortical

Surgical pine holes or a site of bone resection may weaken the bone, known as:

Stress raiser

3 types of incomplete fractures that are seen in children

Torus

Green Stick

Plastic deformity

Incomplete fracture seen in children which is cortical buckling due to compression

Torus

Incomplete fracture seen in children that results in incomplete fracture on tensino

Green stick

Incomplete fracture seen in children which results from bending of the bone without angular break and remodeling

Plastic deformity

3 types of complete fractures

transverse, oblique, spiral

Type of fx where a fragment of bone is being detached by the tension from the muscles or ligaments

Avulsion fracture

Type of Dx that presents as usually a corner fracture that is chipped rather than avulsed

Chip fracture

Type of fx that results in telescoping of osseous trabeculae. No typical radiolucent line is seen on radiographs and instead a zone of sclerosis or condensation may be present

Impaction (Compression) Fracture

Type of Fx usually in the calvaria and occasionally on the tibial plateau

Depression fracture

Type of Fx that results from repeated stress applied to normal bone leading to bone marrow hyperemia and bone resorption (ex: march fx of 2nd or 3rd metatarsal bones, tibial stress fx in runners, etc)

Stress (fatigue) fracture

Type of Fx that results from normal stresses like normal weight bearing or walking but applied to osteoporotic bone. Ex: Vertebral osteoporosis, sacral insufficiency Fx

Insufficiency Fracture

Type of Fx that results from weakened bone by pathology such as neoplasms, infection, congenital defect of collagen, etc

Pathologic Fracture

Type of fracture that has more than 2 segments, has subtypes: Segmenetal and Butterfly

Comminuted Fracture

Subtype of comminuted Fx in which 2 separate fracture lines produce an isolated segment of bone

Segmental Fracture

Subtype of comminuted fracture in which there is a wedge shaped fragment created at the apex of the maximal force

Butterfly Fractuer

When skin is intact and no communication with the outside air is present, a fracture is considered:

Closed

When skin is broken and communication between bone and outside air is present, a fracture is considered:

Open

It must be stated when a fracture extends into the joint creating an _______-_________ fracture. Greater complications can occur like delayed healing, Chondroblasts, secondary OA

Intra-articular

Fractures that cause a complete loss of apposition due to forced traction

Distraction

When a fracture causes one fragment of bone to overlap another this is called:

Bayonet apposition

Alignment of a fracture is considered ________ if the distal portion of bone deviates away from midline (Laterally)

Valgus

Alignment of a fracture is considered _______ if the distal portion of bone deviates towards the midline (medially

Varus

_________ means that fractures maintain alignment, can be lost in laterality or with anterior-posterior displacmenet

apposition

Type of salter Harris fracture that goes through the growth plate itself but is often unrecognized because of minimal displacement. Prognosis is fine if diagnosed early

Salter Harris type 1

What is one clinical example of salter Harris type 1 fractures?

SCFE

Type of salter Harris fracture that is the most common (>75%), fracture through the physis and a part of the metaphysis forming a thurston-holland fragment. Fx is proximal to the epiphysis. Good healing prospects

Salter Harris type 2

Type of salter Harris fracture that goes through the plate and into the epiphysis. Distal to epiphyseal line (physis)

Salter Harris type 3

Type of salter Harris fracture that transversus the metaphysis, physis and into the epiphysis

Salter Harris type 4

Type of salter a Harris fracture that is a crush injury to the growth plate. Often unrecognized or confused with type 1 but essentially damages physeal blood supply. Very bad because can cause premature fusion of growth plate resulting in stunted growth

Salter Harris type 5

What types of salter Harris fractures are rarest but show the highest complications leading to premature plate closure, limb deformities, shortening and other sequela

Salter Harris type 4 & 5

Sub type of insufficiency fracture that develops in bones with insufficient osteoid. Most often seen in rickets and osteomalacia, hyperparathyroidism, renal osteodystrophy, pages disease and other conditions that disturb normal bone pathology

Pseudo fracture

What bones most often have stress fractures?

Lower extremity

Occasionally on UE associated with repetitive activities

These fractures show very characteristic appearance on xrays as widened transverse radiolucent lines oriented at the right angle typically to the medial cortex

Pseudofractures

Where are pseudofractures most often found?

Medial aspect of the cortex of long bones

During bone bruise injuries, cell damage creates what?

Intra-osseous edema

Fractures that occur when intra-osseous edema and injury have occured. Osteoclasts will become activated by inflammatory mediators released from injured cells. As a result, more significant bone resorption will occur and what was initially undetected on xrays as bone bruise may progress to fracture several days later. Best example is scaphoid fractures

Occult fractures

Often referred to as:

Looser zones

Milkman lines

Umbau zones

Pseudofractures

Complete loss of articular contact/alignment with resultant injury to periarticular restraints

Dislocation

Partial loss of articular alignmnet

Subluxation

Separation of fibrous joints or fibrocartilagenous joints often seen as suture diastasis in the scull and symphysis pubis

Diastasis

Aka growing skull fracture, develops prior to closure of the skull sutures (

Leptomeningeal cyst

3 main phases of fracture healing

Inflammatory: 48hrs

Repair: 7-14 days

Remodeling: 9-24 months

Phase of healing in which hematoma and inflammatory mediators within the firs t48 hrs initiate chemotaxis with phagocytes and repair cells being drawn to fracture site (shortest phase)

