Fracture

Closed Fracture
Monteggia fracture-dislocation: Fracture of the
proximal third of the ulna, with dislocation of the
head of the radius
Galeazzi fracture-dislocation:Fracture of the distal third of
the radius with dislocation of the distal radio-ulnar joint
Night-stick fracture:Isolated fracture of the shaft of
the ulna, sustained while trying to ward off a stick
blow.
Colles’ fracture:A fracture occurring in adults, at
the cortico-cancellous junction of the distal end of the
radius with dorsaltilt and other displacements
Smith's fracture:A fracture occurring in adults, at
the cortico-cancellous junction of the distal end of the radius
with ventraltilt and other displacements
(reverse of Colles').
Barton's fracture (Marginal fracture): Intra-articular
fractures through the distal articular surface of the
radius, taking a margin, anterior or posterior, of the
distal radius with the carpals, displaced anteriorly
or posteriorly
Chauffeur fracture:An intra-articular, oblique
fracture of the styloid process of the radius.
Bennett's fracture-dislocation:It is an oblique, intra-articular
fracture of the base of the first metacarpal
with subluxation of the trapezio-metacarpal joint
Boxers' fracture:It is a ventrally displaced
fracture
through the neck of the 5th metacarpal,
usually
occurs in boxers.
Side-swipe fracture:It is an elbow injury
sustained when one's elbow, projecting
out of a car, is ‘side-swept’ by another
vehicle. It has a combination of fractures
of the distal end of the humerus with
fractures of proximal ends of radius
and/or ulna. It is also called baby car
fracture.
Bumper fracture:It is a comminuted,
depressed fracture of the lateral condyle
of the tibia.
Dashboard fracture:A fracture of
posterior lip of the acetabulum, often
associated with posterior dislocation of
the hip.
Pott's fracture:Bimalleolar ankle fracture.
Cotton's fracture: Trimalleolar ankle
fracture.
Massonaise's fracture:It is a type of ankle
fracture
in which fracture of the neckof the fibula
occurs.
Straddle fracture:Bilateral superior and
inferior
pubic rami fractures.
Pilon fracture:It is a comminuted intra-
articular
fracture of the distal end of the tibia.
Aviator's fracture:Fracture of neck of the
talus.
Malgaigne's fracture:A type of pelvis
fracture in
which there is combination of fractures,
pubic rami anteriorly and sacro-iliac joint
or ilium posteriorly, on the sameside.
Mallet finger:A finger flexed at the DIP
joint due to avulsion or rupture of
extensor tendon at the base of the distal
phalanx.
Chopart fracture-dislocation: A fracture-dislocation
through inter-tarsal joints.
Jone's fracture: Avulsion fracture of the base of the
5th metatarsal.
Rolando fracture: Fracture of the base of the first
metacarpal (extra-articular).
Jefferson’sfracture:Fracture of the first cervical vertebra.
Whiplash injury:Cervical spine injury where sudden
flexion followed by hyperextension takes place.
Chance fracture:Also called seat belt fracture, the
fracture line runs horizontally through the body of the
vertebra, through and through, to the posterior elements.
March fracture: Fatigue fracture of the shaft of 2nd
or 3rd metatarsal.
Burst fracture:It is a comminuted fracture of the
vertebral body where fragments ‘‘burst out’’ in
different directions
Clay-Shoveller fracture:It is an avulsion fracture of
spinous process of one or more of the lower cervical
or upper thoracic vertebrae.
Hangman's fracture:It is a fracture through the
pedicle and lamina of C2vertebra, with subluxation
of C2over C3, sustained in hanging.
Open Fracture
- Kerusakan jaringan tulang dengan disertai kerusakan kulit beserta jaringan
lunak dibawahnya yang mengakibatkan fraktur dan hematomenya kontak
dengan dunia luar.

- 1/3 pasien open fraktur mengalami multiple injury.

