Fractures (main): Difference between revisions
(Updated principles of fracture description.) |
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==Describing Fractures== | ==Describing Fractures<ref>Wolfson, A. B., Cloutier, R. L., Hendey, G. W., Ling, L., & Schaider, J. (n.d.). Approach to Musculoskeletal Injuries. In Harwood-Nuss' clinical practice of emergency medicine (6th ed.). LWW.</ref>== | ||
[[File:Types of fracture.jpg|thumb|Types of fractures]] | |||
[[File:Fracture Naming Construct.png|thumb|Fracture naming construct]] | |||
A systematic approach for the description of fractures should be used to aid in clear communication with radiologists and consulting specialists. | A systematic approach for the description of fractures should be used to aid in clear communication with radiologists and consulting specialists. | ||
*'''Laterality''' | |||
*'''[[Open fracture|Open]] vs. Closed''' | |||
*'''Affected Bone''' | |||
** Intra-articular vs. extra-articular | *'''Location''' | ||
** Portion of long-bone (proximal, middle, distal) | **Intra-articular vs. extra-articular | ||
** Anatomic site (ex. supracondylar, intertrochanteric, subtrochanteric, femoral neck) | **Portion of long-bone (proximal, middle, distal) | ||
**Anatomic site (ex. [[supracondylar]], [[Intertrochanteric femur fracture|intertrochanteric]], [[Subtrochanteric femur fracture|subtrochanteric]], [[Femoral neck fracture|femoral neck]]) | |||
*'''Direction''' (orientation of fracture line relative to long-axis) | |||
** Transverse | **Transverse | ||
** Oblique | **Oblique | ||
** Spiral | **Spiral | ||
**Impacted | |||
**Torus / [[Greenstick Fracture|Greenstick]] (Peds) | |||
** Impacted | *'''Alignment''' | ||
**Torus / Greenstick (Peds) | **Displacement (distal relative to proximal fragment) | ||
** 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) | ||
** Angulation | **Angulation | ||
*** Deviation from longitudinal axis, described in degrees and direction | ***Deviation from longitudinal axis, described in degrees and direction | ||
*** Direction of apex of angle formed from redrawn longitudinal axes of fracture fragments | ***Direction of apex of angle formed from redrawn longitudinal axes of fracture fragments | ||
** Rotation | ***Valgus angulation is lateral | ||
*** Twisting around longitudinal axis (distal relative to proximal fragment) | ***Varus angulation is medial | ||
*** Described as medial or lateral rotation (towards or away from midline respectively) | **Rotation | ||
** Separation | ***Twisting around longitudinal axis (distal relative to proximal fragment) | ||
*** Distance two fragments have been pulled apart (but not offset from each other) | ***Described as medial or lateral rotation (towards or away from midline respectively) | ||
** Shortening | **Separation | ||
*** Amount by which a bone's length has been reduced (expressed in mm or cm) | ***Distance two fragments have been pulled apart (but not offset from each other) | ||
*** May occur by impaction or by overriding | **Shortening | ||
** Other | ***Amount by which a bone's length has been reduced (expressed in mm or cm) | ||
*** Incomplete: Only one side of cortex disrupted | ***May occur by impaction or by overriding | ||
*** Stress: Caused by repetitive low-force trauma/impact | **Other | ||
*** Pathologic: Caused by trivial trauma or biomechanically routine force, suggestive of abnormal bone. | ***Incomplete: Only one side of cortex disrupted | ||
*** Fracture-Dislocation: Be careful not to describe these injuries as fractures with displacement | ***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 | |||
*'''Fragmentation''' | |||
**Segmental (>2 fragments, with one segment not connected to either end) | |||
**Comminuted (>3 fragments) | |||
[[Salter Harris]] | *'''[[Salter Harris]]''' | ||
==Anatomic Terms== | |||
*'''Diaphysis''' - shaft | |||
*'''Metaphysis''' - widened ends of the bones adjacent to the physis | |||
