Skeletal Trauma
Skeletal trauma can be divided into three major groups of injuries to the musculoskeletal system: fractures, dislocations, and fracture/dislocations. A fracture is a disruption in the continuity of cortical and/or cancellous bone. A dislocation is a disru
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Skeletal Trauma Francis X. McGuigan
Skeletal trauma can be divided into three major groups of injuries to the musculoskeletal system: fractures, dislocations, and fracture/dislocations. A fracture is a disruption in the continuity of cortical and/or cancellous bone. A dislocation is a disruption of the normal articulating anatomy of a joint. Dislocations can be either a complete disruption of the normal anatomy or a partial dislocation, termed a subluxation. A fracture/dislocation is a fracture occurring in or near a joint that results in a subluxation or dislocation of the joint.
Fractures Fracture Descriptors A number of different terms are used to describe the configuration and features of any given fracture. These general descriptors are as follows: 1. Open versus closed: A closed fracture is one in which the skin is intact over the fracture site and an open fracture is one in which the skin is disrupted. 2. Simple versus comminuted: A simple fracture is one in which there are only two major fragments and one fracture line. A comminuted fracture is one in which there are multiple fragments of bone and multiple fracture lines. 3. Complete versus incomplete: A complete fracture is one in which the fracture line goes completely across the bone. Incomplete fractures, most typically seen in children, have a fracture line that only crosses one cortex of the bone involved.
F.X. McGuigan (B) Department of Orthopedic Surgery, Foot and Ankle Center, Georgetown University Medical Center, 3800 Reservoir Road NW, Pasquerilla Healthcare Center (PHC), Ground Floor, Washington, DC 20007, USA e-mail: [email protected]
S.W. Wiesel, J.N. Delahay (eds.), Essentials of Orthopedic Surgery, C Springer Science+Business Media, LLC 2010 DOI 10.1007/978-1-4419-1389-0_2,
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F.X. McGuigan
Fracture Deformities A fracture can be deformed in any one of three possible planes. Traditionally, the deformity is described by the relative position of the distal fragment in relation to the proximal fragment. Classic deformations are described as follows (Fig. 2.1): 1. Displacement is the amount of translation of the distal fragment in relation to the proximal fragment in either the anterior/posterior or the medial/lateral planes. Displacement is the opposite of apposition. 2. Angulation occurs when two fracture fragments are not aligned and an angular deformity is present in either the anterior/posterior or the medial/lateral planes.
Fig. 2.1 (a) Angulation is described by the direction in which the apex of the fracture is pointing. (b) Displacement (arrows) is defined by the position of the distal fragment in relation to the proximal fragment. (Netter images reprinted with permission from Elsevier. All rights reserved)
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Alignment means that the axes of the proximal and distal fragments are parallel to each other and the joint above and below are in the normal (anatomic) relationship. Angulation is typically described by the direction in which the apex of the angle points – medial, lateral, dorsal, vo
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