Acute Fracture

Fractures can be devastating. While acute fracture pain usually resolves within 2 to 3 months, chronic fracture pain can occur, and is manifested as a deep, dull, nagging pain near the fracture site. Up to 50% of hip fracture patients do not regain their prefracture function by up to 1 year following hip fracture. About 25% of women will spend some time in a nursing home after a hip fracture. Between 10% and 20% of hip fracture patients die within 1 year following the fracture. In the late 1990s, 51% of women and 96% of men were not screened for osteoporosis nor did they receive treatment after a fracture. ... 

Chapman, M.W., Bucholz, R., Cornell, C. 1997. Treatment of acute fractures with a collagen-calcium phosphate graft material. A randomized clinical trial. J Bone Joint Surg Am 79(4), 495-502. 

Marrow ischaemia will cause signal intensity changes within marrow which can lead to infarction. Transient ischaemia can occur following an acute fracture with the marrow returning to normal weeks later. 

Freiberg s disease is avascular necrosis of a metatarsal head, usually the second. This should not be confused with an acute fracture. Flattening of the head and altered density help to differentiate the two (Fig. 16.8). 

The atlanto-dens interval (ADI) is the distance between the anterior aspect of the dens and the posterior aspect of the anterior ring of the atlas. While the normal ADI in adults is normally 3 mm, in children this can be up to 5 mm. An ADI of >5 mm in flexion and >4 mm in extension is abnormal. The distance is wider in children due to the lucent cartilage in the interval combined with the hyper mobility. The dens may be slightly posteriorly tilted in up to 4% of normal children and should be differentiated from acute fractures (Swischuk et al. 1979). The posterior tilting may result in a spuriously increased ADI in the cranial aspect due to a V shaped appearance to the joint. Normal ADI is noted at the caudal aspect of the joint in such cases. 

Pliskow RJ, Ohme RK (1979) Corpus cavernosography in acute fracture of the penis. AJR Am J Roentgenol 133 331-332... 

Frequently branched, 1.5-3 mm in diameter, rough. Membranous scaly leaves 2-3 mm long, with 3 lobes (rarely 2), apex acute. Fracture showing a triangular rounded pith. 

Case 2 A 57-year-old male with metastatic prostate cancer, presenting with an acute fracture of the... 

The tibialis posterior tendon is the most commonly injured tendon on the medial side of the ankle. Its rupture is typically encountered in middle-aged obese women or as a result of systemic disease, such as rheumatoid arthritis or seronegative spondyloarthropathy (Johnson 1983). Acute fractures of the ankle may also be responsible for some cases of rupture of this tendon. In most cases, tibialis posterior tendon tears occur around the medial malleolus, but they may also be encountered at the navicular insertion. Rupture of the is frequently overlooked clinically because it often develop with no history of trauma. Initially, the patient complains of pain and swelling around the affected tendon. Then, as the severity of the lesion gradually progresses toward rupture elongation, gradual collapse... 

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