Radiology
·
Check name and date
·
Check quality and that film
covers the pathology you want
·
ALWAYS take 2 views at 90%
·
Include 2 joints: one above and
one below:
o Especially in paired bones of arm and leg. If there is a fracture with
shortening, there will also be dislocation
o Need to assess rotation relative to joint
·
Sometimes need to Xray 2 times.
Eg May not see a scaffoid fracture until 10 – 14 days later (will see it with a
bone scan after ~ 24 hours)
·
Sometimes need to do opposite
side to get a good idea of normal – especially if dealing with a complicated
joint in a child with lots of epiphyseal plates around. Don‟t do it routinely
due to  radiation
·
Which bone
· Site (where on the bone):
o For a femur it can be capital (through the head), subcapital (below the head), transcervical (through the neck), intertrochanteral, supracondylar, at the junction of the proximal and middle thirds, etc
o Diaphysis: mid-portion or shaft of a long bone. Outer cortex and inner medulla
o Epiphysis: Ends of long bones
o Metaphysis: rapidly growing trabecular bone underlying the growth plate
·
Type:
o Greenstick: only the convex side of the injured cortex is disrupted,
transverse fracture. Only in kids (higher collagen content and less
mineralisation). Can also present as:
§ Bowing of a long bone
§ Buckle: fracture around the epiphysis if the force was along the axis of
the bone
o Transverse: force at 90% to bone ie direct blow (Þ also
soft tissue injury). Stable when reduced
o Oblique: force at 90% while weight bearing (net vector is oblique). Slips out of reduction
o Spiral: rotatory force – twisting.
Don‟t need big force
o Comminuted (> 2 pieces)
o Epiphyseal: described by Salter-Harris Classification: from I to V (most
complex). II most common (break through epiphysis with a small chip of bone)
o Intra-articular
o Segmental: 2 breaks separated by a section of normal bone. Big force required
o Stress: fractured bone trying to heal itself and refracturing, etc. May
be visible on X-ray, will be visible as a hot spot on bone scan
o Avulsion: ligament tears off bone
·
All fractures can also be:
o Pathological
o Simple or compound (bone communicates with air). If compound then
Gustilo Classification from I (minor) to III (extensive)
· Further description of the fracture: LARD
o Length: is it shortened or distracted (lengthened, eg soft tissue falling into the gap at the time of impact)
o Angulation: degree and direction. Described as the distal relative to the proximal
portion when in the anatomical
position. Medial is varus, lateral is valgus
o Rotation
o Displacement/Translation: are the two ends aligned? Range from 0 to 100% displaced, and direction of displacement
·
Associated symptoms: eg
o Compound wound (eg may see air
in soft tissue)
o Compartment syndromes
o Foreign bodies, etc
·
Types of joint injury:
o Sprain: tearing of ligaments
o Subluxation: partial loss of congruity of the articular surfaces
o Dislocation: complete loss of congruity of the articular surfaces
o Fractured dislocation
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