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Hello everyone. I'm doctor. And today I'll be given a presentation on the essential biological basics of fractures. I think, you know, day to day are still AICs either as medical students or clinicians during our internship and foundation year, something that we tend to encounter or we will encounter would be fractures. They're very common develop in the wards to develop the emergency system. And even when we are out of departments like emergency medicine orthopedics, we tend to sometimes meet patients with fractures that need referral to other services or higher level of care. So I think it's an important thing for doctors generally to be aware of, for people interested in radiology to be aware of people interested in, to be aware of. So that's what we will be talking about today. I'll start by aligning our objectives. I'm hoping that by the end of the presentation, you will be able to understand the importance of accurate fraction descriptions orthopedics. Why it's important, why we talk about it, why we do it and why we feel that most people should understand the basis of fracture patients. The next thing would be we should be able to identify the key elements involved in describing fractures. Yeah, there's a systematic approach that we that would be important in approaching fractures, understanding how that could be helpful. Well, next we should be, there are common fracture patterns that we encounter daily in practice. There should be hopefully by the end of the presentation, we should be able to differentiate between the type of fracture patterns. And then something that people commonly say with fractures is that they are displaced, they or angulated. I wanna show you some images of this, how to describe them, how to identify and displacement. And then we should recognize the significant difference between open and close factors. It's very important as a distinction to understand what factors are open, which factors are closed and how this is important and relevant to how the fractures are managed. So what is a fracture? It seems like a very good question that everyone knows about fractures um breaking, it continues to your bone. This is really develops for lots of reasons. But most of the time it as a result of either trauma or some kind of direct injury to the bone which causes that break or that push incontinent. Sometimes fractures could be pathological where they develop spontaneously as a result of weakness or brittle bones. So or as a result of malignancy, yeah, because of how frac common fractures are. It's very important that uh they uh describe accurately, it's crucial for communication and their management because the pattern of a fracture, the type of a fracture affects the way the factor is managed. May differentiate. It may be important for to differentiate if the bladder fracture is gonna be managed conservatively or if it will require surgery and how urgent that surgery will be. So, it's very important that as clinicians, we should be able to describe fractures accurately and be able to communicate that to between ourselves and to other referring clinicians and specialists. The best way to do this would be to use a systematic approach and and consistent descriptions that would be uniform. So if you do, if you're a doctor, I think love listeners from are from all over the world. So if you're a doctor in Egypt, if you're a doctor in Nigeria, if you're a doctor in the United Kingdom, it should be a standard description that everyone would be easily understand and would be universal. So what are the key elements of describing fractures? One thing that would be important would be where exactly is the location? What part of the bone is it? The first thing would be? What bone is it? So, is it the femur, is it the humerus? Is it the radius? Is it one of the metacarpal bones or metatarsal bones? And then within that bone, is it the proximal aspect of the bone? Is it it MHA is it a distal aspect of the bone? I understand that obviously a lot of this in writing, wouldn't I will give a clear picture. So in the next slide, I'm gonna give you an example and kind of work through what I mean by describing key elements of the bone. The next thing is it, what's the type of fracture? Is it a complete or incomplete fracture, incomplete fractures, we have complete bridge of bone. There's a complete discontinuity of the bone all the way from the cortices to from one from the outer cord to the in my cortic um for the medial or lateral cortices and then in incomplete fractures that break or that bridge is incomplete, it could be tinted. It could be a third. It could just be a small bridge but it is incomplete. There is no complete bridge of bone, cortical and marrow bone continuity. The other thing to be aware of would be this fracture is displaced are the um the fracture will be displaced if it's proximal and distal and it's translated angulated or rotated. So it's like mm mm. So it's ha has this been displaced with displacement is very important because a degree of displacement could mean that there is urgent need for this fibroid to be repaired. Sly otherwise, it's not gonna be healed by, it's not gonna heal any other way. So, displacement is an important feature to be able to identify and we're also going to point that out with an example. The next thing would be is a soft tissue involvement. Is it an open or closed fracture, open or closed fractures are managed differently with open fractures requiring more urgency. So, um sometimes it may be difficult. Obviously, if the with the patient in front of you, you could easily, you could kind of tell that if fracture is open or close or there may be some ra fractures, some radi features that could be seen that could give you an idea if your fracture is open or closed. The next thing would be, are there any special contributions? What am I looking at? Is this a pediatric fracture? Could it be pathological in the sense that it may not be have developed as a result of an arthro truma a major direct trauma? Or there was there's something else that predisposed that fracture to break in the either as a result of osteopenia or osteoporosis or as a result of bone disease like um metastasis or a primary bone tumor. So looking at this image, it it just kind of mirrors into what we've been trying to discuss or talk about. I will try to use a descriptor. So with the later point, the, yeah. So when the first we are seeing a transverse fracture, this typically develops as a result of a direct blue. And these are all examples of complete fracture where from the outer to the inner cartridges of the bone, there has been a complete breach or breaking bone continuing. So it's complete, it's stronger. It's a straight long, uh It's a straight uh longitudinal line directly across the b it's a straight transit line directly across the bone. The next