FRACTURES

(On Which We Will Likely Be Pimped)

 JEFFERSON FRACTURE
Fracture of C1 ring
Axial loading injury with compression
force to C1
Unilateral or bilateral fractures of anterior
and posterior arches of C1
 CLAY-SHOVELER’S FX
Avulsion fracture of spinous process of C7
or T1
Sudden load on flexed spine
 HANGMAN’S FRACTURE
Bilateral pedicle or pars fractures
involving C2 vertebral body
A/w anterior subluxation or dislocation of
C2 vertebral body
Severe extension injury (MVC causing
head to hit dashboard, hanging)
 CLAVICULAR FRACTURE
Extremely common
Does not completely ossify until late teens
Fall on outstretched hand, fall onto
outside of shoulder, direct hit to clavicle
Treatment: “Figure-of-8” sling; No
activities that exacerbate pain; full
recovery in 12 weeks.
 SCAPULAR FRACTURE
Uncommon
Scapular body fx are the MC type
Commonly (80-90%) associated with other
injuries – lung and chest
Don’t require surgery

GLENOID (cartilage) fracture – requires

surgery when unstable or fragments are far
out of alignment
 HUMERUS FRACTURE
Proximal occur near the shoulder joint;
treatment depends on rotator cuff tendon
position
Mid-shaft – Injury to radial nerve causes wrist
drop and numbness of the hand dorsum
Distal are uncommon in adults; often require
surgery
Most heal without surgery
Over 90% with nerve injury have complete
recovery of nerve in 3-4 months
HOLSTEIN-LEWIS FRACTURE
Distal third humeral fracture
18% are associated with radial nerve palsy,
particularly if break is between middle and
distal thirds of humerus
Due to direct blow or torsion injury
Competitors in throwing events
 ULNAR FRACTURE
Forearm is struck by an object
Nightstick Fracture

Treatment of isolated ulnar fx: cast or

brace; surgery if unstable
 MONTEGGIA FRACTURE
Giovanni Monteggia – 1814

Fracture of Ulna
Dislocation of radial head within the elbow
joint

Treatment: Surgery
 RADIAL HEAD
Most common part broken in elbow
fracture
MC caused by fall onto outstretched hand
+/- surgery depending on displacement
 GALEAZZI FRACTURE
Fracture of Radius
Injury of the distal radio-ulnar joint of
wrist (shortening and dislocation of distal
ulna)
Mechanism: fall on outstretched hand
with elbow flexed
Treatment: Surgery to repair radius, then
inspection of distal radio-ulnar joint
 NURSEMAID’S ELBOW
Common in young children (< 5 yo)
Subluxation of radius at elbow joint --bone
has slid out of proper position
Classically a sudden pull on child’s arm
Present with arm flexed a/g body
If treated (replaced) quickly,
immobilization is not necessary
For multiple subluxations, cast to allow
ligaments to heal
 SMITH’S FRACTURE
Fracture of radius near the wrist joint
Displaced anteriorly (in front of normal
position)
MC found after falling on to the back of
the hand

Treatment: Requires fixation

 COLLES’ FRACTURE
Fracture of radius
Displaced posteriorly (behind normal
position)
MC after fall onto outstretched hand

Treatment: Cast +/- surgery, depending

on shortening and displacement of radius
 SCAPHOID BONE FX
Scaphoid sits below the thumb; shaped like
a kidney bean
Retrograde blood supply
Many are misdiagnosed as sprain
May not show up on xray until healing
begins (may immobilize empirically and
repeat xray in 1-2 wks)
May cast for trial period with routine xrays
Total healing time of 10-12 weeks
 BOXER’S FRACTURE
Classically at the base of 5th metacarpal
(metacarpal neck)
Seen after punching person or object
Commonly a bump over the back of palm
just below the small finger knuckle; may
not go away even with treatment
Treatment: casting or surgery (pins)
 BENNETT’S FRACTURE
Intra-articular fracture/dislocation of base
of 1st metacarpal
Small palmar fragment continues to
articulate with trapezium
Mechanism: forced abduction of thumb

Treatment: open reduction and internal

fixation
 ROLANDO FRACTURE
Fracture through thumb metacarpal base
Comminuted intraarticular fracture

Prognosis is worse than Bennett’s

Treatment: open reduction and internal
fixation
INTERTROCHANTERIC HIP FX
Occurs lower than femoral neck fracture
Bone blood flow is usually intact, so repair,
not replacement is performed

Treatment: Metal plate and screws

FEMORAL NECK FRACTURE
Just below the ball of the ball-and-socket
hip joint
The ball is disconnected from rest of the
femur
Blood supply is often disrupted, so there’s
a high risk of non-healing

Treatment: Often with partial hip

replacement, esp if > 65 yo
 FEMORAL SHAFT FX
Severe injury

Treatment: Intramedullary rod (MC),

plate and screws, or external fixator
SUPRACONDYLAR FEMUR FX
Unusual injury just above knee joint
High risk of knee arthritis later
More common in pts with severe
osteoporosis and those with previous knee
replacement surgery

Treatment: Cast, brace, external fixator,

plate, screws, intramedullary rod
 PATELLAR FRACTURE
Fall onto kneecap or when quadriceps is
contracting, but knee joint is straightening
(“eccentric contraction”)
Attempt “straight leg raise”
yes? Non-operative treatment may be possible
no? surgery – combo of pins, screws, and wires
TIBIAL PLATEAU FRACTURE
Just below knee joint
Involves the joint cartilage  risk of
arthritis

Treatment: If non-displaced, may be

treated without surgery. Surgery for
displaced fractures
 TIBIAL SHAFT FRACTURE
Most common type of tibial fracture
Most can be treated by long leg cast
May require plates, screws, external
fixator, or intramedullary rod
TIBIAL PLAFOND FRACTURE
“Tibial Pilon Fracture”
End of shin bone and involves ankle
Soft-tissue around ankle may be
problematic if very swollen – makes
surgery difficult

Treatment: casting, external fixation,

limited internal fixation, internal fixation,
ankle fusion
 POTT’S FRACTURE
Fracture of the lower end of fibula with
displacement of tibia
Causes the foot to “turn out”
 TALUS FRACTURE
Complications:
Ankle arthritis
Subtalar arthritis
Foot deformity
Avascular necrosis
 CALCANEUS FRACTURE
Fall from heights or MVC
Like an orange if you stand on it, the
calcaneus widens and squashes flat
Inversion and eversion are affected
(subtalar joint – b/w talus and calcaneus)
 FRACTURES OF
5 METATARSAL
th

Avulsion: “Dancer’s fracture;” tiny flecks

of bone are pulled off by attached tendon;
heal well in cast
Jones: occurs at proximal end (in
midportion of foot); cast for 6-8 wks
Avulsion (Dancer’s)
Jones’ fracture
 TORUS FRACTURE
“Buckle fracture”
Compression fracture of a long bone,
mostly in children; usually occurs near
metaphysis
Better seen on lateral films
Distal radius is most common site
Treatment: well-fitting immobilizing cast
for 2-4 weeks
 GREENSTICK FRACTURE
Usually from a quick twisting motion
occompanied by axial compression such as
a fall backwards on the outstretched hand
Supinated twist  palmar angulation
Pronated twist  dorsal angulation
No disruption of cortex; may have
buckling on opposite side of bone from the
break; “incomplete break”
THE END
(FINALLY!!!!)