Fractures & Dislocations

ALMAS KHAN
Radiology Technologist
KHORFAKKHAN HOSPITAL

TALK PLAN

Signs or Symptoms of a Fracture

Types of fracture and dislocations

Emergency care for fracture

patient

Diagnosis of fracture

Treatment of fracture

Physiology of fracture healing

Role of Radiographer

FRACTURE
i.

Bones form the skeletal frame work of the body

and supports the body against gravity.
ii. It helps in movement and activities.
iii. Bones protect some body parts.
iv. Bone marrow produces blood products.
v. When outside forces are applied to bone it has
the potential to fail. Fractures occur when bone
cannot withstand those outside forces
vi. A bone fracture (sometimes abbreviated FRX
or Fx or F or #

Description of Location of #
Which bone?
Thirds (long bones)
Proximal, middle, distal
third

Anatomic orientation
E.g. proximal, distal,
medial, lateral, anterior,
posterior

Epiphysis
Physis
Metaphysis

Diaphysis
(Shaft)

Anatomic landmarks
E.g. head, neck, body /
shaft, base, condyle

Segment (long bones)

Epiphysis, physis,
metaphysis, diaphysis

Articular
Surface

Signs or Symptoms of a
Fracture

Pain and tenderness

Loss of function
A wound (with bone sticking out)
Deformity
Unnatural movement
Shock
Swelling and bruising

Emergency Care For Fractures

& Dislocations

Administer O2
Control any bleeding & dress open wounds
Check distal pulse
Apply slight tractionif splinting long bones in
arms and
legs If injury to a joint
DO NOT apply traction
Splint in the position found
Apply splint above & below the fracture
Re-check distal pulses after splinting
Control swelling with ice pack & elevation if distal
pulse is present and strong
Maintain body temperature

Diagnosing Bone Fractures

X-rays of injured
area
Some fractures are
difficult to see in
an x-ray, so a CT
scan, MRI, or other
bone scans are
used

Types of
Fractures

COMPLETE

bone is
completely
broken into 2 or
more fragments.
-eg:
transverse
fracture
oblique
fracture
spiral fracture
impacted
fracture
comminuted

INCOMPLETE

bone is
incompletely
divided and the
periosteum
remains in
continuity.
-eg:
greenstick
fracture
torus fracture
stress fracture
compression
fracture.

COMPLETE FRACTURES

INCOMPLETE FRACTURE

Open Fractures
An open fracture is a broken
bone that penetrates the
skin. This is an important
distinction because when a
broken bone penetrates the
skin there is a need for
immediate treatment, and
an operation is often
required to clean the area of
the fracture.
The risk of infection, there
are more often problems
associated with healing

Comminuted fracture
Comminuted
fracture - a fracture
in which the bone
breaks into more
than two
fragments; usually
caused by severe
forces

Spiral Fracture
Fracture where at least one part of the bone has
been twisted

Spiral fracture of femur

Oblique Fracture
When the bone is broken on a steep
angle

fibula

Transverse Fracture

A fracture that
occurs at a right
angle to the bones
axis

Impacted Fracture

A fracture in which
the ends of bones
are driven into one
another (common
in children)
Also known as a
buckle fracture

Greenstick
An incomplete
fracture in a long
bone of a child
(bones are not yet
fully calcified and
they break like a
green stick)

Compression Fractures
Compression Fracture usually
occurs in the vertebrae.
When the front portion of
vertebrae in the spine
collapses due to
Osteoporosis which causes
bones to become brittle and
susceptible to fracture , with
or without trauma.
An x-ray of the spine can
reveal the bone injury ,
however sometimes a CT
scan or MRI will be used to
insure that no damage is
done to the spinal cord.

