Language of Fractures

[Pages:13]Language of Fractures

page 1 of 13

Language of Fractures

Looking at Bones in General

Topics

Language of Fractures

Intro 1 2 3 Title:

Patterns Robert Jordan Schultz

Orientation Displaced Angulated

Orthopedic Surgeon Out of print since 1990

Bone Ends Ideas in this talk:

Immature My 20 years of trying

S-H Plastic

to understand fractures

Torus

Occult

Stress 4

Don't Miss



? 2011 Ken L Schreibman, PhD/MD

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Slide 1 of 76

Language of Fractures

Looking at Bones in General

Why are Fractures Hard?

Intro 1 2 3 There are 206 bones!

Patterns Carpals: Scaphoid, Lunate, Triquetrum, Pisiform (proximal row)

Orientation

Hamate, Capitate, Trapezoid, Trapezium (distal row)

Displaced Fingers: Thumb, Index, Long, Ring, Small

Angulated

(Metacarpals, Phalanges)

Bone Ends Tarsals: Talus, Calcaneus, Navicular, Cuboid, 3 Cuneiforms

Immature Arm: Scapula, Humerus, Radius, Ulna

S-H

Leg: Femur, Patella, Tibia, Fibula

Plastic Pelvis: Sacrum, Innominate (Ilium, Ischium, Pubic)

Torus Spine: Cervical (7), Thoracic (12), Lumbar (5), [ribs & sternum]

Occult

Skull: 1 big bone + Mandible

Stress 4

Maxilla, Nasal, Frontal, Parietal, Occipital, Temporal,

Don't Miss

(Zygomatic, Sphenoid, Ethmoid, Lacrimal)



? 2011 Ken L Schreibman, PhD/MD

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Slide 2 of 76

Language of Fractures

Looking at Bones in General

Why are Fractures Hard?

Intro 1 2 3 There are 206 bones!

Patterns Orientation

Displaced

They're all different!

They have different functions.

Angulated Exposed to different

Bone Ends mechanical forces.

Immature They each respond differently

S-H

to stress/trauma.

Plastic

Torus

Occult

Stress 4

Don't Miss



? 2011 Ken L Schreibman, PhD/MD

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Slide 3 of 76

Language of Fractures

Looking at Bones in General

Example: Metatarsals

Intro 1 2 3 1st MT:

Patterns Orientation

Displaced Angulated Bone Ends

Fractures

Rare

Common

OA

Immature 2nd MT:

S-H

Fractures

Plastic

Common

Torus

Stress

Occult

(Fatigue)

Stress 4

"March"

Don't Miss



? 2011 Ken L Schreibman, PhD/MD

H,K 37yoF

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5th MT:

Fractures

Very Common Base 5th MT

1) Avulsion Fx 99% Heal

2) Jones Fx 50% non-union

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Slide 4 of 76

Language of Fractures

Looking at Bones in General

Why are Fractures Hard?

Intro 1 2 3 There are 206 bones!

Patterns Orientation

They're all different!

Displaced They have different functions.

Angulated Exposed to different mechanical

Bone Ends forces.

Immature S-H Plastic Torus

Occult

They each respond differently to stress/trauma.

Even where fractures occur within a bone affects the

Stress 4 treatment, prognosis

Don't Miss



? 2011 Ken L Schreibman, PhD/MD

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Slide 5 of 76

Language of Fractures

Looking at Bones in General

Example: Proximal Femur Factures

Intro 1

2

3

Femoral Neck Fx min displaced

Patterns

Orientation

Displaced

Intertrochanteric Fx min displaced

Intact Dynamic Hip Screw

Angulated

Bone Ends

Immature

C,T 63yoM Subtrochanteric Fx

S-H

Percutaneous Pinning

Femoral Neck Fx displaced

M,L 90yoF

Plastic Torus

Hip Prosthesis

Occult

Stress 4

Don't Miss K,C 35yoF

Intramedullary nail C,G 71yoF



? 2011 Ken L Schreibman, PhD/MD

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Slide 6 of 76

?Ken L Schreibman, PhD/MD 7/28/15

Language of Fractures

page 2 of 13

Language of Fractures

Looking at Bones in General

Bone Model

Intro 1 2 3 White Line = Black Box = Radiograph

Patterns

Cortical Bone

Orientation

Displaced

Angulated Bone Ends Immature

S-H

T i b i a

Plastic

Torus

Occult

Gray Fill =

Stress 4 Trabecular Bone

Don't Miss (Cancellus)



