How to understand that bones are fused?

A displaced fracture is a type of injury in which the bone ceases to be integral and the resulting bone fragments go beyond the boundaries of its normal position. The cause of such damage is most often a traumatic effect on a particular bone, while the applied force exceeds the reserve strength of the bone tissue. Less commonly, bone damage with subsequent disruption of the relative position of bone fragments can occur due to a sharp contraction of muscle fibers attached to the bones. Most often, displaced fractures affect long bones of the tubular type, especially if the line of damage runs in the area of ​​​​their body. However, intra-articular and para-articular fractures can also be accompanied by a change in the position of bone fragments. A common sign of a displaced fracture is a decrease in the length of the limb and its visual deformation (elongation of a segment of the arm or leg is much less common). The nature of the displacement of bone segments can be varied – around a vertical, horizontal axis or simultaneously in 2 directions. In case of double fractures, when there are 2 lines of damage, the fragments can shift in different planes. The final diagnosis is made on the basis of objective data, supplemented by the results of x-ray scanning. X-rays usually clearly visualize bone fragments and their position. However, in complex clinical cases, computed tomography or magnetic resonance imaging may be required. For intra-articular fractures, for example, transcondylar or transtrochanteric, arthroscopy (endoscopic examination of the joint cavity from the inside) may be indicated. Fractures with altered position of bone fragments are classified as complex. In order for bone tissue to regenerate and lead to consolidation of the injured area, it is important to create optimal conditions, in particular to compare the fragments and then fix them. Conservative tactics consist of manual reposition in accordance with a certain algorithm of actions. However, this approach is not always effective. In such situations, surgical treatment is indicated – skeletal traction or open surgery for a displaced fracture. This disease is treated by:

Types of displaced fractures

• Open and closed. In the first case, there is a wound on the skin in the area of ​​the fracture, and it can be primary (received simultaneously with bone damage) and secondary (the skin is injured by bone fragments). With closed fractures, the skin remains intact.
• Single and multiple. The latter type of injury is considered more serious and is usually observed when falling from a height.
• The location of displaced fractures can be very diverse. In the area of ​​the upper limb, this is a fracture of the clavicle, shoulder bone, ulna or radius bone (forearm), hand bones (wrist, metacarpal bones or phalanges of the fingers). A displaced fracture of the lower extremity can affect the following bones: the femur, one or two tibias of the leg (tibia, fibula, ankle injuries are especially common), bones of the foot (tarsal and metatarsal bones, phalanges of the fingers). Bone fragments can also shift in case of fractures of the skull bones (nose bone, jaw bone), chest (ribs) and vertebrae.
• Intra-articular fractures, which usually involve the head of the bone, are included in a separate category. They can affect the wrist, ankle and other joints. In periarticular fractures, the line of damage runs close to the joint, but is located outside it.

Symptoms of a displaced fracture

Symptoms of a displaced fracture may include the following:

• intense pain, the severity of which increases over time;
• swelling and bruising in soft tissues;
• curvature of the damaged body segment;
• shortening of an arm or leg (a symptom of lengthening is less common);
• bone crunch, which is determined when palpating the injured area or attempting to move (caused by friction of bone segments against each other);
• dysfunction of the injured area.

Causes

A displaced fracture can be a consequence of domestic, industrial or sports injuries. The mechanism of injury may be as follows:

• compression or compression of the bone;
• excessive flexion-extension;
• pathological rotation;
• a tear-off mechanism, which is realized under the influence of a sharp contraction of the attached muscles.

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If you experience these symptoms, we recommend that you make an appointment with your doctor. Timely consultation will prevent negative consequences for your health.

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Order transcripts of images

When answering how to determine a fracture from an image, the radiologist will tell you about 3 typical signs of diagnosing pathology – a line of clearing, the presence of fragments, displacement of fragments. When there is a traumatic effect on the osteoarticular system, different types of damage are formed. It is not at all necessary that a clearing line will be visible on the x-ray. When bone fragments are superimposed in the projection of the fracture, on the contrary, a darkening is formed. We will consider the subtleties of diagnosing traumatic bone injuries in the article. General diagram of different types of fractures

