good slide maked about fracture for teaching. study well.

1. Fractures & Dislocations
ALMAS KHAN
Radiology Technologist
KHORFAKKHAN HOSPITAL

2. 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

3. 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 Fx or #

4. Description of Location of #
• Which bone?
• Thirds (long bones)
• Proximal, middle, distal third
• Anatomic orientation
• E.g. proximal, distal, medial,
lateral, anterior, posterior
• Anatomic landmarks
• E.g. head, neck, body / shaft,
base, condyle
• Segment (long bones)
• Epiphysis, physis, metaphysis,
diaphysis
Epiphysis
Metaphysis
Diaphysis
(Shaft)
Physis
Articular
Surface

5. 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

6. Emergency Care For Fractures
& Dislocations
• Administer O2
• Control any bleeding & dress open wounds
• Check distal pulse
• Apply slight traction—if 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

7. 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

8. COMPLETE
• bone is completely
broken into 2 or more
fragments.
• -eg:
• transverse fracture
• oblique fracture
• spiral fracture
• impacted fracture
• comminuted fracture
• segmental fracture
INCOMPLETE
• bone is incompletely
divided and the
periosteum remains in
continuity.
• -eg:
• greenstick fracture
• torus fracture
• stress fracture
• compression
fracture.
Types of Fractures

9. COMPLETE FRACTURES

10. INCOMPLETE FRACTURE

11. 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 when a fracture is
open to the skin.

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

13. Spiral Fracture
• Fracture where at least one part of the bone has been twisted
Spiral fracture of femur

14. Oblique Fracture
• When the bone is broken on a steep angle
fibula

15. Transverse Fracture
• A fracture that occurs at
a right angle to the
bone’s axis

16. Impacted Fracture
• A fracture in which the
ends of bones are
driven into one another
(common in children)
• Also known as a “buckle
fracture”

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

18. 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.

19. Hairline Fracture
• A very thin crack or break in the bone
Hairline fracture of the foot

20. 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)

21. Skull Fracture and Sutures

22. 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).

23. 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

25. Pediatric Supra-condylar
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

26. 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

27. 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 forearmor falling onto
flexed wrists, as opposed to a Colles'
fracture which occurs as a result of falling
onto wrists in extension.

28. Colle’s fracture Smith’s fracture
• Fig : -

29. 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

30. 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 )

32. 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 retro-
peritoneum .
• Rx: Surgery of visceral injuries

33. HOW FRACTURES HEAL?-Physiology
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
• Healing by callus
• Healing without callus

34. 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

35. Treatment - Traction of the forearm
Internal fixation

36. 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

37. Complications
Infection
Non-union
Implant
failure
Refracture

38. CAUSES OF DELAYED UNION OR NON-
UNION OF THE FRACTURES
Distraction &
separation of the
fragments
Interposition of soft
tissues between the
fragments.
Excessive movement
at the fracture site
Poor local blood
supply
Severe damage to
soft tissues which
makes them
nearly/non-viable.
Infection
Abnormal bone.

39. 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

40. 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

41. 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

42. 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

43. 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.

44. RICE
• R - Rest
• I - Immobilize
• C - Cold
• E - Elevate

45. 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

46. Anterior Dislocation, Right Shoulder

47. Glenohumeral Reductions
• Hippocratic Method
1. Practitioner’s stockinged
foot is place in between the
patient’s 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.

48. 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.

49. 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.

50. Role of Radiographer
 Explain the procedure polarity and assist the pt’s 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

51. 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

52. 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