? 2011 Ken L Schreibman, PhD/MD

G,D 18yoM

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Slide 7 of 76

Language of Fractures

Looking at Bones in General

Terminology

Intro 1 2 3 AP Lateral Radiographic Views

Patterns

AP (Anterior Posterior)

Orientation

Displaced L Angulated A

Bone Ends T

Immature E

S-H

R

Plastic Torus

A L

Occult

Stress 4

Don't Miss

P

TM iE bD iI aA

L

O S T E R I O

R

Most frontal radiographs

A PA (Posterior Anterior)

N Hands, wrists

T Chest (Standard non-portable)

E Lateral view

R From the side (RL, LR)

I O R

Patient sides

Medial: Towards Lateral: Towards

the the

middle side

Anterior: Front (Volar)

Posterior: Back (Dorsal)



? 2011 Ken L Schreibman, PhD/MD

G,D 18yoM

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Slide 8 of 76

Language of Fractures

Looking at Bones in General

Simple vs Comminuted

Intro 1 2 3

Patterns

Orientation Displaced

Proximal

Angulated

Bone Ends

Immature

S-H

Plastic

Torus

Distal

Occult

Stress 4

Don't Miss



? 2011 Ken L Schreibman, PhD/MD

T,L 59yoM

Proximal Distal

Simple Fx:

2 fragments

Proximal fragment

[L] proximus: "nearest" Near body attachment

Distal fragment

[L] distare: "distant" away from attachment

Comminuted:

>2 fragments

Segmental fragment

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Slide 9 of 76

Language of Fractures

Looking at Bones in General

Simple vs Comminuted

Intro 1 2 3

Patterns

Orientation

Displaced

Angulated

Bone Ends Immature

S-H

Butterfly

Plastic

Torus

Occult

Stress 4

Don't Miss



? 2011 Ken L Schreibman, PhD/MD

B,J 41yoM

Simple Fx:

2 fragments

Proximal fragment

[L] proximus: "nearest" Near body attachment

Distal fragment

[L] distare: "distant"

away from attachment

Butterfly

Comminuted:

>2 fragments

Segmental fragment Butterfly fragment

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Slide 10 of 76

Language of Fractures

Looking at Bones in General

Simple vs Comminuted

Intro 1 2 3 Patterns Orientation

Displaced Angulated Bone Ends Immature S-H Plastic Torus Occult Stress 4 Don't Miss



? 2011 Ken L Schreibman, PhD/MD

H,L 66yoM

Simple Fx:

2 fragments

Proximal fragment

[L] proximus: "nearest" Near body attachment

Distal fragment

[L] distare: "distant" away from attachment

Comminuted:

>2 fragments

Segmental fragment Butterfly fragment Severely comminuted

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Slide 11 of 76

Language of Fractures

Looking at Bones in General

Fracture Orientation

Intro 1 2 3 Patterns Orientation

Displaced Angulated Bone Ends Immature S-H Plastic Torus Occult Stress 4 Don't Miss



? 2011 Ken L Schreibman, PhD/MD

Transverse

Horizontal

V,B 20yoM

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Slide 12 of 76

?Ken L Schreibman, PhD/MD 7/28/15

Language of Fractures

page 3 of 13

Language of Fractures

Looking at Bones in General

Fracture Orientation

Intro 1 2 3 Patterns Orientation

Displaced Angulated Bone Ends Immature S-H Plastic Torus Occult Stress 4 Don't Miss



? 2011 Ken L Schreibman, PhD/MD

J,P 50yoF

Transverse

Horizontal Avulsion

End of bone

Weber A Longitudinal

Vertical Compression

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Oblique

Diagonal Most common

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Slide 13 of 76

Language of Fractures

Looking at Bones in General

Fracture Orientation

Intro 1 2 3

Patterns

Orientation

Displaced

Angulated

Bone Ends

Immature

S-H

Plastic

Torus

Occult

Stress 4

Don't Miss



Universal Studios

? 2011 Ken L Schreibman, PhD/MD Orlando, Florida

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Spiral Fracture

Twisting injury Resembles:

Oblique fracture

Butterfly frag.

Need multiple views to see the spiral

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Slide 14 of 76

Language of Fractures

Looking at Bones in General

Fracture Orientation

Intro 1 2 3 Patterns Orientation

Displaced Angulated Bone Ends Immature S-H Plastic Torus Occult Stress 4 Don't Miss



? 2011 Ken L Schreibman, PhD/MD

AP Lateral Spiral Fracture

Twisting injury Resembles:

Oblique fracture

Butterfly frag.

