FRACTURES

Skull fracture Basilar skull fracture Blowout fracture - a fracture of the walls or floor of the orbit

A severe blow to the orbit (as from a baseball) may cause the contents of the orbital cavity to explode downward through the floor of the orbit into the maxillary sinus. Damage to the infraorbital nerve, resulting in altered sensation to the skin of the cheek, upper lip, and gum, may occur.

Mandibular fracture Nasal fracture

Fractures of the nasal bones, because of the prominence of the nose, are the most common facial fractures; the overlying skin may also be lacerated. Although most are simple fractures and are reduced under local anesthesia, some are associated with severe injuries to the nasal septum and require careful treatment under general anesthesia.

Le Fort fracture of skull - facial fractures involving the maxillary bone and surrounding structures in a usually bilateral and either horizontal, pyramidal or transverse way.

Maxillofacial fractures usually occur as the result of massive facial trauma. There is extensive facial swelling, midface mobility of the underlying bone on palpation, malocclusion of the teeth with anterior open bite, and possibly leakage of cerebrospinal fluid

Spinal fracture Cervical fracture

Fracture of C1, including Jefferson fracture Fracture of C2, including Hangman's fracture Flexion teardrop fracture - a fracture of the anteroinferior aspect

of a cervical vertebral Clay-shoveler fracture - fracture through the spinous

process of a vertebra occurring at any of the lower cervical or upper thoracic vertebrae

Burst fracture - in which a vertebra breaks from a high-energy axial load

Compression fracture - a collapse of a vertebra, often in the form of wedge fractures due to larger compression anteriorly.

Chance fracture - compression injury to the anterior portion of a vertebral body with concomitant distraction injury to posterior elements

Holdsworth fracture - an unstable fracture dislocation of the thoracolumbar junction of the spine

Rib fractureSternal fractureShoulder fracture Clavicle fracture

Classification is based on fracture location:– Fracture located at medial, middle (most common), or distal third

of the clavicle.Clinical Features• Pain in the shoulder region• May or may not have an obvious deformity

Scapular fractureScapular fractures commonly occur in association with other serious

injuries. The diagnosisoften is easily missed on the initial exam.• Mechanism typically is a direct blow to the shoulder usually after a

significant, highvelocity trauma (MVA, motorcycle accident).• Associated with other significant injuries such as rib fractures,

pulmonary contusions, pneumothorax/hemothorax.• Fracture sites: glenoid, glenoid rim, coracoid, scapular neck and

body, acromion

Arm fracture Humerus fracture (fracture of upper arm)

Holstein-Lewis fracture - a fracture of the distal third of the humerus resulting in entrapment of the radial nerve.

Posadas fracture – transcondylar fracture of the elbow

Proximal humeral fracture

Four-Part Classification One-part humeral fracture: nondisplaced,

impacted fractures. All parts still in alignment.

Two-part humeral fracture: one fragment is displaced with respect to the other three.

Three-part humeral fracture: two fragments are displaced.

Four-part humeral fracture: all fragments are displaced.

Forearm fracture

Radius fracture Essex-Lopresti fracture - a fracture of the 

radial head with concomitant dislocation of the distal radio-ulnar joint with disruption of the interosseous membrane.

Radial Head Fracture• Dislocations of the elbow are commonly associated with radial head fracturesClassification• Type I: nondisplaced• Type II: marginal radial head fracture, minimal displacement• Type III: comminuted fracture

Distal radius fracture Galeazzi fracture - a fracture of the radius with

dislocation of the distal radioulnar joint Colles' fracture - a distal fracture of the radius

with dorsal (posterior) displacement of the wrist and hand

Smith's fracture - a distal fracture of the radius with volar (ventral) displacement of the wrist and hand

Barton's fracture - an intra-articular fracture of the distal radius with dislocation of the radiocarpal joint

Forearm fracture Ulnar fracture

Monteggia fracture - a fracture of the proximal third of the ulna with the dislocation of the head of the radius

Hume fracture - a fracture of the olecranon with an associated anterior dislocation of the radial head

Night Stick fracture – fracture of the shaft of the ulna Olecranon Fracture• Direct blow to the elbow such as a fall onto the elbow with the elbow flexed.• Fall on an outstretched arm in association with a dislocation.Classification• Nondisplaced• DisplacedClinical Features• Swelling and ecchymosis with an obvious deformity.• Pain on gentle range of motion.• Numbness and paresthesias with radiation distally to the fourth and fifth digits with ulnar nerve involvement.

