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Trauma Cheat Sheet (DRAFT) by

Trauma on imaging and stuff

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Describing trauma

- Type
Complete: Transv­erse, Oblique, Spiral­/Co­mmi­nuted
Incomp­lete: Greens­tic­k/Torus
Salter Harris: Growth Plate f#
- Where
Diaphysis, Metaph­ysis, Epiphysis
-Displ­acement
Angula­tion, Transl­ation, Rotation
-Joint involv­ement?

Defini­tions

Open/C­losed F#
Closed: Does no Break Skin
Open: Breaks Skin
Commin­uited F#
Has 2 or more bony fragments separated from the bone
Non-co­mmi­nuited F#
Through the bone from one cortical surface to another- separates the bone into 2 fragments
Avulson F#
A portion of bone is torn away by forceful muscle­/te­ndo­n/l­iga­mentous pulling
Impaction f#
Portion of bone is driven into the adjacent bone - two types, depressed and compre­ssion
Depressed: Inward bulging of an outer cortex
Compre­ssed: Trabecular compaction resulting in decreased size of involved bone
Chip/c­orner f#
A type of avulsion fracture - seperation of a small chip of bone form the corner of a short tubular bone
Stress f# - Fatigue = F# caused by repetitive stress - microt­raumas
Insuff­iciency f# stress f# through bone weakened by disease
Occult f# Clinical signs of f# without radiol­ogical evidence can show up within 7-10 days
Bone Bruise Trabecular micro f# with oedema and haemor­rhage seen on MRI
Pseudo-f# Not a true f# - linear lucencies caused by metabolic disorders such as Osteom­alacia, Rickets and Pagets
Incomplete f# Only one cortex broke, leaving a buckli­ng/­def­ormity - Greenstick f#
Greenstick f# - <10 years old - horizontal f# through the convex side of a long bone, concave side remains intact
Torus - Bulging of a cortex

Types of F#

Oblique: Across the shaft of a long bone @ 45 degree angle
Spiral: Torsion and compre­ssion - ends of the bones are sharp/­pointed
Transv­erse: At a right angle to the shaft of a long bone - usually caused by bone weakened by disease

Spatial Relati­onships of f#

Alignment: Position distal fragment in relation to the proximal fragment - angulation + rotation
Apposi­tion: Amount of bony contact at the fracture site

Traumatic Articular Lesions

Sublux­ation - Partial loss of contact between articular components of a joint
Disloc­ation Complete loss of contact between articular components of a joint
Diastasis Displa­cement or full separation of a syndemosis - most common @ pubic symphysis and distal tibio-­fibular syndes­mosis
Osteoc­hondral Defect: F# at a joint surface that may involve only the cartilage and underlying bone

F# Compli­cations

Immediate
Arterial Injury
Compar­tment Syndromes
Gas Gangrene
Fat embolism
Thromb­oem­bolism
Interm­ediate
Osteom­yelitis
Hardware Failure
CRPS
Post-T­rau­matic osteolysis
Re-fra­cture
Synostosis (union­/fusion of adjacent bones)
Delayed Union
Delayed Compli­cations
Osteon­ecrosis
DJD
Osteop­orosis
Non-union
Malunion

Salter­-Harris

Type I Through the growth plate only
Type II: Seperates off a small portion of the metaphysis and then traverse along the growth plate
Type III: F# is through the growth plate then turns into the epiphysis - intraa­rti­cular f#
Type IV F# separates off a portion of the metaphysis and the epiphysis, also an intra-­art­icular f#
Type V: Rare - Compre­ssion injury of epiphyseal plate - worst prognosis

Fractures and Disloc­ations

- Cx (C4-C7 vertebral bodies most fractured) occurs with axial loading of the neck in flexion
- Compre­ssion f# - axial compre­ssion + forced flexion, usually below T6.
In elderl­y/o­ste­opo­rotic patients, minimal trauma can cause these fracture, occurs at any level
Rule out conditions such as bony mets , multiple myeloma + Paget's
S&S
- Local spasm + swelling
Tenderness
Local flexion deformity can occur
Pain on percus­sio­n/v­ibr­ation
Manage­ment:
Healing time = 8-10 weeks, longer in elderly
Refer to f# unit at hospital