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13.03.01 Orthopaedics - Fractures

Terminology
  • Fracture line
    • Transverse
    • Oblique
    • Spiral (often in legs, from rotational force when walking etc)
  • Bits
    • Comminuted = Smashed up (>2 bits)
    • Segmental = >1 fracture line
    • Avulsion = Bit ripped off
  • Childhood fractures
    • Torus (bulge)
    • Greenstick
  • Distraction
    • Distance between bone ends
  • Displacement
    • Distance of malalignment (measured in % of bone width or mm)
  • Angulation
    • Distal relative to proximal fragment


Epiphyseal plate fusion / End of bone growth




Salter-Harris classification

  • Type II is the most common
  • Type V is the worst and the easiest to miss, but also the rarest





Two key (common) fractures in kids

  • Slipped upper femoral epiphysis (disjointed head)
  • Supracondylar humerus fracture (angle of distal humerous goes back instead of forward)

Wrist fractures

  • Colles
    • Dinner-fork deformity / Posterior displacement
    • Conservative management / Splinting
  • Smith
    • Anterior displacement
    • Requires surgery


Ligaments of the ankle

  • Talus should have equal space all around it
    • If not => Talar shift, from ligament damage (NB this is unstable)


Notes

  • The growth plate is the most fragile/vulnerable bit in kids
  • Divide the length of bones into thirds when reporting position
  • Subluxation is partial dislocation
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