ŠĻą”±į>ž’ Y[ž’’’X’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’ģ„ĮM šæœ"bjbjā=ā= .X€W€Wœ’’’’’’lÜÜÜÜÜÜÜšnnnn$’¬šś12J J J J J J J J y1{1{1{1{1{1{1$,3 L5PŸ1ÜJ J J J J Ÿ1ś!ÜÜJ J “1ś!ś!ś!J FÜJ ÜJ y1ś!J y1ś!Øś!¢&V).@ÜÜķ.J > PŠæ{RĘš~n i. ķ.ŒŹ10ś1u.xœ5š `œ5ķ.ś!ššÜÜÜÜŁFRACTURES/ COMMON ORTHOPAEDIC CONDITIONS Bone/ area of the bodyPossible fractures and other common orthopaedic conditionsGeneral types of fractures Common joint injuries Open – fractured bone penetrates surface of skin Closed – fracture does not penetrate skin Greenstick – incomplete fracture – usually in growing children Epiphysis injury – in growing children – epiphyseal plate at end of long bones Stress – due to repeated strain in the same direction, e.g. march fracture of metatarsal bone Pathological – fracture occurring through abnormal bone (N331.) Congenital Inflammatory Neoplastic – benign or malignant Metabolic Sprains – soft tissue injury (STI) Subluxations – partial dislocation of a joint (coding as below) Dislocations – complete dislocation of a joint Common types – Shoulder (S41..) (Can be anterior, posterior and recurrent) Knee (S46..) Elbow (S42..) Hip (S45..) Cranium (skull)Skull fracture (S0...) - Frontal, temporal, parietal, occipital, sphenoid and ethmoid Face (S02..)Nose (nasal fractures) Zygoma – cheek bone Orbital fractures (eye socket) Mandible – lower jaw bone (closed – S022.) Maxilla – upper jaw bone Can be classified as: Le Fort 1 – Maxilla # with nose and orbits intact Le Fort 2 – Maxilla # into orbits and across the nose (middle 3rd of face is mobile) Le Fort 3 – Through lateral wall of orbit and across nose Spine (Vertebral column) - with no cord damage (S10..)Common spinal fractures/ injuries Fracture of transverse processes – usually in lumbar region Fractures of vertebral bodies - Wedge fractures (compression of vertebral body) - Burst fractures (bursting of vertebral body) Fracture dislocation of spine – severe injury – usually causing paralysis Cervical spine (C1-7) individual vertebrae odontoid process (C2) atlas bone (C1) Thoracic/ Dorsal spine (T/D 1-12) individual vertebrae Lumbar spine (L1-5) individual vertebrae transverse process fractures Sacrum (5 fused vertebrae – centre of back of pelvis) (Fractures of sacrum are uncommon, usually associated with fractured pelvis) Coccyx (4 small fused vertebrae - tail bone) Prolapsed intevertebral disc (PID) – Most common site noted is L5/S1 which is the disc between the fifth lumbar vertebra and the first sacral vertebraClavicle (Collar bone) Shaft (usually middle third of bone – often complicated by mal-union) Dislocations Dislocated AC joint (acromio-clavicular joint) – joint at lateral aspect of clavicle connecting to shoulder joint. Dislocated SC joint (sterno-clavicular joint) – uncommon – inner end of clavicle Scapula (Shoulder blade)Usually neck, body or blade of scapula Fractures of acromion and/ or glenoid Sternum (Breast bone) (S128.)Sternum bone Ribs (1-12)Isolated fractures to single ribs Multiple fractures – Flail chest – part of the chest wall is free to move independently of the thorax which can cause respiratory failure Upper limb: Shoulder Humerus (upper arm) (S22..) Radius and Ulna (lower arm) Carpals (wrist) Metacarpals (hand) (1-5) MCPJ – Metacarpo-phalangeal joint (joint between fingers and hand) Phalanges (fingers) (1-5)  Fracture dislocation of the shoulder (S41..) is common – fracture of greater tuberosity occurs in association with dislocation of head of humerus. Soft tissue injury (STI) Injuries of the rotator cuff Rupture of the long head of the biceps Head of humerus Neck of humerus (anatomical neck or surgical neck) Greater tuberosity (usually avulsion) Lesser tuberosity Shaft of humerus Epicondylar fractures Lateral humeral condyle Fracture of capitulum – lateral epicondyle Avulsion of epiphysis of medial condyle Lower end of humerus (commonly noted as ELBOW FRACTURE) (S228.) Supracondylar