Need multiple views to see the spiral

A,J 41yoM

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Slide 15 of 76

Language of Fractures

Looking at Bones in General

Fracture Orientation

Intro 1 2 3 Patterns Orientation

Displaced Angulated Bone Ends Immature S-H Plastic Torus Occult Stress 4 Don't Miss



? 2011 Ken L Schreibman, PhD/MD

AP Lateral Spiral Fracture

Twisting injury Resembles:

Oblique fracture Butterfly frag.

Need multiple views to see the spiral

K,P 68yoF

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Slide 16 of 76

Language of Fractures

Looking at Bones in General

Fracture Orientation

Intro 1 2 3 Patterns Orientation

Displaced Angulated Bone Ends Immature S-H Plastic Torus Occult Stress 4 Don't Miss



? 2011 Ken L Schreibman, PhD/MD

H,C 3yoM

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Spiral Fracture

Twisting injury Resembles:

Oblique fracture Butterfly frag.

Need multiple views to see the spiral

Toddlers Fx

Distal Tibia < 5 years old

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Slide 17 of 76

Language of Fractures

Looking at Bones in General

Displacement

Intro 1 2 3 Patterns Orientation

Displaced Angulated Bone Ends Immature S-H Plastic Torus Occult Stress 4 Don't Miss



? 2011 Ken L Schreibman, PhD/MD

F,J 33yoM

RULE:

We describe displacement of distal fragment

relative to proximal fragment

"There is an oblique fracture of the distal tibia, with

lateral displacement of the distal fracture fragment ?-shaft width."

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Slide 18 of 76

?Ken L Schreibman, PhD/MD 7/28/15

Language of Fractures

page 4 of 13

Language of Fractures

Looking at Bones in General

Displacement

Intro 1 2 3 Patterns Orientation

Displaced Angulated Bone Ends Immature S-H Plastic Torus Occult Stress 4 Don't Miss



? 2011 Ken L Schreibman, PhD/MD

R,G 33yoM

RULE:

We describe displacement of distal fragment

relative to proximal fragment

"There is an transverse fracture of the distal tibia, with lateral displacement of the distal fracture fragment

by 1-shaft width."

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Slide 19 of 76

Language of Fractures

Looking at Bones in General

Displacement: Check all Views

Intro 1 2 3 Patterns Orientation

Displaced Angulated Bone Ends Immature S-H Plastic Torus Occult Stress 4 Don't Miss



? 2011 Ken L Schreibman, PhD/MD

Lateral

AP

"Minimally "Posterior (dorsal) displaced on displacement 2-shafts" AP view"

N,D 21yoM

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Slide 20 of 76

Language of Fractures

Looking at Bones in General

Open (Compound) Fracture

Intro 1 2 3 Patterns Orientation

Displaced Angulated Bone Ends Immature S-H Plastic Torus Occult Stress 4 Don't Miss



? 2011 Ken L Schreibman, PhD/MD

N,D 21yoM

Fractured end of the

bone is poking through

the skin.

Common with Tibia Fxs

Very little skin covers tibia

Sterile bone is exposed

to the non-sterile air...

Bone is now infected

"Osteomyelitis"

Requires:

Surgical washout IV antibiotics (6 weeks)

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Slide 21 of 76

Language of Fractures

Looking at Bones in General

Displacement... exceptions

Intro 1 2 3 Clavicle

Patterns Proximal fragment relative to distal

Orientation Neck muscles pull the proximal fragment up

Displaced Angulated Bone Ends

"Superior displacement proximal clavicle fragment ?-shaft width"

"Superior displacement proximal clavicle fragment 2-shaft widths"

Immature

S-H

Plastic

Torus

Occult

Stress 4

Don't Miss V,K 2yoF

C,J 5yoM



? 2011 Ken L Schreibman, PhD/MD

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Slide 22 of 76

Language of Fractures

Looking at Bones in General

Displacement... exceptions

Intro 1 2 3 Clavicle

Patterns Proximal fragment relative to distal Orientation Neck muscles pull the proximal fragment up

Displaced "Superior displacement proximal Angulated clavicle fragment >2-shaft widths, Bone Ends with a segmental fragment"

