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Language of Fractures Page 1 of 13 Language of Fractures page 1 of 13 Language of Fractures Looking at Bones in General Language of Fractures Looking at Bones in General Topics Language of Fractures Why are Fractures Hard? Intro 1 2 3 Title: Intro 1 2 3 There are 206 bones! Patterns Robert Jordan Schultz Patterns Carpals: Scaphoid, Lunate, Triquetrum, Pisiform (proximal row) Orientation Orthopedic Surgeon Orientation Hamate, Capitate, Trapezoid, Trapezium (distal row) Displaced Displaced Fingers: Thumb, Index, Long, Ring, Small Angulated Out of print since 1990 Angulated (Metacarpals, Phalanges) Bone Ends Ideas in this talk: Bone Ends Tarsals: Talus, Calcaneus, Navicular, Cuboid, 3 Cuneiforms Immature My 20 years of trying Immature Arm: Scapula, Humerus, Radius, Ulna S-H to understand fractures S-H Leg: Femur, Patella, Tibia, Fibula Plastic Plastic Pelvis: Sacrum, Innominate (Ilium, Ischium, Pubic) Torus Torus Spine: Cervical (7), Thoracic (12), Lumbar (5), [ribs & sternum] Occult Occult Skull: 1 big bone + Mandible Stress 4 Stress 4 Maxilla, Nasal, Frontal, Parietal, Occipital, Temporal, Don’t Miss Don’t Miss (Zygomatic, Sphenoid, Ethmoid, Lacrimal) www.schreibman.info Jump to last Jump to www.schreibman.info Jump to last Jump to © 2011 Ken L Schreibman, PhD/MD slide viewed next slide Slide 1 of 76 © 2011 Ken L Schreibman, PhD/MD slide viewed next slide Slide 2 of 76 Language of Fractures Looking at Bones in General Language of Fractures Looking at Bones in General Why are Fractures Hard? Example: Metatarsals Intro 1 2 3 There are 206 bones! Intro 1 2 3 1st MT: Patterns Patterns Fractures Orientation They’re all different! Orientation They have different functions. Rare Displaced Displaced Common Angulated Exposed to different Angulated th Bone Ends mechanical forces. Bone Ends OA 5 MT: Immature They each respond differently Immature 2nd MT: Fractures S-H to stress/trauma. S-H Fractures Very Common Base 5th MT Plastic Plastic Common 1) Avulsion Fx Torus Torus Stress Occult Occult 99% Heal (Fatigue) 2) Jones Fx Stress 4 Stress 4 “March” Don’t Miss Don’t Miss 50% non-union www.schreibman.info Jump to last Jump to www.schreibman.info Jump to last Jump to © 2011 Ken L Schreibman, PhD/MD slide viewed next slide Slide 3 of 76 © 2011 Ken L Schreibman, PhD/MD H,K 37yoF slide viewed next slide Slide 4 of 76 Language of Fractures Looking at Bones in General Language of Fractures Looking at Bones in General Why are Fractures Hard? Example: Proximal Femur Factures Femoral Neck Fx Intertrochanteric Fx Intact Intro 1 2 3 There are 206 bones! Intro 1 2 3 min displaced min displaced Patterns Patterns Dynamic Orientation They’re all different! Orientation Hip Displaced They have different functions. Displaced Screw Angulated Exposed to different mechanical Angulated Bone Ends forces. Bone Ends Percutaneous C,T 63yoM Pinning M,L 90yoF Immature They each respond differently Immature Subtrochanteric Fx Femoral Neck Fx S-H to stress/trauma. S-H displaced Plastic Plastic Hip Torus Even where fractures occur Torus Prosthesis Occult within a bone affects the Occult Stress 4 treatment, prognosis Stress 4 Don’t Miss Don’t Miss K,C 35yoF Intramedullary nail C,G 71yoF www.schreibman.info Jump to last Jump to www.schreibman.info Jump to last Jump to © 2011 Ken L Schreibman, PhD/MD slide viewed next slide Slide 5 of 76 © 2011 Ken L Schreibman, PhD/MD slide viewed next slide Slide 6 of 76 ©Ken L Schreibman, PhD/MD 7/28/15 www.schreibman.info Language of Fractures page 2 of 13 Language of Fractures Looking at Bones in General Language of Fractures Looking at Bones in General Bone Model Terminology Intro 1 2 3 White Line = Black Box = Radiograph Intro 1 2 3 AP Lateral Radiographic Views Patterns Cortical Bone Patterns AP (Anterior Posterior) Orientation Orientation Most frontal radiographs P A Displaced Displaced L O PA (Posterior Anterior) Angulated T Angulated T M N Hands, wrists A S T Bone Ends i Bone Ends T i E T Chest (Standard non-portable) b b D E Immature Immature E E Lateral view i i I R From the side (RL, LR) S-H S-H R R I a A a A I Patient sides Plastic Plastic L O Torus Torus L O R Medial: Towards the middle R Lateral: Towards the side Occult Gray Fill = Occult Stress 4 Trabecular Bone Stress 4 Anterior: Front (Volar) Don’t Miss (Cancellus) Don’t Miss Posterior: Back (Dorsal) www.schreibman.info Jump to last Jump to www.schreibman.info Jump to last Jump to © 2011 Ken L Schreibman, PhD/MD G,D 18yoM slide viewed next slide Slide 7 of 76 © 2011 Ken L Schreibman, PhD/MD G,D 18yoM slide viewed next slide Slide 8 of 76 Language of Fractures Looking at Bones in General Language of Fractures Looking at Bones in General Simple vs Comminuted Simple vs Comminuted Intro 1 2 3 Simple Fx: Intro 1 2 3 Simple Fx: Patterns 2 fragments Patterns 2 fragments