Wrist bones

SCAPHOID FRACTUREGeneral• One of the most common fractures of the wrist comprising 70% of carpal bone fractures.Mechanism of Injury• A fall or blow on a hyperextended (dorsiflexed) wrist.• Osteonecrosis of the bone may develop secondary to its blood supply.• The majority of the blood supply is to the distal 1/3 of the bone. Therefore, the middle and proximal portion of the bone have a large nonunion rate (1/3 developing osteonecrosis).

Wrist bones

HAMATE FRACTURESGeneral• Body fractures often from direct trauma.• Fractures of the hook of the hamate can occur at end swing while holding a racquet, bat,or club.Clinical Features• Ulnar and palmar wrist pain with racquet, bat, or club swing.• Pain over the hook of the hamate.• Pain over the dorsoulnar hamate.

TRAPEZIUM FRACTURESGeneral• Isolated fractures are rare.• May occur when the base of the thumb metacarpal is forced by axial load into the trapezium.• Can occur also as an avulsion fracture.

Hand fractures

Rolando fracture - a comminuted intra-articular fracture through the base of the first metacarpal bone

Bennett's fracture - a fracture of the base of the first metacarpal bone which extends into the carpometacarpal (CMC) joint.

Boxer's fracture - a fracture at the neck of a metacarpal

Pelvic fracture Duverney fracture - an isolated pelvic

fracture involving only the iliac wing. HIP FRACTURES

General• Osteoporosis of the hip carries increased incidence of fracture.• Osteoporosis of the hip is associated with both fixed and modifiable risk factors.– Fixed risk factors include age, sex, and race.Approximately 60% of hip fractures occur in patients > 75 years of age.Females have higher incidence of hip fracture than males.

Classification is based on the anatomy of the proximal femur and consists of 3 main types: intracapsular, intertrochanteric, and

subtrochanteric

INTRACAPSULAR OR FEMORAL NECK FRACTURES• Morbidity associated with the fracture involves disruption of the blood vessels to the femoral head causing necrosis.• Postoperatively, complications can include a nonunion or osteonecrosis.

• Fractures of the femoral neck are classified by Garden Classification– Stage I: incomplete, nondisplaced with occasional valgus angulation.– Stage II: complete, nondisplaced, occasionally unstable.– Stage III: displaced with the hip joint capsule partially intact.– Stage IV: displaced with the hip joint capsule completely disrupted.

INTERTROCHANTERIC HIP FRACTURESGeneral• This is the most common type of hip fracture.• Highly fragmented fractures may result in significant blood loss and hypovolemia.• Postoperatively, a leg length discrepancy may result due to comminution status postfixation.• Moderately high forces are generated in this area, and a strong fixation is required.• Fractures may be undisplaced, displaced 2-part fractures, or unstable 3-part fractures.

SUBTROCHANTERIC HIP FRACTURESGeneral• This region is subjected to very high mechanicalstresses and is the most difficult to stabilizesurgically.• Fractures may be simple, fragmented, orcomminuted.

Patella fracture Crus fractureTibia fracture Bumper fracture - a fracture of the lateral 

tibial plateau caused by a forced valgus applied to the knee

Segond fracture - an avulsion fracture of the lateral tibial condyle

Gosselin fracture - a fractures of the tibial plafond into anterior and posterior fragments

Toddler's fracture - an undisplaced and spiral fracture of the distal third to distal half of the tibia

Fibular fracture Maisonneuve fracture - a spiral fracture of

the proximal third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane.

Le Fort fracture of ankle - a vertical fracture of the antero-medial part of the distal fibula with avulsion of the anterior tibiofibular ligament.

Bosworth fracture - a fracture with an associated fixed posterior dislocation of the proximal fibular fragment which becomes trapped behind the posterior tibial tubercle. The injury is caused by severe external rotation of the ankle.[10]

Combined tibia and fibula fracture Trimalleolar fracture - involving the 

lateral malleolus, medial malleolus and the distal posterior aspect of the tibia

Bimalleolar fracture - involving the lateral malleolus and the medial malleolus.

Pott's fracture

Foot fracture Lisfranc fracture - in which one or all of the 

metatarsals are displaced from the tarsus Jones fracture - a fracture of the proximal

end of the fifth metatarsal March fracture - a fracture of the distal third

of one of the metatarsals occurring because of recurrent stress

Nutcracker fracture: cuboid fracture Calcaneal fracture