Fractures (main): Difference between revisions
(Updated principles of fracture description.)
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==Describing Fractures==
==Describing Fractures==
*Open versus Closed
A systematic approach for the description of fractures should be used to aid in clear communication with radiologists and consulting specialists.
*Location
# Laterality
**Intra-articular versus articular
# Affected Bone
**Mid-shaft, proximal 1/3, or distal 1/3
# Location
**Supracondylar
** Intra-articular vs. extra-articular
**Intertrochanteric, subtrochanteric, femoral neck, or subcapital
** Portion of long-bone (proximal, middle, distal)
*Orientation of the fracture line
** Anatomic site (ex. supracondylar, intertrochanteric, subtrochanteric, femoral neck)
**Transverse
# Open vs. Closed
**Oblique
# Direction (orientation of fracture line relative to long-axis)
**Spiral
** Transverse
**Comminuted
** Oblique
**Segmental
** Spiral
** Segmental (>2 fragments, with one segment not connected to either end)
** Comminuted (>3 fragments)
** Impacted
**Torus / Greenstick (Peds)
**Torus / Greenstick (Peds)
*Displacement
# Alignment
**Extent to which fracture fragments are offset from each other
** Displacement (distal relative to proximal fragment)
***State in terms of direct measurement (e.g. 4mm) or %width of bones (50% displacement)
***State in terms of direct measurement (e.g. 4mm) or %width of bones (50% displacement)
**Direction of displacement is based on position of distal fragment relative to proximal
** Angulation
*Separation
*** Deviation from longitudinal axis, described in degrees and direction
**Distance the two fragments have been pulled apart (but not offset from each other)
*** Direction of apex of angle formed from redrawn longitudinal axes of fracture fragments
*Shortening
** Rotation
**Amount by which a bone's length has been reduced (expressed in mm or cm)
*** Twisting around longitudinal axis (distal relative to proximal fragment)
**May occur by impaction or by overriding
*** Described as medial or lateral rotation (towards or away from midline respectively)
*Angulation
** Separation
**Described in terms of degree and direction
*** Distance two fragments have been pulled apart (but not offset from each other)
***Degree
** Shortening
****Calculate amount of "unbending" needed to make fx fragments parallel
*** Amount by which a bone's length has been reduced (expressed in mm or cm)
***Direction
*** May occur by impaction or by overriding
****Described by direction of the apex of the angle formed by the two fragments OR
** Other
****Described by direction the terminal fragment is deviated
*** Incomplete: Only one side of cortex disrupted
****Examples: anterior or posterior, lateral or medial, radial or ulnar, dorsal or volar
*** Stress: Caused by repetitive low-force trauma/impact
*Rotational Deformity
*** Pathologic: Caused by trivial trauma or biomechanically routine force, suggestive of abnormal bone.
**Usually apparent on physical exam, not on radiographs
*** Fracture-Dislocation: Be careful not to describe these injuries as fractures with displacement
*Fracture-Dislocation
 
**Be careful not to describe these injuries as fractures with displacement
[[Salter Harris]]
*[[Salter Harris]]


==Head and Neck==
==Head and Neck==

Revision as of 21:55, 10 June 2016

Describing Fractures

A systematic approach for the description of fractures should be used to aid in clear communication with radiologists and consulting specialists.

  1. Laterality
  2. Affected Bone
  3. Location
    • Intra-articular vs. extra-articular
    • Portion of long-bone (proximal, middle, distal)
    • Anatomic site (ex. supracondylar, intertrochanteric, subtrochanteric, femoral neck)
  1. Open vs. Closed
  2. Direction (orientation of fracture line relative to long-axis)
    • Transverse
    • Oblique
    • Spiral
    • Segmental (>2 fragments, with one segment not connected to either end)
    • Comminuted (>3 fragments)
    • Impacted
    • Torus / Greenstick (Peds)
  1. Alignment
    • Displacement (distal relative to proximal fragment)
      • State in terms of direct measurement (e.g. 4mm) or %width of bones (50% displacement)
    • Angulation
      • Deviation from longitudinal axis, described in degrees and direction
      • Direction of apex of angle formed from redrawn longitudinal axes of fracture fragments
    • Rotation
      • Twisting around longitudinal axis (distal relative to proximal fragment)
      • Described as medial or lateral rotation (towards or away from midline respectively)
    • Separation
      • Distance two fragments have been pulled apart (but not offset from each other)
    • Shortening
      • Amount by which a bone's length has been reduced (expressed in mm or cm)
      • May occur by impaction or by overriding
    • Other
      • Incomplete: Only one side of cortex disrupted
      • Stress: Caused by repetitive low-force trauma/impact
      • Pathologic: Caused by trivial trauma or biomechanically routine force, suggestive of abnormal bone.
      • Fracture-Dislocation: Be careful not to describe these injuries as fractures with displacement

Salter Harris

Head and Neck

Maxillofacial Trauma

Vertebral fractures and dislocations types

Vertebral anatomy.
Numbering order of vertebrae.

Upper Extremity

Humerus Fracture Types

Humeral anatomy

Elbow

Forearm Fracture Types

Carpal fractures

AP view

Hand and Finger Fracture Types

Torso

Chest

Abdomen

Spine

Lower Extremity

Proximal Leg

Distal Leg Fracture Types

Foot and Toe Fracture Types

Hindfoot

Midfoot

Forefoot

Other

See Also

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