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Chapter: Medicine Study Notes : Musculo-Skeletal


Check quality and that film covers the pathology you want



·        Check name and date

·        Check quality and that film covers the pathology you want


Rules of 2


·        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


Describing a fracture


·        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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