pathology lesson 9

RFP

  • SAT: 280863 STUDY1 1191 41.56 MA 18 5cm SP H23
  • FoV: 199 220 296 512
  • Tra>Cor(6.1)> SASSAT:
    • 5cm TP O SP H44.5 TR 6300.0
    • SL 5.0 TE 124.0
    • COV 199 220 TA 04:24

Course Information

  • Institution: LOYALIST
  • Program: Medical Radiation Technology
  • Semester: 2
  • Week: 5
  • Lesson: 9
  • Module: 2
  • Topic: Skeletal Pathology

Lesson Objectives

  • Differentiate and identify common classifications of skeletal fractures.
  • Discuss fracture treatment options, as well as signs and possible complications of fracture healing.

Skeletal System: Fracture Classifications

  • 3.1.1 Avulsion
  • 3.1.2 Bennett's
  • 3.1.3 Bimalleolar
  • 3.1.4 Blow-out
  • 3.1.5 Boxer's
  • 3.1.6 Clay Shovelers
  • 3.1.7 Closed
  • 3.1.8 Colle's
  • 3.1.9 Comminuted
  • 3.1.10 Complete
  • 3.1.11 Compound/Open
  • 3.1.12 Compression
  • 3.1.13 Contrecoup
  • 3.1.14 Depressed
  • 3.1.15 Displaced
  • 3.1.16 Galeazzi
  • 3.1.17 Hangman's
  • 3.1.18 Impacted
  • 3.1.19 Incomplete/Greenstick
  • 3.1.20 Intertrochanteric
  • 3.1.21 Jefferson
  • 3.1.22 Jones
  • 3.1.23 Linear
  • 3.1.24 LeFort
  • 3.1.25 Longitudinal
  • 3.1.26 March
  • 3.1.27 Monteggia
  • 3.1.28 Oblique
  • 3.1.29 Pathological
  • 3.1.30 Salter-Harris
  • 3.1.31 Simple
  • 3.1.32 Smith's
  • 3.1.33 Spiral
  • 3.1.34 Supracondylar
  • 3.1.35 Transverse
  • 3.1.36 Trimalleolar
  • 3.1.37 Tripod
  • 3.1.38 Undisplaced

Fracture Definition

  • Fractures: Defined as a disruption of bone caused by mechanical forces applied either directly to the bone or transmitted along the shaft of a bone.
  • Some fractures are subtle and difficult to detect, known as occult fractures:
    • Typically appears as a radiolucent line crossing the bone and disrupting the cortical margins.
    • Overlap of fragments may produce a radiopaque line.
    • Secondary signs include joint effusion, soft tissue swelling, and interruption of the normal pattern of bony trabeculae.

Role of Medical Radiation Technologists (MRTs)

  • MRTs are expected to have the knowledge and skills to perform the best diagnostic imaging tests possible.
  • Requires understanding anatomy and how to best visualize on radiographic projections, adjusting beam geometry and technical acquisition factors as needed.
  • Ability to adapt to provide the best diagnostic imaging, assess patient's conditions, abilities and needs, and identify common skeletal abnormalities.

Fracture Classification & Treatment

Classification Criteria

  • Fractures are classified by:
    • Extent
    • Direction
    • Position
    • Number of fracture lines
    • Integrity of the overlying skin

Complete vs Incomplete Fracture

  • Complete Fracture: Results in a discontinuity between two or more fragments.
  • Incomplete Fracture: Causes only partial discontinuity, with a portion of the cortex remaining intact.

Closed vs Open Fracture

  • Closed Fracture: The overlying skin is intact and the bone does not break through.
  • Open Fracture: The overlying skin is disrupted and the bone is exposed, also called a compound fracture.

Transverse vs Longitudinal Fracture

  • Transverse Fracture: Runs at a right angle or perpendicular to the long axis of a bone, commonly results from a direct blow or fracture within pathologic bone.
  • Longitudinal Fracture: Occurs along the axis of the bone, mostly used for long-bone fractures.

Oblique vs Spiral Fracture

  • Oblique Fracture: Runs at 45 degrees to the long axis of the bone caused by angulation or both angulation and compression forces.
  • Spiral Fracture: Encircles the shaft, generally longer than oblique fractures, results from torsional forces, often associated with high impact and displacement.

Avulsion and Comminuted Fractures

Avulsion Fracture

  • Fragments are torn from the bone, usually due to indirectly applied tension forces within attached ligaments and tendons.

Comminuted Fracture

  • Composed of more than two bone fragments resulting in a "shattered" appearance.