Immature

S-H

Healing

Plastic

Torus

Occult

Stress 4

Don't Miss



? 2011 Ken L Schreibman, PhD/MD

F,N 13yoM

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Slide 23 of 76

Language of Fractures

Looking at Bones in General

Displacement... exceptions

Intro 1 2 3 Clavicle

Patterns Proximal fragment relative to distal Orientation Neck muscles pull the proximal fragment up

Displaced "Superior displacement proximal Angulated clavicle fragment >2-shaft widths, Bone Ends with a segmental fragment"

Immature

Required internal

S-H

fixation

Plastic

Torus

Occult

Stress 4

Don't Miss



? 2011 Ken L Schreibman, PhD/MD

C,J 20yoM

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Slide 24 of 76

?Ken L Schreibman, PhD/MD 7/28/15

Language of Fractures

page 5 of 13

Language of Fractures

Looking at Bones in General

Displacement... exceptions

Intro 1 2 3 Spine ? Spondylolisthesis

T12

Patterns Displacement of the upper vertebral

Orientation Displaced

body relative to lower vertebral body

L1 L2

Angulated Bone Ends "Anterior slippage of Immature L5 on S1"

S-H

"Spondylolisthesis of

Plastic L5 on S1"

Torus Occult

Stress 4

"Anterolisthesis of L5 on S1"

L4

L5 S1

L3

L4

L5 S1

Don't Miss



? 2011 Ken L Schreibman, PhD/MD

V,G 26yoM

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Slide 25 of 76

Language of Fractures

Looking at Bones in General

Impaction

Intro 1 2 3 Patterns Orientation

Displaced Angulated Bone Ends Immature S-H Plastic Torus Occult Stress 4 Don't Miss



? 2011 Ken L Schreibman, PhD/MD

Fragments are driven into each other.

Foreshortened

"Telescoped in"

H,L 66yoM

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Slide 26 of 76

Language of Fractures

Looking at Bones in General

Override

Intro 1 2 3 Patterns Orientation

Displaced Angulated Bone Ends Immature S-H Plastic Torus Occult Stress 4 Don't Miss



? 2011 Ken L Schreibman, PhD/MD

LateAraPl Similar to impaction

Foreshortened Fragments overlap

OVERRIDE

S,A 46yoM

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Slide 27 of 76

Language of Fractures

Looking at Bones in General

Override

Intro 1 2 3 Patterns Orientation

Displaced Angulated Bone Ends Immature S-H Plastic Torus Occult Stress 4 Don't Miss



? 2011 Ken L Schreibman, PhD/MD

AP

Lateral

Posterior Displaced

OVERRIDE

L,B 12yoF

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Slide 28 of 76

Language of Fractures

Looking at Bones in General

Override

Intro 1 2 3 "Superior displacement proximal clavicle 1-shaft width"

Patterns

Orientation

Displaced Angulated

OVERRIDE

Bone Ends

Immature

S-H

Plastic

Torus

Occult

Stress 4

Don't Miss



? 2011 Ken L Schreibman, PhD/MD

C,A 6yoM

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Slide 29 of 76

Language of Fractures

Looking at Bones in General

Distraction

Intro 1 2 3 Patterns Orientation

Displaced Angulated Bone Ends Immature S-H Plastic Torus Occult Stress 4 Don't Miss



? 2011 Ken L Schreibman, PhD/MD

Fragments pulled apart

Doesn't usually occur as the result of direct trauma

Trauma tends impact/override

Patella fractures tend to distract

Distraction can occur when reducing fractures under traction

M,M 64yoM

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Slide 30 of 76

?Ken L Schreibman, PhD/MD 7/28/15

Language of Fractures

page 6 of 13

Language of Fractures

Looking at Bones in General

Diastasis: Joint Widening

Intro 1 2 3 Scaphoid-Lunate Joint

Patterns Orientation

Displaced

Space between scaphoid

& lunate should not be wider than the spaces

Angulated

between carpal bones.