Hairline Fracture
A very thin crack or break in the
bone

Hairline fracture of the foot

Stress
Fracture

Stress fracture - fracture

without being visibly broken;
microscopic fissures in bone
that forms without any
evidence of injury to other
tissues; caused by repeated
strenuous activity (ex: running)

Skull Fracture and Sutures

Depression Fracture
A depressed skull fracture is a break
in a cranial bone (or "crushed" portion
of skull) with depression of the bone
in toward the brain.
The brain can be affected directly by
damage to the nervous system tissue
and bleeding.
The brain can also be affected
indirectly by blood clots that form
under the skull and then compress the
underlying brain tissue (subdural or
epidural hematoma).

Pathologic Fracture
A type of fracture that is a
secondary result of another
illness or chronic condition
that weakens the bones of
the skeletal system
The x-ray to the right
shows thinning of the
femurs, resulting in a
fracture of the proximal
end of the right bone
x-ray showing pathological
fracture right humorous
due to bone cyst

Pediatric Supracondylar fracture

Supracondylar fractures of the

elbow are one of the most common
fractures in children
Radiographer with a significant
challenge. In addition to the
normal difficulties associated with
imaging children, the
radiographer must consider that
the patient may be in severe pain

Scaphoid Fracture
History
FOOSH
Dull, deep, ache in radial
side of wrist
occur most commonly
from a fall on the
outstretched hand
early (first week) may
appear negative
An X-ray a couple of
weeks later may then
more clearly reveal the
fracture. In questionable
cases, MRI scan, CT scan,
or bone scan

Colle`s and smith`s fracture

Fig : -

Describe by : - Abraham colle`s 1814.

It is not just fracture lower end of
radius but a fracture dislocation of
the inferior radioulnar joint .
Occurs about 2.5 cm above the
carpal extremity of the radius .
A Smith's fracture, also
sometimes known as a reverse
Colles' fracture is a fracture of the
distal radius. It is caused by a
direct blow to the dorsal forearm
or falling onto flexed wrists, as
opposed to a Colles' fracture
which occurs as a result of falling

Colles fracture
fracture
Fig : -

Smiths

BENNETTS 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

Salter Harris
I S = Slipped . Slipped growth plate
II A = Above . The fracture lies above the growth plate
(metaphyseal)

III L = Lower . The fracture is lower than (below) the growth

plate ( epiphyseal)

IV T = Through. The fracture through the growth plate

including the

( metaphysis and epiphysis )

V R = Rammed . The growth plate has been rammed or ruined

( the physis

suffers a compression injury )

Associated Complications: Visceral injury

Fractures around the trunk are
often complicated by visceral
injury.
E.g. Rib fractures
pneumothorax / spleen trauma /
liver injuries.
E.g. Pelvic injuries bladder or
urethral rupture / severe
hematoma in the retroperitoneum .

Rx: Surgery of visceral injuries

HOW FRACTURES HEAL?-Physiology

Healing by callus
Healing without callus
When bone breaks, so do the blood
vessels that supply the bone
1) a clot forms in the damaged area
2) blood vessels and cells invade
the clot and produce a fibrous
network and cartilage between
broken bones (callus)
3) osteoblasts enter callus and
begin forming cancellous bone
4) Cancellous bone is remodeled to
form compact and cancellous
bone; repair is complete

Treatment of Fractures
There are two main
types of treatments:
External fixation - casts
Internal fixation surgery
Wires - used on small
fractures
Plates - hold two
lengths of bone
together with screws
Nails or rods - placed in
centers of long bones
and held in place with
screws
Screws - most common
method; used by self
or with other items

Treatment - Traction of the forearm

Internal fixation

Cast Splintage
External fixation
Methods:
Plaster of Paris
Fibreglass

Especially for distal limb # and for most

children #
Disadvantage: joint encased in plaster
cannot move and liable to stiffen
Can be minimized:
Delayed splintage (traction initially)
Replace cast by functional brace after few weeks

Infection

Refractur
e

Complicatio
ns

Implant
failure

Nonunion

CAUSES OF DELAYED UNION

OR NON-UNION OF THE
FRACTURES
Interposition of
Excessive

Distraction &
separation of
the fragments

Poor local
blood supply

soft tissues
between the
fragments.

movement at
the fracture
site

Severe damage
to soft tissues
which makes
them
nearly/nonviable.

