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