Bone Ends Immature

S-H Plastic

S L

Not always due to trauma Scapholunate diastasis

Torus Occult

Stress 4 Don't Miss

Chondrocalcinosis

+ Chondrocalcinosis = CPPD aka "Pseudo-Gout"



? 2011 Ken L Schreibman, PhD/MD

W,M 88yoF

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Slide 31 of 76

Language of Fractures

Looking at Bones in General

Diastasis: Joint Widening

Intro 1 2 3 Pubic Symphysis

Patterns Orientation

Pre Motorcycle Accident

Displaced

Angulated

Bone Ends

Immature

S-H

Plastic Torus

Superior Pubic Ramus

Occult Stress 4 Don't Miss

Pubic Body

Inferior

Pubic

Ramus

Pubic

Symphysis



? 2011 Ken L Schreibman, PhD/MD

S,G 59yoM

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Slide 32 of 76

Language of Fractures

Looking at Bones in General

Diastasis: Joint Widening

Intro 1 2 3 Pubic Symphysis

Patterns

Orientation

Displaced

Angulated

Bone Ends

Immature

S-H Plastic

Diastasis Pubic Symphysis

Torus

Occult

Stress 4

Don't Miss



? 2011 Ken L Schreibman, PhD/MD

S,G 59yoM

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Slide 33 of 76

Language of Fractures

Looking at Bones in General

Angulation

Intro 1 2 3 Patterns Orientation

Displaced Angulated Bone Ends Immature S-H Plastic Torus Occult Stress 4 Don't Miss



? 2011 Ken L Schreibman, PhD/MD

Lateral

Need to specify what is angulated relative to what.

"Segmental tibia fractures, none of the fragments are very displaced"

"Dorsal angulation of the

Angle

distal fracture fragments"

or

"Vertex anterior angulation"

P,C 56yoF

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Slide 34 of 76

Language of Fractures

Looking at Bones in General

Angulation

Intro 1 2 3 Patterns Orientation

Displaced Angulated Bone Ends Immature S-H Plastic Torus Occult Stress 4 Don't Miss



? 2011 Ken L Schreibman, PhD/MD

L

A

T

E

Angle

R A

L

B,M 53yoM

AP Need to specify what is angulated relative to what.

"Lateral angulation of the

distal fracture fragment"

M E

or

D "Vertex medial angulation"

I A

or

L "Valgus angulation"

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Slide 35 of 76

Language of Fractures

Looking at Bones in General

Angulation: Valgus vs Varus

Intro 1 2 3 VALGUS:

Patterns Orientation

Displaced

Vertex deviated MEDIAL

Knee deviated medially

Angulated (knock-kneed)

Bone Ends

= "Genu Valga"

Immature Angle femoral neck/shaft

S-H

(normally 120?)

Plastic

is deviated medially

Torus

= "Coxa Valga"

Occult Stress 4 Don't Miss

Vertex deviated towards GENITALS



? 2011 Ken L Schreibman, PhD/MD

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Slide 36 of 76

?Ken L Schreibman, PhD/MD 7/28/15

Language of Fractures

page 7 of 13

Language of Fractures

Looking at Bones in General

Hallux Valgus

Intro 1 2 3

"Bunion"

Patterns Orientation

Displaced Angulated Bone Ends Immature S-H Plastic Torus Occult

VALGUS

1st MTP (Metatarsal-phalangeal joint)

"Hallux"

Joint deviates

Hallux

Varus

medially

"Valgus"

Very common

VARUS

in women

Due to tight

pointy shoes

Stress 4

Don't Miss

L,J 76yoF



? 2011 Ken L Schreibman, PhD/MD

A,F 69yoF

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Slide 37 of 76

Language of Fractures

Looking at Bones in General

Ends of Bones

Intro 1 2 3

Femoral Head

Humeral Head

Patterns Orientation

Displaced Angulated

Greater Lesser Trochanter

Lesser Greater

Tuberosity

Bone Ends

Joints: Articular Surfaces

Immature S-H Plastic Torus

Spherical articular surface: "Head" Knuckle-shaped surface: "Condyle"

Tendon Insertions

Occult Stress 4 Don't Miss

Medial Epicondyle Medial Femoral Condyle



math.mercyhurst.edu

? 2011 Ken L Schreibman, PhD/MD

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Slide 38 of 76

Language of Fractures

Looking at Bones in General

Extra vs Intra-Articular Fractures

Intro 1 2 3 Patterns Orientation

Displaced Angulated Bone Ends Immature S-H Plastic Torus Occult Stress 4 Don't Miss



? 2011 Ken L Schreibman, PhD/MD

Intra-articular fractures

Involve articular cartilage Extend into joints

Risk of developing 2? OA

Reduction must be anatomic

Extra-articular fractures

Don't involve joints Reduction can be relatively

anatomic Bones will remodel

Particularly with weight-bearing

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Slide 39 of 76

Language of Fractures

Intro 1 2 3 Patterns Orientation

Displaced Angulated Bone Ends Immature S-H Plastic Torus Occult Stress 4 Don't Miss



