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Why is it important to know skeletal trauma and surgical radiography terms?
- Allows technologist to understand:
- which type of injury or fracture is suspected
- which projection to make
- how to avoid positioning that could cause pain or injury
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Dislocation / luxation
- Bone is displaced from a joint
- Movement of these parts could be painful and must be avoided
- Get two projections, 90 degrees apart to show degree of separation
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If dislocated joint has relocated, are x-rays still necessary?
- Yes.
- Damage could have still occurred
- Get two projections, 90 degrees apart
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Subluxation
Partial dislocation
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Nursemaid's Elbow / Jerked Elbow
- Partial dislocation of radial head of child's elbow, due to hand / wrist being sharply jerked by an adult.
- Frequently reduced when forearm is supinated for AP elbow projection.
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Sprain
Forced wrenching or twisting of a joint that results in a partial rupture or tearing of supporting ligaments, without dislocation.
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Possible damage caused by sprain
- May result in severe damage to associated:
- blood vessels
- tendons
- ligaments
- nerves
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Contusion
Bruise type of injury with possible avulsion fracture.
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Fracture
A break in the bone.
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Positioning of possible fractures
- Use caution when moving possible fractures parts
- Never force a potentially fractured limb or body part into position
- Adapt positioning as needed
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Apposition
Describes the manner in which the fragmented ends of the bone make contact with each other.
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Anatomic apposition
Ends of the broken fragments make end-to-end contact.
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Lack of apposition
Ends of fragments are aligned but pulled apart and are not making contact with each other.
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Bayonet apposition
- Fragments overlap and the shafts make contact, but not at the fracture ends.
- (Bont. 573)
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Angulation
- Loss of alignment of the fracture.
- Long bone fragments at angles to each other.
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Apex Angulation
Kind of like, if a straight bone is broken into a kind of sideways V shape. If the point of the V points toward the midline of the body or away from midline of body.
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Varus deformity
Break opens away from midline of the body, apex of the now broken bone points away from midline of the body.
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Valgus deformity
Break opens toward midline of body, apex of now broken bone points towards midline of body.
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Simple / closed fracture
Bone does not break through the skin.
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Compound / open fracture
Portion of broken bone protrudes through the skin.
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Incomplete fracture
Bone is not broken all the way through / not broken all the way across.
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Torus fx
- Incomplete fracture.
- Buckle of cortex ( outer portion of the bone ) with possibly little or not displacement.
- No complete break in cortex.
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Greenstick fx
- Fracture is on one side of bone only.
- Coretex on only one side of bone is broken, other side is bent.
- Happens most often to young children whose bones are still rubbery.
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Complete fx
Break is complete across entire bone.
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Complete fx
Transverse fx
Fracture is transverse across bone, at near right angles to long axis of the bone.
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Complete fx
Oblique fx
Fracture passes through bone at oblique angle.
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Complete fx
Spiral fx
Bone has been twisted apart and the fracture spirals around the long axis.
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Comminuted
- Bone is splintered or crushed at site of impact.
- Results in two or more fragments.
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Comminuted
Segmental fx
Bone is broken at two places, creating three bone segments from an original one.
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Comminuted
Butterfly fx
- Two fragments oneacy side of a main, wedge-shaped, separate fragment.
- Kind of a Y-shaped break transverse across a long bone.
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Comminuted
Splintered fx
Bone is splintered into thin, sharp fragments.
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Impacted fx
- One fragment is firmly driven into the other.
- I.E. shaft of a long bone being driven into the head of that bone.
- Common at distal or proximal ends of femur, humerus, radius.
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Barton's fx
Intra-articular fracture of posterior lip of distal radius.
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Baseball / mallet fx
Fracture of distal phalanx caused by ball striking the end of an extended finger (ouch).
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Bennet's fx
- Longitudinal fracture of the base of the first metacarpal, with fracture line entering the carpometacarpal joint.
- Usually includes posterior dislocation of subluxation.
