Fracture

dr. Rani Maria

 A fracture is described as a disruption in the
continuity of all or part of the cortex of a bone.
COMPLETE: cortex is broken through and
through
INCOMPLETE: only a part of the cortex is
fractured
Incomplete fractures tend to occur in bones that
are softer than normal, such as those in children,
adults with bone-softening diseases such as Paget
disease
 Fracture in Children
Greenstick fracture : incomplete
fractures in children, only one part of
the cortex
Torus fracture (buckle fracture):
compression of the cortex

Greens Buckle
tick (torus)
Fracture lines, when viewed in the correct orientation, tend to
be blacker (more lucent) than other lines normally found in
bones, such as nutrient canals.
A, This is a nutrient canal (white arrows), whereas a true fracture is
seen in another patient in (B) (dotted black arrows). Notice how the
nutrient canal has a sclerotic (whiter) margin and is confined to the
cortex, which is not the case with fracture lines that are darker and
Fracture versus
epiphyseal plate.
Pitfalls in fracture diagnosis.
A, Old, unhealed fracture fragments (white arrow).
B, Sesamoids (bones that form in a tendon as it passes over a joint) (white
arrows).
C, Accessory ossicles (accessory epiphyseal or apophyseal ossification
centers that do not fuse with the parent bone, such as this os trigonum;
white arrow). These examples can sometimes mimic acute fractures.
Unlike fractures, these small bones are corticated (i.e., there is a white line
that completely surrounds the bony fragment), and their edges are usually
smooth. Sesamoids and accessory ossicles are usually bilaterally
 Recognizing Dislocations and
Subluxations
Dislocation, the bones that originally
formed the two components of a joint
are no longer in apposition to each
other. Dislocations occur only at joints
Subluxation, the bones that originally
formed the two components of a joint
are in partial contact with each other.
Subluxations also occur only at joints
Dislocation and subluxation. A, In a dislocation, the bones that
originally formed the two components of the interphalangeal joint are no
longer in apposition to each other (white arrows). The terminal phalanx is
dislocated laterally.
B, In a subluxation, the bones that originally formed the two components
of a joint are in partial contact with each other. The humeral head (H) is
subluxed inferiorly (white arrow) in the glenoid (G) because of a large
hematoma in the joint secondary to a fracture of the surgical neck of the
Describing fractures
 Fracture fragments
Simple fracture: if the fracture
produces two fragments
Comminuted fracture: if the fracture
produces more than two fragments
Segmental fracture is a comminuted
fracture in which a portion of the shaft
exists as an isolated fragment
Butterfly fragment is a comminuted
fracture in which the central fragment has
a triangular shape
 Segmental fracture and butterfly fractures.
These are two comminuted fractures. A, There is a segmental fracture in
which a portion of the shaft exists as an isolated fragment. Notice how
the fibula has a center segment (S) and two additional fragments, one on
either side (white arrows). B, A butterfly fragment is a comminuted
fracture in which the central fragment has a triangular shape (dotted
 Direction of fracture line
Transverse fracture the fracture line is perpendicular
to the long axis of the bone. Caused by a force directed
perpendicular to the shaft
Diagonal or oblique fracture the fracture line is
diagonal in orientation relative to the long axis of the
bone. Caused by a force usually applied along the same
direction as the long axis of the affected bone
Spiral fracture a twisting force or torque produces a
fracture similar to those that might be caused by
planting the foot in a hole while running. Spiral fractures
are usually unstable and often associated with soft
tissue injuries, such as tears in ligaments or tendons
 Transverse, diagonal, and spiral fracture lines
A, In a transverse fracture (white arrow), the fracture line is
perpendicular to the long axis of the bone.
B, Diagonal or oblique fractures (black arrow) are diagonal in orientation
relative to the normal axis of the bone. C, Spiral fractures (white arrows)
are usually caused by twisting or torque injuries
 Relationship of one fracture
fragment to another
Abnormalities of the position of bone
fragments secondary to fractures describe the
relationship of the distal fracture
fragment relative to the proximal
fragment
Four major parameters most commonly used
to describe the relationship of fracture
fragments
Displacement
Angulation
Shortening
Rotation
 Definition
Displacement describes the amount by which
the distal fragment is offset, front-to-back and
side-to-side, from the proximal fragment
Angulation describes the angle between the
distal and proximal fragments
Shortening describes how much, if any, overlap
there is of the ends of the fracture fragments
VS distraction,which refers to the distance the
bone fragments are separated from each other
Rotation is an unusual abnormality in fracture
positioning almost always involving the long bones
Fracture parameters.
A, Displacement
B, Angulation
C, Shortening
D, Distraction

Rotation
 Relationship of the fracture to
the atmosphere
closed fracture is the more
common type of fracture, in
which there is no
communication between
the fracture fragments and
the outside atmosphere.
open or compound
fracture, there is
communication between
the fracture and the Open fracture
outside atmosphere
 Avulsion fracture
Avulsion is a common
mechanism of fracture
production in which the fracture
fragment (avulsed fragment) is
pulled from its parent bone by
contraction of a tendon or
ligament.
Particularly common in
younger individuals engaging
in athletic endeavors: dancers
fracture, skiers fracture, and
sprinters fracture.
Avulsion fractures, ASIS, and lesser
avulsion of the anterior superior trochanter
iliac spine (ASIS) (solid white arrow),
which is the site of
the insertion of the sartorius muscle. There is also an avulsion of a
 Stress fracture
Stress fractures occur as a result of numerous
microfractures in which bone is subjected to
repeated stretching and compressive forces
85% appears normal on initial imaging
Radionuclide bone scan will usually be positive
much earlier than conventional radiographs:
within 6 to 72 hours after the injury
Common locations for stress fractures:
shafts of long bones such as the proximal
femur, proximal tibia, the calcaneus, and the 2nd
and 3rd metatarsals (march fractures).
 Stress fracture, two frontal views taken 5
weeks apart
The fracture may not be diagnosable until after periosteal new bone
formation forms (white arrow) or, in the case of a healing stress
fracture of cancellous bone, the appearance of a thin, dense zone of
sclerosis across the medullary cavity (black arrow)
 COMMON FRACTURE

EPONYMS
Colles Fracture

Colles fracture, frontal (A) and lateral (B) views. A Colles fracture is
a fracture of the distal radius (solid white arrows) with dorsal
angulation of the distal radial fracture fragment (black arrow) caused
by a fall on the outstretched hand (sometimes abbreviated as
FOOSH). There is frequently an associated fracture of the ulnar

Smith fracture. A Smith fracture is
a fracture of the distal radius (white
arrow) with palmar angulation of
the distal radial fracture fragment
(black line angle), the reverse of a
Colles fracture. It is caused by a fall
on the back of the flexed hand
Boxers fracture is a fracture of
the neck of the 5th metacarpal
(little finger) with palmar
angulation of the distal fracture
fragment.
Jones fracture, base of 5th metatarsal. A Jones fracture is a
transverse fracture of the base 5th metatarsal (white arrow). It occurs
about 1 to 2 cm from the tuberosity of the 5th metatarsal (black arrow)
and frequently takes longer to heal than an avulsion fracture of the
tuberosity. It is caused by plantar flexion of the foot and inversion of the
THANK YOU
 Sesamoids are bones that form in a
tendon as it passes over a joint. The
patella is the largest and most
famous sesamoid bone.
Accessory ossicles are accessory
epiphyseal or apophyseal ossification
centers that do not fuse with the
parent bone.