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Abduction Movement of a part away from the midline, e.g. abduction at the shoulder moves the arm away from the trunk and out to the side. At the thumb, it describes movement of the digit forward from the anatomical position, away from the palm. This is because, in evolutionary terms, the thumb of the primitive hand lies in the same plane as the fingers and a… Adduction Movement of a part towards the midline, e. g. adduction at the hip joint moves the leg toward the midline and adduction of both legs would press the knees together or cross the legs. Algodystrophy See Reflex Sympathetic Dystrophy , Complex regional pain syndrome Allodynia pain from stimuli that are not normally painful, or pain that occurs other than in the area stimulated Allograft Graft of tissue from another individual of the same species, who is genetically different from the recipient. Bone is generally transplanted without revascularisation. Histocompatibility studies (tissue typing), essential in organ transplantation, are not necessary in bone allografting. Anaerobic Those metabolic processes which are not dependent on oxygen. Anaerobic organisms can therefore thrive in tissues which are hypoxic or anoxic. Anastomosis A junction between two vessels, or other tubular anatomical structures. Anatomical position The reference position of the body – standing facing the observer, with the palms of the hands facing forward. Anatomical reduction ; the exact adaptation of fracture fragments (hairline adjustment) in preparation for surgical fixation. It will result in complete restoration of the normal anatomy. While overall stability does not necessarily depend on precise reduction, precise reduction more reliably results in stability and increased strength of fixation. It is more important… Angular stability the property of an implant for fracture stabilisation, which is designed in such a way that the discreet parts of the implant, when assembled, are fixed in their angular relationship to each other. Usually applied to plates and screws, when the screw heads, once driven home in the plate hole, bind to the plate - this is achieved by an external thre… Angulation The orientation of one body (e.g. bone fragment) to another in such a manner that the two parts meet at an angle other than a straight line. The standard surgical convention is that the angulation is characterized by describing the deviation of the distal part from its anatomical position. For example, at a Colles' fracture, the distal radial fragm… Ankylosis Fusion of a joint by bone or a tight fibrous union, occurring as a result of a disease process, e.g. following septic arthritis (pyarthrosis), in ankylosing spondylitis, healed tuberculosis of bone etc. Antalgic Literally against pain. Used to describe an alteration of gait, where the stance phase one one side is abruptly shortened to avoid weight-bearing pain in that leg. Anterior The front aspect of the body in the anatomical position. If A is in front of B in the anatomical position, then A is said to be anterior to B. Antibiotic Any drug, such as penicillin, produced by certain fungi, bacteria, and other organisms, which can inhibit the growth of (bacteriostatic), or destroy (bactericidal Antibody A substance produced by the host`s immune system, in response to the detection of an antigen Antigen Component of a foreign biological substance (transplanted tissue, invading virus, etc.), which stimulates the host`s immune system to attack that foreign substance by elaborating an antibody Arthritis Literally, an inflammatory condition of a diarthrodial (synovial) joint. It may be septic or aseptic. The former may be blood-borne infection (haematogenous), more common in children, or it may follow penetration of the joint by wounding or surgery. Aseptic arthritides are usually of the rheumatoid type (including Reiter`s syndrome, psoriatic arthr… Arthrodesis Fusion of a joint by bone, as a planned outcome of a surgical procedure. Articular Fracture The articular surface is disrupted and completely separated from the diaphysis. The severity of these fractures depends on whether their articular and metaphyseal components are simple or multifragmentary. Articular fracture - partial These fractures involve only part of the articular surface, while the rest of that surface remains attached to the diaphysis. Atrophic nonunion if a fracture fails to heal because the biological responses leading to bony union are frustrated, usually due to adverse biological status of the fracture locus, the nonunion is categorised as atrophic, with absence of callus, rounding off of the bone ends and finally the formation of a false joint, or pseudarthrosis. See Nonunion. Autograft Graft of tissue from one site to another within the same individual (homograft Avascular necrosis Bone which has been deprived of its blood supply dies. In the absence of sepsis, this is called avascular necrosis (aseptic necrosis). The dead bone retains its normal strength until the natural process of revascularisation by “creeping substitution Avulsion Pulling off Biocompatibility The ability to exist in harmony with, and not to injure, associated biological tissues or processes. Biopsy The surgical removal of a piece of tissue for histological or microbiological examination, usually undertaken to establish a diagnosis. Bone Graft Bone removed from one skeletal site and placed at another. Bone grafts are used to stimulate bone union and also to restore skeletal continuity where there has been bone loss – see Allograft, Autograft, Xenograft Broad Spectrum Refers to antibiotics which are active against a wide spectrum of different organisms. Butterfly