fracture Y shaped fractures of lower end of humerus (not common) Upper forearm Olecranon (top of ulna at back of elbow – ‘funny bone’) Head of radius (flat top end of radius at elbow) Fractured neck of radius (just below head of radius) Monteggia fracture dislocation (fracture of upper third of ulna with dislocation of radial head) Lower forearm Colles (S23..) (fracture of lower radius with posterior displacement) Smiths (fracture of lower radius with anterior displacement) Barton’s fracture (lower end of radius) Galleazzi (fracture of lower third of radius with dislocation of lower end of the ulna) Fracture of radial styloid Fracture separation of lower radial epiphysis (in children) Buckle fracture (in children) – no actual break in bone continuity, the dorsal surface of the radius being merely buckled. Fracture of radial and/ or ulnar shafts ‘Pulled elbow’ – in young children lifted by the hand – dislocation of radial head Rupture of the biceps insertion Carpal bones (scaphoid, lunate, hamate, trapezium, triquetral, trapezoid, capitate and pisiform) Waist of scaphoid fracture Tuberosity of scaphoid fracture Dislocation of lunate bone Sprained wrist – STI of the wrist Fracture of base of 1st metacarpal Bennett’s fracture (base of first metacarpal – usually in young adults due to sports injury) Boxers fracture – fracture at base of 5th metacarpal Fractures of metacarpal shafts Fractures of metacarpal necks Fractures of the phalanges Fractures of the distal phalanx Mallet finger (distal interphalangeal joint avulsion) Dislocation of interphalangeal joints Carpal tunnel syndrome Pelvis Ilium - wing Acetabulum (socket where head of femur sits) - Anterior and posterior column fractures Pubic Rami or Ischial Rami fractures (usually occur in pairs) ‘Open book’ fractures and Malgaigne fractures (when pelvic ring is fractured in two places – usually due to extreme force, e.g. being run over) Disruption of the pubic symphysis (diastasis) Lower limb: Femur (upper leg) Patella (knee cap) Tibia and Fibula (lower leg) Tarsals (ankle) Metatarsals (foot, 1-5) Phalanges (toes)  Head of femur Neck of femur Trochanteric fracture (Pertronchanteric and intertrochanteric fractures) Subtrochanteric fracture Shaft of femur Supracondylar Condylar fractures Comminuted, stellate or transverse fractures ACL (anterior cruciate ligament damage) LCL (lateral collateral ligament damage) MCL (medial collateral ligament damage) Tibial plateau Tibial tuberosity Tibial crest Tibial tubercle Inner condyle tibial eminence Shaft of tibia Lateral malleolus Neck of fibula Head of fibula Shaft of fibula Outer condyle of fibula Medial malleolus Bilateral malleolus Trimalleolar fracture Pott’s fracture (dislocation of the ankle, involving the lower end of the tibia, displacement of the talus and sometimes fracture of the medial malleolus) Tarsal bones (calcaneum (heel), talus, navicular, cuboid and cuneiform x3) Proximal, medial and distal phalanx Useful terminology/ abbreviations pertaining to orthopaedics: Terminology/ abbreviationDefinitionProximalNearer to or nearest to the centre MedialToward the midline of the body DistalA point beyond, or away from, any reference point such as the centre of the body, e.g. the hand is distal to the elbow LateralOf, at or towards the side of the body PosteriorPertaining to the back of the body FrontalPertaining to the front of the body GreenstickIncomplete fracture of a long bone common in children (bone bent on one side and splintered on the other) EpiphysisGrowing sector at the end of a long bone SubluxationPartial or incomplete dislocation of a joint DislocationSeparation, especially the disarticulation of the bearing surfaces of a joint ORIFOpen Reduction and Internal Fixation (common operation to repair fractures) POPPlaster of Paris #Fracture  )*A}ŗ¾ėńTd£©ßä 9A…ŒØ“Öčō/7ƒ‹­µÕŻßōžLNSZx†„­ÉĪŠ×v x Č ÷ ž ’ - 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