*'''Physis''' - radiolucent growth plate between metaphysis and epiphysis | |||
*'''Epiphysis''' - secondary ossification center at the end of the bones | |||
*'''Apophysis''' - secondary ossification center at site of tendon or ligament attachment | |||
==Head and Neck== | ==Head and Neck== | ||
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{{Cervical spine injuries}} | {{Cervical spine injuries}} | ||
== Upper Extremity == | ==Upper Extremity== | ||
{{Proximal arm fracture DDX}} | {{Proximal arm fracture DDX}} | ||
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**[[Olecranon fracture]] | **[[Olecranon fracture]] | ||
**[[Elbow dislocation]] | **[[Elbow dislocation]] | ||
**[[Capitellum fracture]] | |||
*Pediatric | *Pediatric | ||
**[[Nursemaid's elbow]] | **[[Nursemaid's elbow]] | ||
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==Other== | ==Other== | ||
*[[Salter-Harris fractures]] | *[[Salter-Harris fractures]] | ||
==Management== | |||
{{General Fracture Management}} | |||
==See Also== | ==See Also== | ||
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*[[Open fracture]] | *[[Open fracture]] | ||
*[[Joint dislocations (main)]] | *[[Joint dislocations (main)]] | ||
==References== | |||
<references/> | |||
[[Category:Orthopedics]] | [[Category:Orthopedics]] |
Revision as of 02:54, 18 September 2019
Describing Fractures[1]
A systematic approach for the description of fractures should be used to aid in clear communication with radiologists and consulting specialists.
- Laterality
- Open vs. Closed
- Affected Bone
- Location
- Intra-articular vs. extra-articular
- Portion of long-bone (proximal, middle, distal)
- Anatomic site (ex. supracondylar, intertrochanteric, subtrochanteric, femoral neck)
- Direction (orientation of fracture line relative to long-axis)
- Transverse
- Oblique
- Spiral
- Impacted
- Torus / Greenstick (Peds)
- 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
- Valgus angulation is lateral
- Varus angulation is medial
- 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
- Displacement (distal relative to proximal fragment)
- Fragmentation
- Segmental (>2 fragments, with one segment not connected to either end)
- Comminuted (>3 fragments)
Anatomic Terms
- Diaphysis - shaft
- Metaphysis - widened ends of the bones adjacent to the physis
- Physis - radiolucent growth plate between metaphysis and epiphysis
- Epiphysis - secondary ossification center at the end of the bones
- Apophysis - secondary ossification center at site of tendon or ligament attachment
Head and Neck
Maxillofacial Trauma
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
Vertebral fractures and dislocations types
- Cervical fractures and dislocations
- Thoracic and lumbar fractures and dislocations
Upper Extremity
Humerus Fracture Types
Elbow
- Adult
- Pediatric
Forearm Fracture Types
- Distal radius fractures
- Radia ulna fracture
- Isolated radius fracture (proximal)
- Isolated ulna fracture (i.e. nightstick)
- Monteggia fracture-dislocation
- Galeazzi fracture-dislocation
- Forearm fracture (peds)
Carpal fractures
- Scaphoid fracture
- Lunate fracture
- Triquetrum fracture
- Pisiform fracture
- Trapezium fracture
- Trapezoid fracture
- Capitate fracture
- Hamate fracture
Hand and Finger Fracture Types
Torso
Chest
Abdomen
Spine
Lower Extremity
Proximal Leg
Distal Leg Fracture Types
- Tibial plateau fracture
- Tibial shaft fracture
- Pilon fracture
- Maisonneuve fracture
- Tibia fracture (peds)
- Ankle fracture
- Foot and toe fractures
Foot and Toe Fracture Types
Hindfoot
Midfoot
Forefoot
Other
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
See Also
- Fracture management overview
- Splinting
- Diagnoses by Body Part (Main)
- Fractures and dislocations (peds)
- Open fracture
- Joint dislocations (main)
References
- ↑ Wolfson, A. B., Cloutier, R. L., Hendey, G. W., Ling, L., & Schaider, J. (n.d.). Approach to Musculoskeletal Injuries. In Harwood-Nuss' clinical practice of emergency medicine (6th ed.). LWW.