Musculoskeletal Trauma

General Concepts

Terminology

Fracture: Cortical discontinuity in a bone (or cartilage).

Dislocation: Disruption of normal articulating anatomy of a joint.

Fracture/Dislocation: Fracture at/near joint resulting in dislocation.

Approach to Describing a Fracture

1.     Describe the film

2.     Type

·       Complete vs. Incomplete (Greenstick/Buckle)

·       Shape

·       Simple vs. Comminuted (>2 parts)

·       Open vs. Closed 

3.     Location

·       Diaphysis: the shaft of the bone. (proximal, mid-shaft, distal).

·       Metaphysis: the widening portion adjacent to the growth plate.

·       Epiphysis: the end of the bone adjacent to the joint.

·       Physeal (in pediatrics) + Salter Harris.

4.     Displacement 

        Describing the distal fragment unless otherwise indicated.

·       Rotation: Internal rotation vs. External Rotation

·       Angulation: Varus vs. Valgus (VaLgus = Lateral)

·       Translation:

* Medial vs. Lateral Displacement

* Superior vs. Inferior: Bayonet Apposition/Foreshortening vs. Distraction (must measure amount)  

5.     Joint Involvement.

Salter-Harris Classification

Most widely used system for describing physeal fractures = childhood fractures that involve the physeal plate. They are relatively common and important to differentiate from other injuries because the involvement of the physis (growth plate) may cause premature closure resulting in limb shortening and abnormal growth.