Radiologic Evaluation pt 2

define fracture

break in structural continuity of bone or cartilage

describe a closed fracture

skin stays intact

describe a open fracture

bone breaks through the skin

What are the different ways to describe a radiologic fx

• anatomic site and extent

• type

• alignment

• direction

• special features

• associated abnormalities

• special types

how is anatomic site and extent used to describe radiologic fx

reference points to establish the location of a fx

parts of a long bone shaft that can be used to describe anatomic site and extent of radiologic fxs

proximal, middle, distal thirds

junctions

parts of a long bone ends that can be used to describe anatomic site and extent of radiologic fxs

distal or proximal

intra- or extra-articular

parts of a irregular/flat bones can be used to describe anatomic site and extent of radiologic fxs

intra- or extra-articular

describe this fx using anatomic site and extent

junction of the middle and distal third

describe this fx using anatomic site and extent

intra-articular

how is type of fx used to describe radiologic fx

complete or incomplete

define complete fx

all cortical margins are broken equaling 2 or more fragments

define incomplete fx

one cortical margin remains intact

What type of fx is more stable, complete or incomplete

incomplete

Where are incomplete fxs most commonly seen

short, flat, or irregularly shaped bones

Who is most likely to have an incomplete fx

children or older adults with metabolic issues

What type of fx is this

incomplete

how is alignment of fx fragments used to describe radiologic fx

• position

• displacement

• alignment

• angulation

define position in terms of fx alignment

the relationship of fragment to normal structure

How is position named

position of distal fragment in relation to proximal

define displacement in terms of fxs

some loss of contact between broken surfaces of the fragments

how is displacement described in terms of fx fragments

degree of displacement (cortical or shaft widths)

what may cause displacement

distraction

overriding

rotation

define nondisplaced fxs

have some degree of contact remaining between the fx and fragments

describe the displacement of this fx

nondisplaced

describe the displacement of this fx

medial

describe the displacement of this fx

lateral

describe the displacement of this fx

distracted

describe the displacement of this fx

overriding with posterior and superior displacement

describe the displacement of this fx

distracted and rotated laterally

define “in alignment”

when longitudinal axes of both fragments line up in tandem or parallel

How can angualtion be named by

• direction of angular displacement of the distal frag in relation to the proximal

• direction of the apex of the angle

describe the angulation of this fx

distal fragment is angulated (medial angulation (medial apex) of the fracture site with lateral angular displacement of the distal fragment)

how is direction of fracture lines used to describe radiologic fx

describe in reference to longitudinal bone (transverse, longitudinal, oblique, spiral)

define transverse fx

result of bending force; occurs at R angles to the longitudinal axis

define longitudinal fx

approx. parallel to the shaft

define oblique fx

results of combined forces of compression, bending, and torsion to create a diagonal

define spiral fx

twists along long axis of bone due to torsion

define communicated fx

a break or splinter of the bone into >2 fragments

What typically will cause a communicated fx

crushing force or event

how is special features used to describe radiologic fx

• impaction

• avulsion

  • stress fxs

What causes an impaction

compression forces related to axial loading

define impaction

bone is driven into itself

Where does impaction typically occur

in areas of cancellous bone (due to porous nature)

describe the stability of impaction

naturally more stable and close contact

types od imaction fxs

depression and compression

define depression fx

one bone is driven into another

define compression fx

both surfaces of a bone are forced together

define avulsion fx

fragments of bone are pulled away from the main body of bone OR passive resistance of a ligs against a tensile force

Where does avulsion typically occur

bony prominences

how is associated abnormalities used to describe radiologic fx

dislocations

subluxations

soft tissue damage

additional names for stress fx

microfx

fatigue fx

insufficency fxs

what causes stress fxs

repetitive minor trauma on normal bone

What is the difference between fatigue and insufficiency fxs

fatigue: excessive stress on healthy bone; normally in young/active

insufficiency: normal stress on pathologic bone; normally old/inactive

locations for fxs in children

diaphyseal

metaphyseal

physeal

epiphyseal

What are the difficulties with fx assessment in children

epiphyseal growth plates

dense growth lines

secondary centers of ossification

large nutrient foramina

define greenstick fxs

shaft is fractures on the tension side while the cortex and periosteum remains intact on the compression side

describe a torus

impaction fx that results in buckling of the cortex

Where are torus typically seen

at the metaphyseal region due to amount of cancellous bone and newly remodeled trabecular bone

define plastic bowing fxs

compression forces exceed the point in which elastic recoil returns causing a microfx

types of incomplete fxs in children

greenstick

torus

plastic bowing

Type 1 epiphyseal fx on the Salter-Harris classification

fx line extends through the physis, separating and displacing the epiphysis from normal position

prognosis for type 1 epiphyseal fx

good for normal growth

Type 2 epiphyseal fx on the Salter-Harris classification

fx line extends through the physis and exits through the metaphysis creating a triangular wedge that displaces with epiphysis

prognosis for type 2 epiphyseal fx

good for normal growth

Type 3 epiphyseal fx on the Salter-Harris classification

fracture line extends from the joint surface through the epiphysis across the physis

Type 4 epiphyseal fx on the Salter-Harris classification

fracture line extends from the joint surface through the epiphysis, physis, and metaphysis

Type 5 epiphyseal fx on the Salter-Harris classification

fracture is a crush type injury that damages the physis by compression

prognosis for type 3 epiphyseal fx

partial growth arrest is a possibility and surgical fixation may be warranted

prognosis for type 4 epiphyseal fx

partial growth arrest is possible and surgical fixation may be necessary

prognosis for type 5 epiphyseal fx

eventual growth arrest

Phases of Fx healing

GFs involved

how fixation impacts healing

callus formation process

• hematoma forms

• metabolic reaction occurs

• organization/ossification

• new bone proceeds toward and bridges the gap

• callus is formed