X RAY ANALYSIS OF FRACTURE

Dr. M. Fajrin Armin F, Sp.OT

SMF Orthopaedi RSUD dr. H. Abdul Moeloek Provinsi Lampung
 FRACTURES & ASSOCIATED
INJURIES
• Structural break in continuity of :
• Bone
• Epiphyseal plate
• Cartilaginous joint surface

Injury to the soft tissue may be more

significance than the fracture itself!!
 PHYSICAL FACTORS IN
FRACTURES

Mechanism Of Injury Fracture Patern

Twisting Spiral Fracture

Compression Short Oblique Fracture

Bending Triangular butterfly fragment

Tension Transverse or avulsion of small fragment of bone at the insertion of

ligament or tendon
FRACTURE DECSRIPTION

• Site
• Extent
• Configuration
• Relationship of the fracture segments to each other
• Relationship with external environment

Salter RB. Textbook of Disorders and Injury of Musculoskeletal System

 Site
Extent

Relation to external
environment
Relationship to each other Configuration
Salter RB. Textbook of Disorders and Injury of Musculoskeletal System
THE RULE OF 2

• Rule of 2:
• 2 projection
• 2 joint involvement
• 2 extremities (in paediatrics patient)
• 2 location (check other probable site of injury)
• 2 occasion (pre-post manipulation)
 Poor xray
Good xray
V
S
TRANSVERS
E FX Oblique fx Spiral fx
COMMINUTI Butterfly
VE
Segmental
fragment
COMBINATION
EPONYMOUS FRACTURE
 UPPER EXTREMITY

• Bankart fracture: glenoid • Monteggia fracture: forearm

• Barton fracture: wrist • Rolando fracture: thumb
• Bennett fracture: thumb • Smith fracture: wrist
• Chance fracture: vertebral
• Colles fracture: wrist
• Essex-Lopresti fracture: elbow
• Galeazzi fracture: forearm
• Hill-Sachs fracture: shoulder
• Hutchinson fracture: wrist
 LOWER EXTREMITY

• Bosworth fracture: ankle • Jones fracture: foot

• Masionneuve fracture: ankle
• Charcot joint: foot
• Malgaigne fracture: pelvis
• Chopart fracture: foot
• Shepherd fracture: foot
• Cotton fracture: ankle
• Stieda fracture: acute fracture of
• Dupuytren fracture: ankle Stieda process
• Tillaux fracture: ankle
• Duverney fracture: pelvic
• Gosselin fracture: ankle
• Goyrand fracture: French term for a
smith fracture
 OTHERS

• Holdsworth fracture: vertebral

SPECIAL CONSIDERATIONS –
FRACTURES IN CHILDREN

• Often missed or overlooked

• When in doubt, compare with the un-injured site
• Vary appearance in epiphyses and epiphyseal plate during
period of growth
• Physeal injury
SALTER HARRIS FRACTURE IN
CHILDREN
 WHICH TYPE OF SALTER
HARRIS?

II III IV
WHAT HAPPENS IF WE NEGLECT
THE FRACTURE?
IS THERE ANY
FRACTURE?
DESCRIBE THE X-RAY
EXAMPLE 1

• Right femur AP and lateral

• Adequate x-ray
• Correct identity
• Location: right proximal metaphyseal
femur (extraarticular-intertrochanter)
• Pattern: comminutive, reverse oblique
• Displacement: shortening, angulation
(varus)

• Conclusion: comminutive fracture of

right proximal femur
EXAMPLE 2

• Left radius and ulna (forearm) AP

and lateral
• Adequate x-ray
• Correct identity
• Location: left diaphyseal 1/3 middle
radius and ulna
• Pattern: simple oblique
• Displacement: shortening, angulation
• Conclusion: fracture of left radius
and ulna 1/3 middle simple oblique
UPPER EXTREMITY
LOWER EXTREMITY
OTHERS