thing would be oblique fractures. Also another kind of complete fracture. Mm. There is it like an oblique line. There's a complete um again, another complete frac fractal line through the alter and inner cort of the bone, but it's oblique, it's slightly, it's slanted in an oblique dis um uh placement. The other thing would be a spiral fracture. This is the the spiral fractures. The way these fractures appear, these complete fractures appear with a simple fracture line can give an idea of the ki the mechanism of injury. So with spiral fracture is usually as a result of rotational injuries or rotational injuries, either in a motor vehicle accident or fall, but usually rotational fall that apply to the wound that causes the factor to have this spiral pa spiral pattern as described. Yeah, the the other thing we could talk about is that sometimes fractures are really simple where there's just two bone, um a distal and proximal fragment. Sometimes there are multiple fragments, either two fracture lines with three bone this place. As you can see in the image here, this is the image of femur, we see this upper or or more proximal um fractal segment, a middle fracture segment and a distal fracture segment in. And we can see obviously either there are two fracture lines it's still a complete fracture. But two fracture lines, typically, with this kind of injuries, there would have been significant trauma and significant mechanism injury. All high energy injuries that could develop could lead to complex combined fractures where there are multiple fracture lines, multiple bone pieces. They it's difficult to just alienate with multiple bone segments that you can see. So you can see that this typically developed as a result of high energy injury, high energy falls, high impact injuries. And we can see it described here uh with a fracture of tibia with multiple segments, multiple different segments is difficult to pick local life. Again, this kind of fracture pa patterns develop a injury injury. They tend to be a lot more unstable. They tend to require most common fractures would require some kind of surgical input. This is, this circles us back to why it's important to describe these fractures adequately. Next thing would be incomplete fractures where there hasn't been a complete um out at the in Cortis bridge of bone. But we can see that there is a bridge of bone but it hasn't been, there hasn't been a complete out that an cortis and break or bridge of that wound. So we can see it here in this greens fracture common in Children. Well, yes, there has been a fracture, there has been some ation but the the outer bone cortis is still one of the outer bone cortices is still intact. Hasn't been completely breached. We also we have a buccal fracture that develops also in Children as a result of compression of force where we have one part of the bone compressing the other without a complete breach of the outer cortices with green, thick and buccal fractures. We tend to see that these fractures are managed conservatively most of the time in Children. So how uh um I kind of went through most of this in the previous slide when we talked about the transverse fractures, appendicular to the long of the bone you oblique fractures with an angle fracture line, spiral fractures that are caused by a rotational force. So just by looking at the fracture, you can have an idea that you can have a good idea of what may have developed or how these fractures may have developed. And next, the combinative fracture with the bone broken down into multiple fragments on a and incom fracture common in Children. And we highlighted this again with transverse fracture fracture. Sometimes there's something called the butterfly fragment which where the bone fragment looks like the wings of a butterfly and just a thin layer of the outer cord. I'll demonstrate this here. Just a thin layer of the outer cord is still intact with the bone fragment with a triangular bone fragment just detaching. We we should talk and come in fractures. A split with angulation. I think this is also important. It is important when describing these factors to other people to be aware of displacement and angulation. So this plate uh basically describes the extent of separation between the fracture. And so we have a fracture and there are two ends of that fracture. How separated, how away from each other are they? That's very important because it tells us, look how much bone has been lost. How much would be needed. Can this fracture be repaired without needing a bone graft? Can this fracture be repaired by conservatively without requiring surgery or um require requiring surgical intervention to reduce this displacement? You know, so it's it's uh someone hearing that information will be like, yes, it, how displaced is a fracture? You're describing that to the person, they can give them an idea of how important, how urgent you know, what your line of management will likely be. So in translation, this displacement will be a sideway shift. So it will be a separation to the side or this where the fracture ends are shifted towards one side or the other, we can overlap it. There's been a fracture has been displaced but as size of displacement, it kind of is shortened and the fracture ends kind of overlap, overlap each other. Mm And with angulation, the fracture ends have been broken but they form an angle between each other. And the easiest way to describe this placement would be to describe the direction of the apex of the distal fragment or the relation is the distal end of the fracture to the apex. I'm sorry, I will help you. Yes. Yeah. So I this is an image of uh of uh um of a sorry is x-rays tries to describe a an open fracture. It's an open fracture of tibia. Um The there's also tullar a fibular fracture seen. Well, radiologically how you can really tell is you can see this fractal segment is displaced, significantly displaced. This is the apex of the fracture of the fracture end. It is the distal end significantly this uh and translated away from the distal fracture. And then you can see some translucent areas around the bone with a bridge of skin. I know it's difficult to visualize that here. There's been a bridge of the skin. So sometimes just looking at an X ray, you can tell that this fracture, there's a lot of, there's a lot of there's a soft tissue reaction around there. There, there is some um transpl around the bone. This could indicate that look, there could have been a skin, there's significant hematoma formation around the bone and it could give you a hint that this is an open fracture and the final slide just highlights the ref references with uses and I hope that this has been helpful. It's been fast. Well, I just wanted to give an overview of the basics of practices or understand it how, how well they can be described, why it's important to describe them. And I hope that you found this useful.