- Thumb is forced backwards during partial flexion.
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Boxer's fx
- Usually involves distal fifth mecatarpal
- Apex posterior angulation
- Best demonstrated on lateral view
- Usually happens from punching someone or something.
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Colles' fx
- Distal radius is fractures with the distal fragment displaced posteriorly.
- May result from forward foll on an outstretched arm.
- "Dinner fork" deformity?
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Smith's fx / reverse Colles' fx
- Distal fragment of radius displaced anteriorly.
- Commonly results from backward fall on outstretched hand.
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Pott's fx
- Complete fracture of the distal fibula with major injury to the ankle joint.
- Includes ligament damage.
- Frequently includes fracture of distal tibia or medial malleolus.
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Avulsion fx
- Fragment of bone is separated or pulled away by the attached tendon or ligament.
- Results from severe stress to a tendon or ligament in a joint region.
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Blowout and / or tripod fx
- Fracture of the orbital floorand lateral orbital margins.
- Result from direct blow to the orbit and / or maxilla and zygoma.
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Chip fx
- Involves isolated bone fragment.
- Not the result of ligament stress.
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Compression fx
- Vertebral body collapses or is compressed.
- Caused by compression type injury.
- Appears on radiograph as decreased vertical dimension of the anterior vertebral body.
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Depressed fx / ping pong fx
- Depressed fragment of skull.
- Resembles a dented ping pong ball?
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Epiphyseal fx
- Fracture through the epiphyseal plate.
- One of the most easily fractures sites in long bones of children.
- Radiologists may use Salter-Harris classification (scale of 1 - 5) to to describe severity and reasonable indication of prognosis.
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Pathologic fx
Fracture due to a disease process within the bone ( osteoporosis, neoplasia ).
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Stellate fx
- Fracture lines radiate from a central point of injury, with a starlike pattern.
- Most commonly happens on patellas.
- Often caused by knees hitting dash board during a car accident.
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Stress or fatique fx / march fx
- Nontraumatic fracture due to repeated stress on a bone such as running or marching.
- If running - fracture at distal shaft of tibia.
- If marching - mid-shafts of metatarsals.
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Trimalleolar fx
Fracture of medial malleolus, lateral malleolus, and posterior lip of distal tibia.
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Tuft fx / burst fx
- Comminuted fx of distal phalanx.
- May be caused by crushing blow to distal finger or thumb.
- Hitting finger or thumb with hammer.
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Closed reduction
- Fracture fragments are realigned by manipulation ( ouch ) and ar immobilized by a cast or splint.
- Nonsurgical procedure.
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Open reduction.
- Surgical procedure.
- For severe fractures with significant displacement or fragmentation.
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Small to medium plaster cast
Increase exposure by...
+5 to +7 kV
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Large plaster cast
Increase exposure by...
+8 to +10 kV
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Fiberglass cast
Increase exposure by...
+3 to +4 kV
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Pathologic Fracture
Fracture occurring in abnormal bone which is weakened by disease.
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Chip Fracture
Avulsion fracture of a small fragment of bone from the corner of a bone.
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Growth Plate Fracture
- Break in growth plate cartilage. May not be apparent unless there is separation of growth plate from adjacent bone.
- Growth plate fractures may result in altered length of affected bone.
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Slipped Capital Femoral Epiphysiss
SCFE
- Growth plate injury
- Femoral head slips posteriorly and inferiorly from neck of femur at growth plate of young femur.
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Monteggia Fracture
Fracture of proximal third of ulnar shaft with anterior dislocation of radial head.
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Galeazzi Fracture
Fracture of proximal radius with dislocation of distal radial-ulnar joint.
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Maisonneuve Fracture
Disruption of snydesmosis between distal tibia and fibula with fracture of proximal third of fibula.
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Hills-Sachs Deformity
- Compression fracture of the humeral head
- Occurs on the superior and posterior head of humerus after anterior dislocation with scapula.
- If not detected and repaired, could lead to increased incidence of future dislocations.
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