How to determine a fracture from a photograph

Before describing the X-ray criteria for determining a fracture from an image, it is necessary to highlight the extent of the damage, determine the amount of trauma, and identify fragments. Most often, people experience injuries to the upper or lower extremities. The first diagnostic test performed in this case is radiography. After conducting the study, the traumatologist wants to receive a comprehensive answer regarding the patient’s management tactics. In case of a fracture, comparison of fragments or application of plaster is required. For sprains and soft tissue bruises, an elastic bandage is sufficient for treatment. The duration of sick leave for the second nosology is shorter. Heel bone fractures take a very long time to heal. It takes at least 6 months for tissue restoration. The timing is explained by the constant load on the foot when walking, stretching of the bones by a strong plantar aponeurosis. It is not always possible to determine a calcaneal fracture from an image. The heel bone is a strong, massive structure. With an incomplete fracture, the clearing line is not clearly visible. There is no significant displacement of the fragments that would allow a reliable diagnosis. If there is a discrepancy between the X-ray data and the objective condition, traumatologists prescribe an additional examination – computed tomography. Cross sections help visualize the bone structure and clearly identify even small cracks. Diagnostic value in the analysis of radiographs of the hand is played by timely verification of a scaphoid fracture. The formation is small, located among the bones of the wrist. In the absence of divergence of fragments, a thin line of darkening is formed, which an inexperienced radiologist may not notice. If the fusion is improper, a false joint often forms in the scaphoid bone. If a person tries to lift a heavy object with his hand, he experiences sharp pain in the wrist area, during which he cannot fully grasp it with his hand. In practice, there are often cases when specialists expect high-quality healing of the scaphoid bone, but after 3-4 months, recovery does not occur. Due to the ingress of blood, soft tissue, and foreign bodies between the bone fragments, a false joint is formed. In case of pathology, surgery is required to remove objects that interfere with fusion. When studying the described nosological forms, it is necessary to take photographs in two projections – frontal and lateral. Computed tomography is prescribed if there are doubts about the patient’s real condition after traumatic exposure and the conclusion of radiography.

What does a fracture look like on an x-ray?

The radiologist’s description of the fracture is as follows: “On the presented radiograph of the right femur in two projections, a line of clearing can be traced in the projection of the surgical neck with angular displacement of the fragments. Conclusion: fracture of the surgical neck of the right femur.” To assess the displacement of fragments and make a decision by the traumatologist regarding treatment tactics, images in two projections are required. Anterior or posterior displacement is clearly visualized on a lateral radiograph. A direct shot shows deviation from the longitudinal axis to the right or left. Based on the above radiologist’s conclusion, it is easy to determine what a fracture looks like on an x-ray, but only with the classic version. There are complex fractures in which the clearing line looks like a spiral, the bones are driven into each other in the longitudinal direction. At the same time, additional deviations are formed, which are important to describe for the traumatologist, who will install a pin, plate with screws, apply plaster or apply other treatment tactics. It is not always possible to verify a fracture on an X-ray image the first time. “Cracks” are small damage without separation of bone fragments. With oblique passage of X-rays or weak exposure. Pathology is revealed on a series of subsequent radiographs. Under load, the bone fragments diverge, so a classic clearing line appears. The first sign of a fracture may not be a clearing in the area of ​​divergence, but a slight displacement of the bones along the longitudinal, transverse axis. The distal or proximal bone fragment can shift along the axis under the influence of the musculo-ligamentous apparatus, which affects the bone structures.

How to detect a fracture on an x-ray

It is not difficult to identify fractures on an x-ray if you know the x-ray anatomy of the osteoarticular system. All injuries are divided into simple and complicated. Not only bones can be damaged, but also surrounding soft tissues and the muscular-ligamentous apparatus. Improper treatment for complex fractures is accompanied by loss of mobility and depletion of muscle strength in the limb. Simple (closed) fractures can be identified on an x-ray by the location of bone fragments that do not penetrate outward through the skin. Complicated (open) fractures are characterized by pronounced displacement of fragments. The discrepancy between individual fragments is quite large. An angular displacement with rotation relative to the longitudinal axis can be traced. Closed fractures are characterized by damage to the skin and deep tissues. The danger of the open type is extensive bleeding, pain shock due to irritation of many nerve receptors. If there is a perforating wound, the likelihood of bacterial infection increases. Pathogenic microbes enter the body through the wound. Antibacterial drugs are recommended to prevent infection in the early stages. Medicines are prescribed immediately after the pathology is diagnosed. From the radiograph it is possible to trace the dichotomous structure of the fragments: 1. Crushed – many small fragments that are scattered near the clearing line or located at a distant distance from it; 2. Greenstick fractures involve destruction of only one part of the bone. The mechanism of occurrence is the action of a damaging force perpendicular to the longitudinal axis. Such changes are typical for spongy bones, which have little bone tissue and an abundance of cartilage. The structure allows the bone tissue to bend well and not break completely; 3. Splintered – accompanied by the presence of individual fragments located along a separate edge. Pathology occurs under the influence of a small force or excessive tension of the ligaments and tendons. A similar situation can be provoked by muscle tension, sudden tension in a certain part of the body; 4. Transverse – when a force is applied perpendicular to the longitudinal axis of the bone tissue; 5. Inclined – when a plane of force is applied at a certain angle; 6. Spiral – formed by twisting, when multidirectional forces act in a circle between both poles of the bone. Dynamic radiographs allow assessment of fracture line healing during treatment. Proper healing requires close proximity of the bone fragments. If there is foreign tissue between the fragments, the bones will not heal properly. To avoid the situation, plaster and installation of plates with screws are required. On average, a bone callus appears on an image within 20 days. Visualization is made possible by the deposition of calcium salts inside the callus. The fragments are fixed together a little earlier. Around the second week, cartilage tissue appears between the fragments. Fixation creates conditions for further healing. The X-ray image at this stage shows a line of clearing. Cartilage tissue is not visualized. The condition of the fracture will be determined by a traumatologist based on clinical signs. Proper fusion is important not only for the formation of bone structure. Following the bones, the tendon-ligamentous apparatus is installed. Muscles and joints change (stretch or shorten) during healing. Correct installation of fragments and lack of mobility can significantly speed up the treatment time. A broken bone is clearly visible on an x-ray. Minor deformations may not be detected the first time, but subsequently there will be no difficulties with diagnosis.

