FRACTURES AND DISLOCATIONS

FRACTURES AND

DISLOCATIONS

Keith Kenter, MD

Assistant Professor

Sports Medicine & Shoulder Reconstruction

Director of Resident Education

Department of Orthopaedic Surgery

University of Cincinnati

WHY DO WE NEED TO KNOW THIS ?

IMPORTANCE

BECAUSE WE WANT TO BECOME

ORTHOPAEDIC SURGEONS

AND

THIS STUFF IS REALLY COOL

IMPORTANCE

• Communication

• Treatment plans/algorithms

• Prognostic indicators

FRACTURES

DESCRIPTION

• The bone – name

• Location on bone

• Type of fracture

• Fracture personality

• Fracture displacement

• Fracture angulation

BONE NAME

SIMPLY START BY NAMING THE BONE

Commonly named examples:

Jefferson Fracture

Both Bone Forearm Fracture

Tib/Fib Fracture

Jones Fracture

Bennett’s Fracture

Straddle Fracture

LOCATION ON BONE

DESCRIBE THE LOCATION

• Shaft, metaphysis, epiphysis

• Proximal, distal

• Neck, head, dome

• Condyle, tuberosity, styloid

FRACTURE TYPE

• Open (Compound) fracture

• Closed fracture

• Intra-articular fracture (periarticular)

FRACTURE PERSONALITY

GEOMETRIC PATTERN

• Oblique

• Spiral

• Transverse

• Comminuted - Multiple fracture fragments

- Butterfly fragment

- Segmental fragment

• Impacted (Compression)

• Burst (special pattern seen in vertebral bodies)

• Avulsion

FRACTURE DISPLACEMENT

BONY APPOSITION

• Nondisplaced

“fractured not broken”

• Minimally displaced

• Incomplete - only one cortex disrupted

• Intra-articular - measure articular gap of step

off

FRACTURE ANGULATION

• Direction of apex of angle

(apex volar or dorsal, apex medial or lateral)

• Direction of distal fragment

(Valgus or Varus)

• Length of fracture (shortened, distracted)

• Rotation

• Translation

SPECIAL FRACTURES

OPEN FRACTURE CLASSIFICATION

• Grade 1 wound < 1 cm

• Grade 2 wound 1 cm-10 cm

• Grade 3 wound > 10 cm

A adequate soft tissue coverage

B severe soft tissue stripping

C vascular compromise for repair

PATHOLOGIC FRACTURES

Fractures that occur through abnormal bone and

typically spontaneous or with minor trauma

Tumors

Osteoporosis

SPECIAL FRACTURES

STRESS FRACTURES

Microscopic fractures that occur from repetitive

microtrauma

Military recruits

Female triad

(stress fracture, anorexia, amenorrhea)

SPECIAL FRACTURES

SALTER-HARRIS FRACTURES

AVASCULAR NECROSIS

• Femoral neck

• Scaphoid

• Talar neck

SPECIAL FRACTURES

COMPLICATIONS

• Neurovascular injury

• Acute compartment syndrome

• Infection – osteomyelitis

• Nonunion/Delayed union

• Malunion

• Fat embolism

• DVT-Pulmonary embolism

COMPLICATIONS

BLEEDING

• Tibia fracture - 1 unit pRBCs

• Femur fracture - 2 units pRBCs

• Pelvic fracture - 3 units pRBCs

DISLOCATIONS

DEFINITIONS

• Dislocation – Complete disruption of the

articular surface of a joint

• Subluxation – partial dislocation

• Laxity – physiologic translation of a joint

DISLOCATIONS

DESCRIPTION

• Typically described in the direction of the

distal most bone

• Do not forget rotational types of dislocations

(usually in the knee)

COMPLICATIONS

• Neurovascular compromise

• Articular surface and cartilage

• Blood supply

REDUCTION

• Gentle maneuver

• Pain medication

• Control muscle spasms

URGENCIES

• Open fracture

• Dislocations

• Fractures that demonstrate skin compromise

• Neurovascular compromise

• Acute compartment syndrome

• Unstable pelvic fractures with hemodynamic

instability

• Multiple fractures in polytrauma patient

CASE PRESENTATION

58 year old female walking in yard stepped on a

small rock and inverted her ankle. She felt a

pop and had pain with weight-bearing on the

lateral aspect of her foot.

CASE PRESENTATION

19 year old male kicked in shin when playing

soccer. Significant pain in leg and unable to

weight bear.

18 year old male involved in MVC – head on,

unrestrained driver with no LOC.

Complaining of abdominal pain and thigh

pain. No N/V compromise in leg and skin

intact.

CASE PRESENTATION

23 year old male playing ultimate Frisbee

twisted his ankle after catching a long pass.

Immediate pain and swelling and a deformity

noted by his teammates. Unable to weight

bear. Brought to UC where x-rays are

obtained.

CASE PRESENTATION

78 year old female with DM, CHF, and HTN fell

from chair today while in her room at the

nursing home. She is brought to the office

because of pain in her knee region and a

external rotated leg.

CASE PRESENTATION

35 year old female involved in a MVC – T-bone,

restrained driver with no LOC. Only

complaint is pain in her ankle. Her passenger

is upset because of the amount of blood on her

friend’s pants and exposed bone.

CASE PRESENTATION

65 year old female slipped on ice 2 days ago

onto her outstretched hand. Immediate pain in

her shoulder with any motion. She has also

noticed swelling and numbness on the lateral

side of her shoulder.

CASE PRESENTATION

17 year old male playing rugby cut when running

the ball. He was immediately hit anteriorly

and had a twisting and hyperextension injury

to his knee with severe pain. He notices a

deformity about the knee and a cold foot.

CASE PRESENTATION

SUMMARY

• Organized approach when looking at the x-rays.

• Always keep in mind the clinical presentation and

always perform a detailed history and PE.

• Understand that orthopaedic emergencies do occur

and that prompt treatment can save a limb or life.

THANK

YOU