Inflammatory phase

Phase of healing in which cells involved during initial inflammation will gradually begin to form granulation tissue and remove unwanted material and damaged cell. During htis phase within 7-14 days hematoma becomes vascularized and may appear more translucent on xrays

Repair phase

Fracture callus created during the repair phase of healing is still very vulnerable to _________ forces but may be better against ___________ forces

Shearing, axial

Phase of healing in which population of cells will sufficiently evolve into fibroblasts, chondrocytes and osteoblasts and bone mineralization will continue. Takes 9-24 months

Remodeling phase

Due to vascularity of the _________, pediatric fractures heal quicker

Periosteum

Type of disturbed fracture healing that takes twice as long as physiologically expected

Delayed union

Type of disturbed fracture healing where there is no healing for >9 months

Non-union

Type of disturbed fracture healing where there is a week callus with insufficient vacularization and new bone formation

Hypotrophic

Type of disturbed fracture healing where there is abnormal exuberant callus

Hypertrophic

Type of disturbed fracture healing in which there is absent callus often with synovial fluid or infected exudate intervening between fracture ends

Atrophic

_________ complications of fracture include neurological and vascular injury, acute compartment syndrome and renal failure, pulmonary fat embolism and gas gangrene

Immediate

_________ complications of fracture include osteomyelitis, sepsis, complex regional pain syndrome, nonunion/malunion

Intermediate

Healing occured in abnormally positioned fracture ends

Malunion

_________ complications of fracture include ischemic necrosis (AVN), secondary OA

Late

Associated fractures from this may sometimes cause lead toxicity. If bullet is lodged in synovial or serous cavity, hyaluronic acid will chemically remove lead and cause its reabsorption into general circulation potentially causing lead toxicity.

Gun shot wound (GSW)

Result of head injury that must be evaluated with highest level of clinical suspicion

Skull Fx

May present significant life threatening complication with head injury

Intra-cranial hemorrhage

Advanced imaging like what must be used to evaluate head injuries?

CT or MRI

Conventional radiography of evaluation of head injuries has become relatively:

Obsolete, non-existant

Occasionally __________ Sculls may be evaluate by plain film radiographs due to high radiation dose of CT

Pediatric

Type of imaging used most often to evaluate head injury?

CT without contrast

MC type of skull Dx that accounts for 80% of all skull Fx

Linear

Where are linear skull fractures most often found?

Parietal and temporal bones

How do you identify linear skull fractures?

Radiolucent lines that CROSS SUTURES

Type of skull Fx that is considered an open Fx, 15% of all skull fxs

Depressed skull Fx

Depressed skull fractures occur almost always where?

Cranial vault

Best modality for imaging depressed skull fxs?

CT scanning

In depressed skull fx, if depressed fragments extend > _________cm into the cranium neurosurgical referral is crucial

0.5-1

Occasionally named pond skull Fx, variation in depressed skull fx that may be seen in newborn infants as an inward buckling of the calvaria without osseous fragments

Ping-Pong Fx

Type of skull fxs that happen during labor due to forceps possibly, or direct blunt trauma like dropped infant

Ping-Pong Fx

Type of skull fracture that may be traumatic or non-traumatic due to pathology or rarely physiological changes related to rapid growth spurts

Sutural diastasis

At birth, diastatic fxs are considered if suture is wider than _______cm

1

At age 2 diatstatic fxs are considered if suture si wider than _______ mm

3

At age 3 diastatic fxs are considered if suture is wider than ____mm

2

Traumatic sutural separation may be seen in

5

Type of skull fx that is better diagnosed clinically than radiographically. Sphenoid and temporal bones may be involved in >75% of cases with complete or partial obstruction of the sphenoid sinus. Best detected on lateral skull projections

Basilar skull FX

_________ may be noted on skull xrays with basilar fractures

Pneumocephalus

Tearing of the _________ is common in basilar skull fxs

Meninges

Who are at highest risk for subdural/subarachnoid hematoma?

Elderly, children

CSF rhinorrhea and otorrhea

Battle sign

Raccoon eyes are all signs of what?

Basilar skull fx

Best modality to evaluate basilar skull fxs?

CT

__________ hematoma may develop rapidly with acute rise in intracranial pressure, cerebral edema and transtentorial and or subfalcine brain herniation

Epidural

Middle meningeal artery damage can commonly cause what?

Epidural hematoma

Type of hematoma that is caused by affecting the bridging veins

Subdural (subarachnoid) hematoma

Basilar Skull fx have a _________ probability of intracranial hemorrhage and meningitis, making this a medical emergency

High

Subarachnoid hemorrhage are identified in ______% of fatal head injuries due to trauma

30

Mostly found in an pediatric skull

Leptomeningeal Cyst- Growing fracture

Most common of all facial bone fractures accounting for 45% of total

Nasal fractures

Most nasal fractures are induced with the ______ force component and show laterally displaced component

Lateral

Conventional radiographs are _____% sensitive to identifying nasal fractures (on lateral nasal view)

80

Best imaging modality for nasal fractures, 100% sensitive

CT

__________ nasal fractures may not require treatment

Undisplaced

_________ nasal fractures may lead to nasal difficulty breathing, occasionally septal necrosis may develop

Displaced

Most cases of this fracture will force orbital fat and sometimes inferior rectus muscle into the maxillary sinus

Orbital Blow out fracture