fragment Where there is a fracture complex with a third fragment which does not comprise a full cross section of the bone (i.e. after reduction there is some contact between the two main fragments), the small wedge-shaped fragment, which may be spiral, is occasionally referred to as a butterfly fragment – see Wedge fracture Callus Callus formation is the response of living bone to any irritation – chemical (Küntscher 1970), infective, mechanical instability (Hutzschenreuter et al. 1969), etc. Callus is a tissue complex formed at a site of bony repair. Fracture healing tissue makes a gradual and progressive transition through a series of tissue types – haematoma ð granulation… Cancellous bone Is the spongy trabecular bone (spongiosa)found mostly at the proximal and distal diaphyseal bone ends in contrast with the dense cortical bone of the shafts. Cancellous bone has a much larger surface area per unit volume and is, therefore, more readily available to the blood supply, as well as to osteoclasts for resorption. Its large surface/volume… Caudad Literally 'tailward'. If A is nearer to the 'tail', or coccyx, than B, then A is caudad of B. Caudal Pertaining to the tail, or tail region, e.g. caudal epidural injection Causalgia see Complex Regional Pain Syndrome Cephalad Literally 'headward'. If A is nearer to the head than B, then A is cephalad of B. Chemotherapy Treatment of malignant lesions with drugs that impair, or stop, their cellular proliferation. Chondral Pertaining to cartilage. Consisting of cartilage. Chondrocytes The active cells of all cartilage, whether articular cartilage, growth cartilage, fibrocartilage, etc. They produce the chondral matrix, both its collagen and the mucopolysaccharides of the ground substance. Comminution; Comminuted Refers to a fracture with multiple fragments, that is more than 2 main fragments. Syn. multifragmentary Compartment syndrome see Muscle Compartment Complex fracture Fracture in which, after reduction, there is no contact between the main fragments. Complex Regional Pain Syndrome Complex Regional Pain Syndrome (CRPS) is a disorder of unknown pathophysiology, which can affect either the upper or lower limbs. This disabling syndrome is not related to a single nerve territory and is disproportionate to the initiating event. The most prominent features include burning pain and functional impairment of the affected limb. Only 1 … Compound fracture The British school has long referred to fractures with an overlying, communicating wound of the integument as “compoundâ€? fractures, the opposite being “simpleâ€? fractures. No fracture should be regarded as simple, and the use of the archaic word “compoundâ€? does not convey the important clinical distinction. Now largely superseded by Open fracture. Compression The act of pressing together. It can result in deformation (as in shortening a spring) and improvement in, or creation of, stability. Compression is used (1) to provide absolute stability of fracture fixation, where indicated, and (2) to protect the fixation implants and to improve their efficiency by reducing the dynamic stresses on them them. Un… Compression Screw – see Lag screw. Contact healing Occurs between two fragment ends of a fractured bone, at places which are maintained in motionless contact. The fracture is then repaired by direct osteonal remodelling. Contact healing may also be observed where the gap is only a few micrometers wide. See Direct healing Continuous Passive Motion see C.P.M. Coronal This is a vertical plane of the body passing from side to side, so that a coronal bisection of the body would cut it into a front half and a back half. It is so called because at a coronation, the crown (corona in Latin) is held with a hand on either side as it is lowered onto the royal head; the line joining these hands is in the 'coronal' plane. Cortex – see Cortical bone Cortical bone The dense bone forming the tubular element of the shaft, or diaphysis (middle part) of a long bone. The term cortex is also applied to the dense, thin shell covering the cancellous bone of the metaphysis. The two terms are generally used interchangeably. Corticotomy A special osteotomy where the cortex is surgically divided, but the medullary contents and the periosteum are not. Creeping substitution – see Blood supply , Avascular necrosis Cytoplasm The non-nuclear substance of a cell. Debricolage A French term signifying the process of mechanical failure of an internal fixation prior to the onset of solid bone healing. Débridement Literally the “unbridlingâ€? of a wound. Strictly speaking, it refers to the extension of a wound and the opening up of the planes of the injured tissue, usually in the context of open fractures, as described by Amboise Paré in the 16th century. It has come to be used loosely to encompass the whole process of opening up of a wound, or pathological ar… Deformity Any abnormality of the form of a body part. The standard surgical convention is that the deformity is characterised by describing the deviation of the distal part from its anatomical position. Certain deformities have specific names – see Scoliosis, Recurvatum. etc, Delayed union The failure of a fracture to consolidate within the normally expected time, which varies according to age, fracture type and location. Delayed union, like union is a surgical judgment Diaphysis The cylindrical, or tubular, part between the ends of a long bone, often referred to as the shaft. Direct healing A type of fracture healing observed with absolutely stable (rigid) internal fixation. Distal Away from the centre of the body; more peripheral. For example, the hand is distal to the elbow, the phalanges are distal to the metacarpals. In