? 2011 Ken L Schreibman, PhD/MD

Looking at Bones in General

ImMmatauturereBBoonnee

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Slide 40 of 76

Language of Fractures

Looking at Bones in General

Parts of the Immature Bone

Intro 1 2 3 Patterns Orientation

Displaced Angulated Bone Ends Immature S-H Plastic Torus Occult Stress 4 Don't Miss



? 2011 Ken L Schreibman, PhD/MD

End of the bone Ununited Growth Plate

Part that flares out

Shaft

Epiphysis Physis

Metaphysis

Diaphysis

S,A 2yoM

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Slide 41 of 76

Language of Fractures

Looking at Bones in General

Salter-Harris Fractures

Intro 1 2 3 Patterns Orientation

Displaced Angulated Bone Ends Immature S-H Plastic Torus Occult Stress 4 Don't Miss



? 2011 Ken L Schreibman, PhD/MD

All involve the Physis

If fracture doesn't involve the physis not Salter-Harris

If the patient is skeletally mature (physis fused) not Salter-Harris

Physis fractures risk of premature growth plate fusion

Could lead to a leg length discrepancy

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Slide 42 of 76

?Ken L Schreibman, PhD/MD 7/28/15

Language of Fractures

page 8 of 13

Language of Fractures

Looking at Bones in General

Salter-Harris Fractures

Intro 1 2 3 Patterns

"Types I ? V"

Journal Bone & Joint Surgery 1963 v 45-A p.587-662

Orientation As the # goes up,

Displaced fractures get worse

Angulated

Bone Ends

Immature

S-H

Plastic

Torus

Occult

Stress 4

Don't Miss



? 2011 Ken L Schreibman, PhD/MD



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Slide 43 of 76

Language of Fractures

Looking at Bones in General

Salter-Harris: Type I

Intro 1 2 3 Patterns Orientation

Displaced Angulated Bone Ends Immature S-H Plastic Torus Occult Stress 4 Don't Miss



? 2011 Ken L Schreibman, PhD/MD

Physis Only

Can be quite subtle

Especially when non-displaced

Comparison with normal

contralateral side helps

Soft Tissue Painful Swelling Side

NO Soft Normal Tissue

Side Swelling

S-H I

Z,S 14yoM

Horizontal Lucency Fracture?

Unfused Physis? Jump to last slide viewed

NO Horizontal Lucency Physis is Fusing!

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Slide 44 of 76

Language of Fractures

Looking at Bones in General

Salter-Harris: Type I

Intro 1 2 3 Patterns Orientation

Displaced Angulated Bone Ends Immature S-H Plastic Torus Occult Stress 4 Don't Miss



? 2011 Ken L Schreibman, PhD/MD

Physis Only

Can be quite subtle

Even when slightly displaced

Need Multiple Views!

AP View Mortise View Lateral View

S-H I

Looks like normal tibial growth plate

Looks like normal tibial growth plate

Tibial Epiphysis Displaced Dorsally

Y,C 11yoF

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Slide 45 of 76

Language of Fractures

Looking at Bones in General

Salter-Harris: Type II

Intro 1 2 3 Patterns Orientation

Displaced Angulated Bone Ends Immature S-H Plastic Torus Occult Stress 4 Don't Miss



? 2011 Ken L Schreibman, PhD/MD

Physis + Metaphysis

Doesn't extend into the joint Most common type of S-H

PA View

M,K 13yoF

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Lateral

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Slide 46 of 76

Language of Fractures

Looking at Bones in General

Salter-Harris: Type II

Intro 1 2 3 Patterns Orientation

Displaced Angulated Bone Ends Immature S-H Plastic Torus Occult Stress 4 Don't Miss



? 2011 Ken L Schreibman, PhD/MD

Physis + Metaphysis

Doesn't extend into the joint Most common type of S-H

AP View

F,M 2yoF

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Lateral View

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Slide 47 of 76

Language of Fractures

Looking at Bones in General

Salter-Harris: Type III

Intro 1 2 3 Patterns Orientation

Displaced Angulated Bone Ends Immature S-H Plastic Torus Occult Stress 4 Don't Miss



? 2011 Ken L Schreibman, PhD/MD

Physis + Epiphysis

Extends into joint Potentially more serious

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Slide 48 of 76

?Ken L Schreibman, PhD/MD 7/28/15

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