What does a healed fracture look like in a photograph?

A healed fracture is defined in the following x-ray categories: 1. Complete healing of the bones with the absence of a radiolucency line. With high-quality healing, the callus in the image has a high density, is slightly expressed, the longitudinal axis of the bone has a clear line without angular curvature; 2. Incomplete healing is accompanied by partial preservation of the clearing line on one side. In the projection of the peripheral contour, bone callus grows, allowing the fragments to be firmly fixed. Excessive osteophytes can lead to disruption of the musculo-ligamentous apparatus; 3. Long-term healing – with dynamic x-ray control, the clearing line does not disappear in the required time frame. In children with such fractures, traumatic epiphysiolysis can persist for a long time when the line passes through the growth zones. In complex fractures, fixation of fragments with plaster may not be enough. The procedure allows you to compare bone fragments located at a short distance from each other. If there is a large discrepancy or excessive retraction, surgical interventions will be required to assemble the fragments – installation of a pin, fixation with plates with screws, use of the Elizarov apparatus. For any fracture, regardless of type, dynamic monitoring using x-rays is prescribed.

How to see a fracture in a photo

After familiarizing ourselves with the material, readers understood how to see a fracture in the picture, we offer some subtleties of x-ray diagnostics. Let us once again recall the main signs of a fracture on an x-ray: 1. Displacement of fragments; 2. Fracture line (lucidation in the fissure). The displacement is determined by radiographs taken in two different projections (frontal, lateral). The fragments move along the longitudinal and transverse axis. The fragments are wedged together, possibly overlapping or diverging. A lateral displacement can be traced along the width, and an angular displacement along the axis. The rotation of one fragment around an axis is rotation. On X-rays, when there is an angular discrepancy, the measurement is required in degrees; when there is a longitudinal or lateral displacement, the value is indicated in centimeters. The fracture gap is visualized on an x-ray as a strip with jagged, uneven edges. The classic type of nosology can be traced in the bones of the skull. When the opposite edge is reached, the radiologist describes a complete fracture in conclusion. If the clearing line does not reach the opposite part, it is an incomplete fracture. When analyzing images, it is necessary to determine the passage of the clearing line through the articular surfaces. The option is considered intra-articular. This nosology creates great problems in treatment. With any diagnosis you need to be wary of a cancerous tumor. Analysis of the surrounding tissue can reveal a pathological fracture, in which damage occurs due to the destruction of the bone structure by a tumor. In childhood, unique fractures appear, called “epiphysiolysis.” With this form, a traumatic separation of the metaphysis from the epiphysis occurs. The clearing line is projected along the growth cartilage. In a classic image, bending of the metaphysis may be observed. A common option in children is incomplete subperiosteal fractures. Damage to the tubular bones in a child on a radiograph during epiphysiolysis may be accompanied by a “beak symptom.” With this nosology, damage to the cortical layer of bone tissue occurs. The nosology also shows damage to the bone contour over a certain extent, but the divergence of the fragments is not visible. Features include gunshot fractures. In the bones of the pelvis and skull, when exposed to bullets, directly perforated holes are formed. A similar picture can be seen in the picture with damage to the epiphysis and metaphysis. The destruction of the diaphysis is characterized by many cracks and fragments. With gunshot injuries, a bacterial infection is often associated with the pathology. The inflammatory process is often combined with the presence of foreign bodies in soft tissues. The penetration of the metal into the surrounding tissue shows an intense shadow. In conclusion, let us say that in most cases the fracture looks typical on the picture. The images allow us to establish the features of bone damage. It is not always possible to identify classical criteria. The presented x-ray of the left hand shows a fracture of the left radius with the distal fragment extending 2 cm The presented x-ray shows a fracture of the left ulna in the lower third with transverse displacement of the fragments
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