certain instances, it means nearer the end than the beginning; for example, in the digestive system the stomach is distal to the oesophagus, or, in the urinary tract, the bladder is distal to the ureter. Dorsal Pertaining to the back - or dorsum - of the body in the anatomical position. An exception is the foot; the top of the foot, even though it faces forward in the anatomical position, is called the dorsum. Ductility The ability of a material to develop significant, permanent deformation before it breaks. See plastic deformation. Dynamisation The mechanical load transferred across a fracture locus can be increased, at a certain healing stage, in order to enhance bone formation, or to promote 'maturation' of the healing tissues. An example would be the reduction in stiffness of an external fixation, either by loosening some clamps, reducing the number of pins, or moving the tubular const… Elastic deformation see Plastic deformation Endosteal The adjective derived from endosteum, which means the interior surface of a bone – i.e. the wall of the medullary cavity. Energy Transfer When tissues are traumatised, the damage is due to energy that is transferred to those tissues. This is most commonly due to the transfer of kinetic energy from a moving object (car, missile, falling object, etc.). The greater the amount of energy transferred to the tissue, the more extensive the damage. Epiphysis The end of a long bone that bears the articular component (joint). The epiphysis develops embryologically from the cartilaginous element between the joint surface and the growth plate – see Metaphysis. Extension The movement of an articulation that causes the relationship between part above the joint and the part below the joint to becomes straighter. An exception is „extension“ of the foot at the ankle (so-called dorsiflexion); dorsiflexion is the better term, in this context/ Extensor Adjective from the noun 'extension'. The muscles which cause extension of a part are its extensor muscles; the surface of a part where those muscles are found is sometimes called the extensor surface. Extra-articular fracture Does not involve the articular surface, but it may be intracapsular (as in fracture of the femoral neck).. Far cortex (trans-cortex) The cortex more distant from the operator. In plating and tension band wiring, a bony defect has more important consequences in the far cortex than in the near cortex. This difference is due to the inability of a defective far cortex to resist compressive forces. Fascio–cutaneous A term describing tissue flaps that include, as a single layer, the skin, the subcutaneous tissues and the associated deep fascia. Fasciotomy The surgical division the investing fascial wall of an osseo-fascial muscle compartment, usually to release pathologically high intra-compartmental pressure – see Muscle compartment syndrome. Fibrocartilage Tissue consisting of elements of cartilage and of fibrous tissue. This may be a normal anatomical structure, such as certain intra-articular structures (menisci, triangular fibrocartilage at the wrist, or temporo-mandibular joint, or the symphysis pubis), or may constitute the repair tissue after lesions of the articular (hyaline)cartilage. Fixation, flexible Traditionally, internal fixation according to AO ASIF method meant absolutely stable (rigid) fixation, using close adaptation and compression of the bony fragments. Latterly, a less stable fixation (flexible fixation using splinting plates, intramedullary nails, or fixators) has been observed to yield very good results under conditions in which the… Flexion The movement of an articulation that causes the relationship between part above the joint and the part below the joint to become more angulated. Flexor Adjective from the noun 'flexion'. The muscles which cause flexion of a part are flexor muscles; the surface of a part where those rnuscles are found is sometimes called the flexor surface. Floating Knee Isolation of the knee joint from the remainder of the skeleton by fractures of the femur and the tibia in the same limb. Fracture A loss of continuity (breakage), usually sudden, of any structure resulting when internal stresses produced by load exceed the limits of its strength. The complexity and displacement of the fracture depend largely on the energy build-up in the structure prior to fracture. The shape of the fracture planes (transverse fracture, spiral fracture, avuls… Fracture disease A condition characterized by inappropriate pain, soft tissue swelling, patchy bone loss and joint stiffness (Lucas-Championnière 1907). Fracture disease can best be avoided by that system of fracture management most likely to produce skeletal integrity, whilst permitting early active motion of the part (early functional rehabilitation) (Allgöwer 19… Fracture locus (injury zone). Locus derives from the Latin word for “placeâ€?. It is used in yhis context to describe the biological unit comprising the fracture fragments and the immediately associated soft tissues, all of which function together to produce healing of the injury. Fracture, articular involves the articular surface. They are subdivided into partial and complete. Fracture, extra-articular These do not involve the articular surface, although they may be intra-capsular. They include apophyseal and metaphyseal fractures. Fracture, impacted A stable, and usually simple, fracture of the metaphysis or epiphysis in which the fragments are driven one into the other, resulting often in inherent fracture stability. Fracture, multifragmentary A term used to characterize any fracture with one or more completely separated intermediate fragment(s). In the diaphyseal and metaphyseal segments, it includes the