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Toronto Notes 2019
Fractures – General Principles
Orthopedics OR5
Table 2. Muscle and Compartment Review of the Limbs
Arm
Biceps Brachii Brachialis Coracobrachialis
Triceps Aconeus
Forearm
Pronator Teres
Flexor Carpi Radialis Palmaris Longus Flexor Carpi Ulnaris Flexor Digitorum Superficialis
Flexor Digitorum Profundus
Flexor Hallucis Longus Pronator Quadratus
Brachioradialis Extensor Carpi Radialis Longus
Extensor Carpi Radialis Brevis
Extensor Carpi Ulnaris Extensor Digitorum Extensor Digiti Minimi Abductor Pollicis Longus
Extensor Pollicis Longus Extensor Pollicis Brevis Extensor Indicis Supinator
Pectineus
Anterior Compartment
Posterior Compartment
Medial Compartment
Lateral Compartment
Thigh
Sartorius Quadriceps
Rectus Femoris Vastus Lateralis Vastus Intermedius Vastus Medialis
Hamstrings
Semitendinosus Semimembranosus Biceps Femoris
Adductor Longus Adductor Brevis Adductor Magnus Gracilis
Leg
Tibialis Anterior Extensor Hallucis Longus
Extensor Digitorum Longus
Superficial
Gastrocnemius Soleus Plantaris
Deep
Popliteus
Flexor Hallucis Longus Flexor Digitorum Longus
Tibialis Posterior
Fibularis Longus Fibularis Brevis
Fractures – General Principles
Fracture Description
1 . Name of Injured Bone
2 . Integrity of Skin/Soft Tissue
Displacement
Refers to position of the distal fragment relative to the proximal fragment
Varus/Valgus Angulation
Varus = Apex away from midline Valgus = Apex toward midline
Quick Motor Nerve Exam
“Thumbs Up”: PIN (Radial Nerve) “OK Sign”: AIN (Median Nerve) “Spread Fingers”: Ulnar Nerve
X-Ray Rule of 2s
2 sides = bilateral
2 views = AP + lateral
2 joints = joint above + below
2 times = before + after reduction
• closed:skin/softtissueoverandnearfractureisintact
• open:skin/softtissueoverandnearfractureislaceratedorabraded,fractureexposedtooutside
environment, or contaminated (i.e. bowel)
• signs:continuousbleedingfrompuncturesiteorfatdropletsinbloodaresuggestiveofanopenfracture
3 . Location
• epiphyseal:endofbone,formingpartoftheadjacentjoint
• metaphyseal:theflaredportionoftheboneattheendsoftheshaft • diaphyseal:theshaftofalongbone(proximal,middle,distal)
• physis:growthplate
4 . Orientation/Fracture Pattern (Figure 4)
• transverse:fracturelineperpendicular(<30°ofangulation)tolongaxisofbone;resultofdirecthigh
energy force
• oblique:angularfractureline(30°-60°ofangulation);resultofangulationandcompressiveforce,high
energy
• butterfly:fracturesitefragmentwhichlookslikeabutterfly
• segmental:aseparatesegmentofboneborderedbyfracturelines;resultofhighenergyforce
• spiral: complex, multi-planar fracture line; result of rotational force, low energy
• comminuted/multi-fragmentary:>2fracturefragments
• intra-articular:fracturelinecrossesarticularcartilageandentersjoint
• compression:impactionofbone;typicalsitesarevertebraeorproximaltibia
• torus:abucklefractureofonecortex,ofteninchildren(Figure50)
• greenstick:anincompletefractureofonecortex,ofteninchildren(Figure50)
• pathologic:fracturethroughboneweakenedbydisease/tumour
5 . Alignment of Fracture Fragments (Figure 5)
• non-displaced:fracturefragmentsareinanatomicalignment • displaced:fracturefragmentsarenotinanatomicalignment