Butterfly and Segmental Fractures

Butterfly Fracture

  • Elongated triangular fragment of cortical bone generally detached from two other larger fragments, results from two oblique fracture lines.

Segmental Fracture

  • A segment of the shaft is isolated by proximal and distal lines of fracture, which increases the risk of devascularization.

Compression and Depressed Fractures

Compression Fracture

  • Results from a compression force causing compaction of bone trabeculae, mainly in the vertebral body.

Depressed Fracture

  • Occurs in the skull when a force produces a comminuted fracture with portions of the skull forced inward.

Stress and Pathological Fractures

Stress Fracture

  • Also called fatigue fractures, result from repeated stresses on bone that wouldn't normally cause a fracture. Most common in lower extremities.
    • Common sites include shafts of second and third metatarsals, calcaneus, proximal and distal shafts of tibia and fibula, shaft and neck of femur, ischial and pubic rami.

Pathological Fracture

  • Happens at a site of weakness in the bone due to tumors, infections, or metabolic bone disease.

Greenstick and Torus Fractures

Greenstick Fracture

  • One cortex remains intact while the opposite cortex bends and breaks, considered an incomplete fracture, mostly prevalent in infants and children.

Torus or Buckle Fracture

  • Characterized by bulging of the bone cortex with one cortex intact; may only be diagnosed via angulation.

Undisplaced vs Displaced Fractures

Undisplaced Fracture

  • Occurs when there is a plane of cleavage in the bone without angulation or separation.

Displaced Fracture

  • Indicates separation of bone fragments with the direction of displacement describing the relationship of the distal fragment to the proximal one.

Agnulation and Dislocation

Angulation

  • Refers to an angular deformity between major fragment axes.

Dislocation

  • Refers to displacement of a bone from its normal articulation, partially seen as subluxation.

Salter-Harris Fractures

  • Refers to injuries through the growth plate of long bones. If untreated, it could affect growth. Classification includes Types I - V.
  • Type II is the most common with potential complications affecting skeletal growth, especially in children mostly assigned male at birth.

Symptoms of Fractures

  • Pain followed by swelling around the fracture area.
  • Painful to touch.
  • Inability to put weight on the affected limb.
  • Limited range of motion.
  • Bone deformity.

Diagnosis & Management of Fractures

  • Initial radiographs to verify suspected fractures and assess underlying bone conditions.
  • Post-reduction radiographs to determine anatomic position of fragments.
  • Follow-up radiographs to monitor healing and exclude complications.

Role of MRT in Imaging Fractures

  • Imaging the injured body part with two views at 90 degrees to assess continuity or displacement of fractures.
  • Imaging should include joints above and below to check for secondary injuries.
  • It’s crucial to avoid manipulating the area if there’s a visible disturbance.

Treatment Objectives for Fractures

  • Restore function and stability with minimal residual deformity.

Treatment Methods for Fractures

External or Closed Reduction

  • Treated by manipulation without surgery; sedation may be necessary.

Open Reduction

  • Involves surgical manipulation of fragments with hardware application to maintain reduction.

Internal Fixation

  • Utilizes plates, screws, rods, and nails for maintaining reduction.
  • Open Reduction Internal Fixation (ORIF) involves both surgical procedures.

External Fixation

  • Accomplished through splints, external devices or casts.

Fractures & Healing Process

  • Radiographic evidence of healing shows continuous external bridge of callus across the fracture line.
  • At least two views at 90 degrees are required to confirm healing.
  • Delayed union, non-union, and malunion are potential complications requiring careful monitoring and intervention.

Delayed Union

  • Refers to fractures taking longer to heal than normal, potentially due to infection or inadequate immobilization.

Non-union

  • Describes fractures that do not heal even with prolonged immobilization, requiring surgical intervention.

Malunion

  • Occurs when fractured fragments heal in a faulty position, potentially requiring correction.

Summary of Discussion

  • Covered fracture classifications and types, treatment options, and healing processes. Key terms and applications will be integral in MRT practice.

References

  • Campagne, D. (2025). Vertebral compression fractures. MSD Manual Professional Edition.
  • Dixon, A. (2013). Spiral fracture of femur. Radiopaedia.org.
  • Eisenberg, R. L., Johnson, N. M. (2021). Comprehensive Radiographic Pathology. Elsevier.
  • El-Feky, M., Jones, J. (2009). Pathological fracture. Radiopaedia.org.
  • Skalski, M. (2016). Fracture with butterfly fragment. Radiopaedia.org.

Next Steps

  • Upcoming lesson will delve deeper into common fractures of the upper and lower extremities, spine, skull, and facial bones.