Define FRACTURE.
A break on one cortex of a bone within a soft tissue envelope which exits from the opposite cortex.
What are the 4 types of fractures, and their mechanism?
1) Spiral - twisting (long fracture line)
2) Oblique - twisting (short fracture line)
3) Transverse - bending (with bending wedge if third smaller fragment present)
4) Comminuted - high energy force
Why is a comminuted fracture hopeless? and how is it managed?
Comminuted fracture -> no periosteum, no tissue attachment, no blood supply -> dead bone -> prone to infection
MANAGEMENT
- Bone removal
- Bone graft (if possible)
How to read an X-Ray:
1) Name, DOB, Hospital number -> confirm with wristband
2) Date and time of Xray
3) Type of Xray, and side of Xray
- “This is an AP X-Ray examination of the left humerus”
4) Adequacy and Alignment
- “This X-Ray is of acceptable quality”, “too light/dark”, “the film is rotated”, “whole bone length is shown” (if foot, standing or weight-bearing X-Ray?)
5) Bone
- which bone
- where in bone (epiphysis, metaphysis, diaphysis)
- simple or comminuted?
- fracture pattern (transverse, oblique, spiral)
- displacement extent (“minimal displacement”, “bone has translated full cortex”, “angulation”, “shortening”, “rotation”)
- likely mechanism, and force degree
6) Joint involvement?
- “intraarticular/extraarticular”
7) Soft tissue
- air (open fracture)
- foreign material
- swelling/joint fluid (haemarthrosis or rlipohaemarthrosis)
See slide 30 and 31
Why are all pelvic fractures bad?
Pelvic fractures are associated with enormous tissue damage (including organs, and blood vessels)
What is the purpose of the AO classification, and what is it?
PURPOSE:
- fixing is more effective than plastering
- Plastering not ideal for long-term healing -> muscle wasting and joint stiffness
WHAT
1) Common bone fractures (8)
- Humerus
- Forearm
- Femur
- Tibia
- Spine
- Pelvis
- Hand
- Foot
2) Where on bone (3)
- Proximal
- Midshaft
- Distal
3) Type of fracture
4) Near joint?
Give examples of soft tissues in the MSK.
1) Skin
2) Muscle
3) Fascia
4) Tendons and ligaments
5) Nerves
6) Blood vessels
What are the angulations of the lower limb?
1) Valgus
- apex of joint medial
- distal limb away from midline
2) Varus
- apex of joint lateral
- distal limb towards midline
Classification of ANKLE FRACTURES
- Webers classification
- AO classification
WEBERS - based on level of fibula fracture
1) Below syndesmosis -> plaster or splint
2) At syndesmosis -> ankle mortise might shift -> if stiff -> op
3) Above syndesmosis -> ankle mortise disrupted, ligaments and capsule ripped -> op
Types of FEMORAL NECK FRACTURES, and their blood supplies in fracture.
1) Sub capital/ intracapsular * - within capsule -> blood supply interrupted
2) Intertrochanteric/ per trochanteric * - from greater to lesser trochanter -> blood supply not fully disrupted
3) Sub trochanteric
Classification of INTERTROCHANTERIC / PER TROCHANTERIC FRACTURES, and its management.
- Evans classification
- AO classification
MANAGEMENT
- reduce and fix with DHS for all ages
Classification of SUB CAPITAL / INTRACAPSULAR FRACTURES.
- Garden classification
- AO classification
GARDEN CLASSIFICATION
- Grade I -> undisplaced -> reduce and fix
- Grade II -> minimally displaced -> reduce and fix
- Grade III -> displaced -> replace femoral head
- Grade IV -> displaced -> replace femoral head
Describe the blood supply to the femoral neck.
deep femoral artery -> medial and lateral circumflex femoral arteries -> retinacular vessels (in neck) -> arteries in ligamentum teres (in head)
How are SUB CAPITAL / INTRACAPSULAR fractures managed in children vs. adults?
CHILDREN
- emergency -> op within 6hrs
- reduce carefully and anatomically (i.e. perfectly)
- alternatively, open reduction performed
- risk: avascular necrosis -> total hip replacement
ELDERLY
- Grade I and II -> reduce and fix
- Grade III and IV -> replace
- healthy and fit -> total hip replacement
- otherwise -> hemiarthroplasty
Classification of PAEDIATRIC EPIPHYSEAL FRACTURES.
- SALTeR- harris classification
Straight Above beLow Through cRushed
