hi welcome this is Dr Lee manini I'm the chief of the division of sports and exercise medicine at the UMass Chan medical school and the UMass Memorial Health Medical Center I'm an associate professor in the Department of Family Medicine and Community Health and the director of the UMass Primary Care Sports and exercise medicine Fellowship today I'll be talking about common fracture description terms this is part of amssm family medicine Radiology project I have nothing to disclose the objectives for this talk are to introduce everyone to Common fracture terms and to go over common different types of fractures key points in describing a fracture you need to make sure you're correctly describe which bone is involved where on the bone is it the midshaft is it distal is it proximal what type of fracture and then how is the fracture aligned the first term is displacement so displacement ter describes the relationship between the distal and the proximal fragment displacement can be described as either millimeters or a percentage it also can be described as a non-displaced fracture if you use the term minimally displaced that means that it is displaced by 3 mm or less angulated angulation refers to the relationship of the two fractures in either the frontal or the sagittal plane you need to have views that are both that are 90 degrees apart so you need two views typically an AP View and a lateral view when we talk about angulation we talk about whether is an acceptable amount of angulation or or it is an unacceptable amount of angulation if something is angulated too far then it tends to have a risk that we need to take this it to surgery apposition apposition is another type of displacement but instead of talking about where angulation was bending now we're talking about the two ends of the bones if there's shortening of the bone itself and that changes and affects the length of the bone on this top picture you can see the image on the far left has endtoend apposition the second picture to the left has a 50% apposition and then the third picture shows bayonet or side to side app apposition where the two pieces are touching but there's 0% overlap and then the last picture is no apposition in this bottom e x-ray you can see what we would call probably a minimally displaced or um less than a 50% endtoend apposition of this midshaft fracture of the tibia commuted fractures are fractures that are in multiple fragments a simple fracture as you see here on the left and this fracture of the tibia has just two parts one a distal part and a proximal part on the right you can see a comminuted fracture of the femur where it's broken into multiple pieces one type of commuted fracture is a segmental fracture in this case you can see a segmental fract of the tibia where there are three distinct fragments where the tibia has been broken into a distal fragment a middle fragment and a proximal fragment here you see an evulsion fractures evulsion fractures are when a tendon or a ligament pulls and tugs a piece of the bone off these are commonly frown on the hip the elbow and the ankle on the top right you can see a picture of an evulsion fract of the the base of the fifth metatarsal and on the bottom left x-ray you can see an evulsion fracture from the hip an intraarticular fracture describes a fracture that goes into the joint space itself this leads to long-term prognosis of increased risk of osteoarthritis developing there it also leads to cartilage damage on the articular cartilage in the joint surface on the right you can see an intraarticular fracture of the tiia going into the knee joint and on the left intraarticular fracture into the proximal inter fangel joint on a finger transverse describes types of fractures and the relationship of the fracture to the long axis of the bone typically fractures are described as transverse where it goes straight across perpendicular there's also short oblique and long oblique fractures as well the transverse fracture here on the bottom left is a transverse fracture of the mid shaft of the tibia a short oblique fracture which is the middle picture uh on this example on the bottom left image is a slanted fracture where it tends to be at a low angle usually between 30 and 60° and this is relative to the long AIS of the bone so it is closer to the horizontal here you can see a short oblique fracture of the mid shaft of a humoris on the image on the right a long oblique fracture is a fracture that's less than 30° again relative to the long vertical axis of the bone so it is closer to Vertical one common misconception is people can confuse long oblique fractures with spiral fractures and they are not the same spiral fracture is a fracture that happens from a mechanism of extreme twisting and rotational Force again it's not a long oblique fracture and it's where the force is applied at any other angle to the Bone other than a 90 Dee angle on the bottom left you see a spiral fracture of the mid shaft of the humoris and on the right you see an x-ray of a spiral fracture of the distal tibia compression fractures are common in cancellus flat bones I.E the spongy bones in the body vertebrae are a common site of compression fractures um also we see this in you know force or if there's an issue of osteoporosis or osteopenia that increases the risk of compression fractures you can also see a compression fracture at the ends of long bones such as the tibia or the femur here are images of a compression fracture of a lumbar vertebrae impaction fractures are fractures where there's a direct force that goes down the length of the bone think about something hitting here and the fracture impacted and what we call telescoping the fragment where one fragment goes inside the other on the top right this is an ex x-ray of a impaction fracture of the proximal humoris by the humeral head and on the bottom left you see an impaction fracture of the distal radius these usually occur with high trauma or high forces pathologic fractures are fractures at a site where the bone has been weakened the most common type of these are tumors um but you can also have this from osteoporosis the image on the right is a pathologic fracture on the distal radius and the hand and wrist and on the left is a pathologic fracture of the proximal femur so in summary we went through common fracture description terms displace fractures angulation apposition simple versus commuted segmented commuted fractures evulsion fractures interarticular fractures transverse fractures oblique short fractures oblique long fractures spiral fractures compression fractures impaction fractures or impact fractures and pathologic fractures thank you so much for watching and for your attention