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Bone fracture

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Bone Fracture

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Page 1: Bone Fracture GK

Bone fracture

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FactsBone fracture, broken bone, bone crack all mean he same thing. The bone has been damaged such that. None of these terms indicate the severity of the bone damage. Bones are the body's storage place for calcium. Under hormone control, calcium content of bone is constantly increasing or decreasing.

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Common Types and Locations of Fractures

greenstick fracture,spiral fracture,comminuted fracture,transverse fracture,compound fracture,vertebral compression fracture,stress fracture,compression fracture,rib fracture, andskull fracture.wrist fracture (scaphoid fracture)

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JEFFERSON FRACTUREFracture of C1 ringAxial loading injury with compression force to C1Unilateral or bilateral fractures of anterior and posterior arches of C1

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CLAY-SHOVELER’S FXAvulsion fracture of spinous process of C7 or T1Sudden load on flexed spine

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HANGMAN’S FRACTUREBilateral pedicle or pars fractures involving C2 vertebral bodyA/w anterior subluxation or dislocation of C2 vertebral bodySevere extension injury (MVC causing head to hit dashboard, hanging)

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CLAVICULAR FRACTUREExtremely commonDoes not completely ossify until late teensFall on outstretched hand, fall onto outside of shoulder, direct hit to clavicleTreatment: “Figure-of-8” sling; No activities that exacerbate pain; full recovery in 12 weeks.

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SCAPULAR FRACTUREUncommonScapular body fx are the MC typeCommonly (80-90%) associated with other injuries – lung and chestDon’t require surgery

GLENOID (cartilage) fracture – requires surgery when unstable or fragments are far out of alignment

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HUMERUS FRACTUREProximal occur near the shoulder joint; treatment depends on rotator cuff tendon positionMid-shaft – Injury to radial nerve causes wrist drop and numbness of the hand dorsumDistal are uncommon in adults; often require surgeryMost heal without surgeryOver 90% with nerve injury have complete recovery of nerve in 3-4 months

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HOLSTEIN-LEWIS FRACTURE

Distal third humeral fracture18% are associated with radial nerve palsy, particularly if break is between middle and distal thirds of humerusDue to direct blow or torsion injuryCompetitors in throwing events

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ULNAR FRACTUREForearm is struck by an objectNightstick Fracture

Treatment of isolated ulnar fx: cast or brace; surgery if unstable

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MONTEGGIA FRACTUREGiovanni Monteggia – 1814

Fracture of Ulna Dislocation of radial head within the elbow joint

Treatment: Surgery

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RADIAL HEADMost common part broken in elbow fractureMC caused by fall onto outstretched hand+/- surgery depending on displacement

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GALEAZZI FRACTURE Fracture of RadiusInjury of the distal radio-ulnar joint of wrist (shortening and dislocation of distal ulna)Mechanism: fall on outstretched hand with elbow flexedTreatment: Surgery to repair radius, then inspection of distal radio-ulnar joint

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NURSEMAID’S ELBOWCommon in young children (< 5 yo)Subluxation of radius at elbow joint --bone has slid out of proper positionClassically a sudden pull on child’s armPresent with arm flexed a/g bodyIf treated (replaced) quickly, immobilization is not necessaryFor multiple subluxations, cast to allow ligaments to heal

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SMITH’S FRACTUREFracture of radius near the wrist jointDisplaced anteriorly (in front of normal position)MC found after falling on to the back of the hand

Treatment: Requires fixation

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COLLES’ FRACTUREFracture of radiusDisplaced posteriorly (behind normal position)MC after fall onto outstretched hand

Treatment: Cast +/- surgery, depending on shortening and displacement of radius

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SCAPHOID BONE FXScaphoid sits below the thumb; shaped like a kidney beanRetrograde blood supplyMany are misdiagnosed as sprainMay not show up on xray until healing begins (may immobilize empirically and repeat xray in 1-2 wks)May cast for trial period with routine xraysTotal healing time of 10-12 weeks

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BOXER’S FRACTUREClassically at the base of 5th metacarpal (metacarpal neck)Seen after punching person or objectCommonly a bump over the back of palm just below the small finger knuckle; may not go away even with treatmentTreatment: casting or surgery (pins)

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BENNETT’S FRACTUREIntra-articular fracture/dislocation of base of 1st metacarpalSmall palmar fragment continues to articulate with trapeziumMechanism: forced abduction of thumb

Treatment: open reduction and internal fixation

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ROLANDO FRACTUREFracture through thumb metacarpal baseComminuted intraarticular fracture

Prognosis is worse than Bennett’sTreatment: open reduction and internal fixation

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INTERTROCHANTERIC HIP FX

Occurs lower than femoral neck fractureBone blood flow is usually intact, so repair, not replacement is performed