- Luka apapun yang ada pada lokasi yang sama dengan lokasi fraktur harus
dicurigai sebgai akibat dari fraktur terbuka sampai terbukti ia disebabkan oleh
faktor lain.
CLINICAL EVALUATION
What we have to do?
1. Evaluasi ABCDE
2. Resusitasi dan temukan faktor yang mengancam
jiwa
3. Evaluasi cidera kepala, thoracal, abdomen, pelvis
dan spine.
4. Identifikasi semua cidera pada ekstremitas
5. Identifikasi kerusakan neurovaskular
6. Periksa kerusakan jaringan kulit dan soft tissue
7. Identifikasi cidera skeletal -> radiografi
Classification of open fracture
Tscherne Classification
Complication
• Infection:
Cellulitis or osteomyelitis
Certain anatomic areas may be more prone to infection than others:
The tibia with its one-third subcutaneous nature will be affected by the soft tissue stripping at the
fracture site more so than a forearm injury with greater soft tissue coverage. Gross contamination at
the time of injury is causative, although retained foreign bodies, amount of soft tissue compromise
(wound type), nutritional status, and multisystem injury are risk factors for infection.

• Missed compartment syndrome:This devastating complication results in severe loss of function,

most commonly in the forearm, foot, and leg. It may be avoided by a high index of suspicion with
se-rial neurovascular examinations accompanied by compartment pressure monitoring, prompt
recognition of impending compart-ment syndrome, and fascial release at the time of surgery.
Perkin’s timetable
A spiral fracture in the upper limb unites in 3 weeks; for consolidation multiply by 2; for the
lower limb multiply by 2 again; for transverse fractures multiply again by 2. A
more sophisticated formula is as follows. A spiral fracture in the upper limb takes 6–8 weeks
to con-solidate; the lower limb needs twice as long. Add 25% if the fracture is not spiral or if it
involves the femur. Children’s fractures, of course, join more quickly. These figures are only a
rough guide; there must be clinical and radiological evidence of con-solidation before full
stress is permitted without splintage.
DELAYED AND NON-UNION
When a fracture takes more than the usual time to unite, it is said to have gone in delayed union. A
large percentage of such fractures eventually unite. In some, the union does not progress, and they
fail to unite. These are called non-union. Conventionally, it is not before 6 months that a
fracture can be declared as non-union. It is often difficult to say whether the fracture is in delayed
union, or has gone into non-union. Only progressive evaluation of the X-rays over a period of time
can solve this issue. Presence of mobility at the fracture after a reasonable period is surely a sign of
non-union. Presence of pain at the fracture site on using the limbs also indicates
non-union. Non-union may be painless if pseudo joint forms between the fracture ends
(pseudoarthrosis).

Causes:
(1) distraction and separation of the fragments
(2) excessive movement at the fracture line
(3) A severe injury that renders the local tissues non-viable or nearly so;
(4) a poor local blood supply
(5) infection
Common sites: Sites where non-union occurs commonly are neck of the femur, scaphoid, lower
third of the tibia, lower third of the ulna and lateral condyle of the humerus.
Consequences: Delayed and non-union can result in persistent pain, deformity, or
abnormal mobility at the fracture site. A fracture in delayed union, if stressed, can lead to
refracture.

Diagnosis: Delayed union is a diagnosis in relation to time. The fracture may not show
any abnormal signs clinically, but X-rays may fail to show bony union. The following are some of
the clinical findings which suggest delayed union and non-union:
• Persistent pain
• Pain on stressing the fracture
• Mobility (in non-union)
• Increasing deformity at the fracture site (in non-union)
The following are some of the radiological features suggestive of these complications:
• Delayed union: The fracture line is visible. There may be inadequate callus bridging the fracture site.
• Non-union: The fracture line is visible. There is little bridging callus. The fracture ends may be
rounded, smooth and sclerotic. The medullary cavity may be obliterated.
Malunion
When a fracture does not unite in proper
position, it is said to have malunited.
Causes: Improper treatment is the commonest
cause. Malunion is therefore preventable in most
cases by keeping a close watch on position of the
fracture during treatment. Sometimes, malunion is
inevitable because of unchecked muscle pull (e.g.,
fracture of the clavicle), or excessive comminution
(e.g., Colles’ fracture).
Consequences: Malunion results in deformity,
shortening of the limb, and limitation of
movements.
Treatment: Each case is treated on its merit. A
slight degree of malunion may not require any
treatment, but a malunion producing significant
disability, especially in adults, needs operative
intervention.

Common sites: Fractures at the ends of a bone always

unite, but they often malunite e.g., supracondylar
fracture of the humerus, Colles’ fracture etc.