1. FRACTURES
By Mahima Charan
4th Year Medical Student

2. Key Points I. Definition; A disruption in the continuity of a bone.
II. Open Vs Closed
III.Location
IV. Simple/Comminuted
V. Types/Pattern
VI. Displacement/Angulation/Shortening

3. Open Vs Closed Open ( “open to the air”)
A fracture in which bone penetrates through the skin . Look out for an open wound/soft tissue laceration.
Closed
Fracture with intact overlying skin.

4. Location Can be described in many ways; Segmental (long bones)
Epiphysis, Metaphysis, Diaphysis
2. Thirds (long bones)
Proximal 1/3, Middle 1/3, Distal 1/3
3. Anatomical landmarks
Head, Neck, Body, Condyle, Base

5. e.g. anatomical landmarks to describe fractures
Neck of Femur
e.g. anatomical landmarks to describe fractures

6. A fracture that consists of the bone breaking into 2 fragments
Simple Fracture;
A fracture that consists of the bone breaking into 2 fragments
The fracture passes at an angle oblique (> 30o) to the shaft of the long bone
The fracture passes at right angles/<30o to the shaft of the long bone
Oblique
(Metartarsal)
Transverse (Tibia)

7. Simple spiral Fracture
This fracture of the tibia resulted from a twisting injury.
The fracture line spirals along the shaft of the long bone

8. Proximal humeral shaft
Comminuted
A bone injury that results in >2 separate components is known as a commented fracture. This is also known as a multi-fragmentary fracture.
Proximal humeral shaft

10. Fracture Displacement
Displacement of fractures is defined in terms of the abnormal position of the distal fracture fragment in relation to the proximal bone.
Types of displacement include-
Angulation
Rotation
Shortening
Impaction and Distraction

11. Angulation and Rotation
To describe fracture angulation the direction of the distal bone and degree of angulation in relation to the proximal bone should be stated.
Medial angulation can be termed ‘varus’ and lateral angulation ‘valgus’
Rotation of a long bone may be internal or external

12. The fracture on the left has resulted in angulation of the distal component.
The fracture on the right has resulted in rotation of the distal component

13. Shortening
Proximal migration of the distal fracture component results in shortening of the overall bone length.
An oblique fracture is more readily shortened than a transverse fracture, which would need to be fully 'off-ended' before it can shorten.
The fracture on the left is displaced without shortening
The fracture on the right is both displaced and shortened

14. Impaction and Distraction
A fracture resulting in increased overall bone length, is due to distraction (widening) of the bone components.
If there is shortening of bone without loss of alignment, the fracture is impacted. The bone substance of each component is driven into the other.
The left image shows fracture widening or distraction.
The right image shows a line of increased density due to fracture impaction.

15. Let’s have a look at some common fractures…..

16. Humeral
fracture

17. Elbow
The lateral image shows the anterior fat lad is raised way from the humerus but does not show a fracture.
Posterior fat pad visible- ALWAYS ABNORMAL
A fracture of the radial head is visible on the AP image

18. Monteggia vs Galeazzi
A Monteggia injury; fracture of the ulna shaft with dislocation of the radial head at the elbow. The radiocapitellar line should pass through the midline of the capitulum of the humerus.
A Galeazzi injury is a fracture of the radial shaft with dislocation of the ulna from its articulation with the radius at the distal radio-ulnar joint.

19. Monteggia

20. Colles Fracture Common injury in elderly people with low bone density.
Classically the injury comprises a transverse fracture of the distal radius with dorsal displacement and shortening of the wrist.
The fracture is often accompanied by a fracture of the ulnar styloid.
Classical presentation is “Fall on an outstretched hand”

22. Normal Hip Anatomy

23. Garden Classification for NOF Fractures
If displaced, may present with shortened and externally rotated leg!
Tx- I/II Put in a screw
III/IV Austin Moore ( hemiarthroplasty)
Garden Classification for NOF Fractures

24. Avascular Necrosis (greater risk in intracapsular fractures and scaphoid fractures ( tenderness in anatomical snuffbox)

25. Scaphoid Fracture

26. Principles of Management
I. First aid- If open ( clean wound, debride, tetanus injection)
Analgesia for pain associated with fracture
II. Immobilise (traction, splints, casts)
III. Reduction ( if displaced)
IV. Active Rehabilitation
DON’T FORGET YOU NEED 2 VIEWS ON AN XRAY!

27. Open Reduction Internal Fixation

28. Immobilise ( e.g. Kirschner wires

29. Fracture Complications
Soft tissue injury and neurovascular compromise
Malunion
Non-union
Avascular Necrosis
Osteopenia
Compartment Syndrome
Sudecks atrophy (Complex regional pain syndrome)

30. Thankyou very much!
Mahima Charan