Infection

Abnormal
bone.

Missed fractures
Missed fractures occurs in
different reason . It could be
that the doctor is inexperienced
with bone fractures or the
misread radiograph or the
failure to obtain a radiograph.
Poorly positioned or poorly
taken radiograph may also
result in diagnostic errors.
Doctors use today diagnosing
fractures are CT, MRI, Bone
scan . Even a hairline fractures ,
stress fractures can detected
those equipments

Exercise
Prevention of edema
active exercise and elevation
Active exercise also stimulates the
circulation. Prevents soft-tissue adhesion
and promotes fracture healing.

Preserve the joint movement

Restore muscle power
Functional activity

What is a dislocation?
When the bones at a joint are no longer in proper
contact.
Can be caused by severe twisting or indirect force, or
even a muscular contraction
Most frequently dislocated joints
Shoulder
Elbow
Thumb
Finger
Jaw
Knee

Signs and Symptoms of a

Dislocation
Deformity or abnormal appearance
Pain and tenderness aggravated by
movement
Loss of normal function
Joint may be locked in one position
Swelling of the joint

General Treatment
Principles
Stop the activity.
Survey the injured area.
First Aid if qualified.
Get help if not.
Determine if additional medical attention is
necessary.

RICE

R
I
C
E

Rest
Immobilize
Cold
Elevate

Shoulder Dislocation

Take a past medical history

(i.e. has this happened
before?)

Clinical exam (check for

circumflex nerve function)

X-ray to rule out possible

fracture (i.e. head of the
humorous)

Several methods for reduction

Scapular rotation
Traction/counter traction

Anterior Dislocation, Right

Shoulder

Glenohumeral Reductions

Hippocratic Method
1. Practitioners
stockinged foot is
place in between the
patients chest wall
and axilla folds but not
in the axilla.
2. Steady traction is
maintained while the
patient gradually
relaxes.
3. Shoulder is slowly
rotated externally and
abducted.
4. Gentle internal
rotation reduces the
humeral head.

Posterior Elbow Dislocation

Typical mechanism of
an elbow dislocation
1. A fall backward on the
arm with the elbow in
a flexed position and
2. The forearm
supinated is the most
common mechanism.
3. The injury causes
radius and ulna to
dislocate posterior to
the humerus.
4. There may also freq.
Be an associated
fracture of the radial
head or
5. The coracoid process
of the ulna.

Patella Dislocation

Mechanism of Acute
Dislocation
1. Typically, the patient bears
weight on the slightly flexed
knee
2. A sudden external rotation
or twisting load to the femur
causes the patella to slide
superiorly over the lateral
femoral condyle.
3. As the knee flexes, the
patella jumps over the
lateral condyle and the knee
collapses.

Role of Radiographer
Explain the procedure polarity and assist the pts to get
required position.
Maintain immobilization of the injured area while AP and
use horizontal beam for lateral radiograph.
Wise application of all radiographic skills while include
appropriate positioning , exposure factors ( as much as
possible high kv technique) , breathing technique.
Effective communication with referring physician to
achieve the best result.
Best Practices in Trauma Radiography Speed Efficiency in
producing quality images in the shortest possible time
Accuracy Optimum image quality

Continue
Follow universal patient transfer protocol while patient in

transferred to avoid severity of the injury.

The rule for protecting the spine from further injury is to
immobilize it. These precautions are the standard of care
for handling a trauma patient suspected of spine injury.
Patient Preparation Use good communication skills with
appropriate touch and eye contact Trauma often causes
anxiety Check patient for potential artifacts Explain what
you are removing and why Secure all personal effects
using proper procedure for your facility

Tips to Remember
1) Updated in current radiographic
imaging standards the technologist is
armed with the understanding of what it
is to have a high suspicion for injury
that translates into safe quality patient
care.
2) Radiology Technologist can make
minimal diagnosis
3) Update your skills. More in Anatomy