Treatment: Metal plate and screws

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FEMORAL NECK FRACTURE

Just below the ball of the ball-and-socket hip jointThe ball is disconnected from rest of the femurBlood supply is often disrupted, so there’s a high risk of non-healing

Treatment: Often with partial hip replacement, esp if > 65 yo

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FEMORAL SHAFT FXSevere injury

Treatment: Intramedullary rod (MC), plate and screws, or external fixator

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SUPRACONDYLAR FEMUR FX

Unusual injury just above knee jointHigh risk of knee arthritis laterMore common in pts with severe osteoporosis and those with previous knee replacement surgery

Treatment: Cast, brace, external fixator, plate, screws, intramedullary rod

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PATELLAR FRACTUREFall onto kneecap or when quadriceps is contracting, but knee joint is straightening (“eccentric contraction”)Attempt “straight leg raise”

yes? Non-operative treatment may be possibleno? surgery – combo of pins, screws, and wires

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TIBIAL PLATEAU FRACTURE

Just below knee jointInvolves the joint cartilage risk of arthritis

Treatment: If non-displaced, may be treated without surgery. Surgery for displaced fractures

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TIBIAL SHAFT FRACTUREMost common type of tibial fractureMost can be treated by long leg castMay require plates, screws, external fixator, or intramedullary rod

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TIBIAL PLAFOND FRACTURE

“Tibial Pilon Fracture”End of shin bone and involves ankleSoft-tissue around ankle may be problematic if very swollen – makes surgery difficult

Treatment: casting, external fixation, limited internal fixation, internal fixation, ankle fusion

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POTT’S FRACTUREFracture of the lower end of fibula with displacement of tibiaCauses the foot to “turn out”

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TALUS FRACTUREComplications:

Ankle arthritisSubtalar arthritisFoot deformityAvascular necrosis

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CALCANEUS FRACTUREFall from heights or MVCLike an orange if you stand on it, the calcaneus widens and squashes flatInversion and eversion are affected (subtalar joint – b/w talus and calcaneus)

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FRACTURES OF 5th METATARSAL

Avulsion: “Dancer’s fracture;” tiny flecks of bone are pulled off by attached tendon; heal well in castJones: occurs at proximal end (in midportion of foot); cast for 6-8 wks

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Avulsion (Dancer’s)

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Jones’ fracture

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TORUS FRACTURE“Buckle fracture”Compression fracture of a long bone, mostly in children; usually occurs near metaphysisBetter seen on lateral filmsDistal radius is most common siteTreatment: well-fitting immobilizing cast for 2-4 weeks

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GREENSTICK FRACTUREUsually from a quick twisting motion occompanied by axial compression such as a fall backwards on the outstretched handSupinated twist palmar angulationPronated twist dorsal angulationNo disruption of cortex; may have buckling on opposite side of bone from the break; “incomplete break”

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How is a fracture diagnosed?Pain Swelling Bruising Discolored skin around the affected area Angulation - the affected area may be bent at an unusual angle The patient is unable to put weight on the injured area The patient cannot move the affected area The affected bone or joint may have a grating sensation If it is an open fracture there may be bleeding

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When a large bone is affected, such as the pelvis or femur

The sufferer may look pale and clammyThere may be dizziness (feeling faint).. ..as well as a feeling of sickness and nausea

If possible, do not move a person with a broken bone until a health care professional is present and can assess the situation and, if required, apply a splint.

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What are the treatment options for a bone fracture?

Fracture treatment is usually aimed at making sure there is the best possible function of the injured part after healing. Treatment also focuses on providing the injured bone with the best circumstances for optimum healing (immobilization).

For the natural healing process to begin, the ends of the broken bone need to be lined up - this is known as reducing the fracture.

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ImmobilizationPlaster casts or plastic functional braces - these hold the bone in position until it has healed. Metal plates and screws - current procedures use minimally invasive techniques. Intra-medullary nails - Internal steel rods are placed down the center of long bones. Flexible wires may be used in children. External fixators - these may be made of metal or carbon fiber; they have steel pins that go into the bone directly through the skin. They are a type of scaffolding outside the body.

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What are the possible complications of a bone fracture?

Heals in the wrong position - this is known as a malunion; either the fracture heals in the wrong position or it shifts (the fracture itself shifts).

Disruption of bone growth - if a childhood bone fracture affects both ends of bones, there is a risk that the normal development of that bone may be affected, raising the risk of a subsequent deformity.

Persistent bone or bone marrow infection - if there is a break in the skin, as may happen with a compound fracture, bacteria can get in and infect the bone or bone marrow, which can become a osteomyelitis. Patients may need to be hospitalized and treated with antibiotics.

Bone death (avascular necrosis) - if the bone loses its essential supply of blood it may die.