Orientation Proximal Proximal fragment Orientation Proximal fragment Displaced [L] proximus: “nearest” Displaced [L] proximus: “nearest” Near body attachment Near body attachment Angulated Proximal Angulated Bone Ends Distal fragment Bone Ends Distal fragment Immature [L] distare: “distant” Immature Butter- [L] distare: “distant” away from attachment fly away from attachment S-H S-H Butter- Plastic Distal Comminuted: Plastic fly Comminuted: Torus Distal >2 fragments Torus >2 fragments Occult Segmental fragment Occult Segmental fragment Stress 4 Stress 4 Butterfly fragment Don’t Miss Don’t Miss www.schreibman.info Jump to last Jump to www.schreibman.info Jump to last Jump to © 2011 Ken L Schreibman, PhD/MD T,L 59yoM slide viewed next slide Slide 9 of 76 © 2011 Ken L Schreibman, PhD/MD B,J 41yoM slide viewed next slide Slide 10 of 76 Language of Fractures Looking at Bones in General Language of Fractures Looking at Bones in General Simple vs Comminuted Fracture Orientation Intro 1 2 3 Simple Fx: Intro 1 2 3 Transverse Patterns 2 fragments Patterns Horizontal Orientation Proximal fragment Orientation Displaced [L] proximus: “nearest” Displaced Angulated Near body attachment Angulated Bone Ends Distal fragment Bone Ends Immature [L] distare: “distant” Immature S-H away from attachment S-H Plastic Comminuted: Plastic Torus >2 fragments Torus Occult Segmental fragment Occult Stress 4 Butterfly fragment Stress 4 Don’t Miss Severely comminuted Don’t Miss www.schreibman.info Jump to last Jump to www.schreibman.info Jump to last Jump to © 2011 Ken L Schreibman, PhD/MD H,L 66yoM slide viewed next slide Slide 11 of 76 © 2011 Ken L Schreibman, PhD/MD V,B 20yoM slide viewed next slide Slide 12 of 76 ©Ken L Schreibman, PhD/MD 7/28/15 www.schreibman.info Language of Fractures page 3 of 13 Language of Fractures Looking at Bones in General Language of Fractures Looking at Bones in General Fracture Orientation Fracture Orientation Intro 1 2 3 Transverse Intro 1 2 3 Spiral Fracture Patterns Horizontal Patterns Twisting injury Orientation Orientation Displaced Avulsion Displaced Resembles: Angulated End of bone Angulated Oblique fracture Bone Ends Bone Ends Butterfly frag. Weber A Longitudinal Need multiple Immature Vertical Immature S-H S-H views to see the Plastic Compression Plastic spiral Torus Torus Occult Oblique Occult Stress 4 Diagonal Stress 4 Don’t Miss Most common Don’t Miss www.schreibman.info Jump to last Jump to www.schreibman.info Universal Studios Jump to last Jump to © 2011 Ken L Schreibman, PhD/MD J,P 50yoF slide viewed next slide Slide 13 of 76 © 2011 Ken L Schreibman, PhD/MD Orlando, Florida slide viewed next slide Slide 14 of 76 Language of Fractures Looking at Bones in General Language of Fractures Looking at Bones in General Fracture Orientation Fracture Orientation AP Lateral Intro 1 2 3 AP Lateral Spiral Fracture Intro 1 2 3 Spiral Fracture Patterns Twisting injury Patterns Twisting injury Orientation Orientation Displaced Resembles: Displaced Resembles: Angulated Oblique fracture Angulated Oblique fracture Bone Ends Butterfly frag. Bone Ends Butterfly frag. Immature Need multiple Immature Need multiple S-H views to see the S-H views to see the Plastic spiral Plastic spiral Torus Torus Occult Occult Stress 4 Stress 4 Don’t Miss Don’t Miss www.schreibman.info Jump to last Jump to www.schreibman.info Jump to last Jump to © 2011 Ken L Schreibman, PhD/MD A,J 41yoM slide viewed next slide Slide 15 of 76 © 2011 Ken L Schreibman, PhD/MD K,P 68yoF slide viewed next slide Slide 16 of 76 Language of Fractures Looking at Bones in General Language of Fractures Looking at Bones in General Fracture Orientation Displacement Intro 1 2 3 Spiral Fracture Intro 1 2 3 RULE: Patterns Twisting injury Patterns Orientation Orientation We describe Displaced Resembles: Displaced displacement of Angulated Oblique fracture Angulated distal fragment Bone Ends Butterfly frag. Bone Ends Need multiple relative to Immature Immature proximal fragment S-H views to see the S-H Plastic spiral Plastic “There is an oblique fracture Torus Toddlers Fx Torus of the distal tibia, with Occult Occult lateral displacement of the Distal Tibia distal fracture fragment Stress 4 Stress 4 Don’t Miss < 5 years old Don’t Miss ½-shaft width.” www.schreibman.info Jump to last Jump to www.schreibman.info Jump to last Jump to © 2011 Ken L Schreibman, PhD/MD H,C 3yoM slide viewed next slide Slide 17 of 76 © 2011 Ken L Schreibman, PhD/MD F,J 33yoM slide viewed next slide Slide 18 of 76 ©Ken L Schreibman, PhD/MD 7/28/15 www.schreibman.info Language of Fractures page 4 of 13 Language of Fractures Looking at Bones in General Language of Fractures Looking at Bones in General Displacement Displacement: Check all Views Intro 1 2 3 RULE: Intro 1 2 3 Lateral AP Patterns Patterns Orientation
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