wedge and the complex fractures. The terms wedge and complex are used only for diaphyseal or metaphyseal fractures. Fracture, simple A term used to characterize a single circumferential disruption of a diaphysis or metaphysis or a single disruption of an articular surface. Simple fractures of the diaphysis or metaphysis are spiral, oblique or transverse. Frontal Pertaining to the front of the body in the anatomical position. That part of the skull forming the forehead is the frontal bone. The frontal plane of the body, parallel to the front, is the same as the coronal plane Fusion see Arthrodesis Galeazzi injury A fracture of the radial shaft associated with a dislocation of the inferior radio-ulnar joint. Its first description is attributed to Galeazzi (1934). Sometimes referred to as the “reversed Monteggiaâ€? Gap healing The healing process taking place between two fragment ends kept in stable relative position with a small gap between them. Gap healing progresses in two phases: (1) the filling of the gap with lamellar bone orientated parallel to the plane of the fracture gap, (2) the subsequent osteonal remodelling of the newly formed lamellar bone. Gliding hole When a fully threaded screw is used as a lag screw, the cortex under the screw head (near cortex, or cis-cortex) should not engage the screw threads. This can be accomplished by over-drilling the near cortex hole to at least the size of the outer diameter of the screw thread. Gliding splint A splint (such as an unlocked intramedullary nail) which allows for axial shortening. Such a splint provides the possibility for the re-establishment of bony coaptation under conditions of fragment end shortening due to bone surface resorption. Goal of fracture treatment According to Müller et al. (1963), the goal of fracture treatment is to restore optimal function of the limb in respect to mobility and load-bearing capacity. The goal is furthermore to prevent early complications, such as reflex sympathetic dystrophy, fracture disease, or Sudeck's atrophy and, in the case of polytrauma, multiple system organ failu… Haematogenous Blood-borne. Haversian System The cortical bone is composed of a system of small channels (osteons) about 0.1 mm in diameter. These channels contain the blood vessels and are remodelled after a disturbance of the blood supply to bone. There is a natural turnover of the Haversian systems by continuous osteonal remodelling; this process is part of the dynamic and metabolic nature… Hawkin's test . A test for subacromial impingement at the shoulder. With the arm in the throwing position and flexed forward about 30 degrees, passively internally rotate the humerus. Pain suggests impingement of the supraspinatus tendon against the coraco-acromial ligament. Crepitus can also often be detected at the subacromial bursa. For shoulder examination, … Healing Restoration of original integrity. The healing process after a bone fracture lasts many years, until internal fracture remodelling subsides. For practical purposes, however, healing is considered to be complete when the bone has regained its normal stiffness and strength. Heterograft – see Allograft Homograft – see Allograft Horizontal Parallel with the horizon: unrelated to the anatomical position. Hypertrophic nonunion if a fracture fails to heal, despite good fracture locus biology, due to a mechanical environment which is so unstable as to frustrate the tissue responses, the non-union is categorised as hypertrophic. Abundant new bone formation will often produce the so-called “elephant`s footâ€? appearance on x-ray. See Nonunion Hypovolaemia A state where the circulating blood volume is reduced. This can occur due to haemorrhage, or other loss of fluid, such as dehydration. It can lead to shock. Hypoxia A state where the oxygen level in the arterial blood, or in other tissue, is pathologically reduced. Impacted fracture See Fracture impacted Indirect healing Bone healing as observed in fractures treated either with relative stability, or left untreated. Inferior Literally below or lesser than. In the anatomical position, if A is lower than B, A is inferior to B. The opposite is superior. Inoculation The instillation, either accidental or deliberate, of micro-organisms into body tissues, or into a culture medium. Interfragmentary compression Static compression applied to a fracture plane imparts a high degree of stability to the fragments and thus reduces micromotion and strain. Bone surface resorption does not then occur. There is no demonstrable proof that interfragmentary compression, per se, has any effect upon internal remodeling of the cortical bone (Matter et al. 1974). Intramedullary nail – locked or unlocked An intramedullary nail provides some degree of stability, mainly as a result of its (flexural) stiffness. An unlocked nail will allow the fragments to slide together along the nail; the fracture must therefore be provided with a solid support against shortening – see Gliding splint. For the treatment of multifragmentary fractures, where there is ax… Ischaemia Absence of blood flow. Kyphosis Spinal deformity in which there is angulation forwards in the sagittal plane. Sharp angulation may result from abnormality of only one vertebral body, and is called an angular kyphosis, or gibbus (as after a severe wedge fracture, or tuberculous collapse of a vertebral body). A more gentle kyphosis is due to deformity involving several adjacent ver… Lag screw technique Produces interfragmentary compression by driving the bone fragment beneath a screw head against another fragment in which the screw threads obtain purchase The compression produced by a screw so inserted acts directly within the fracture surface and is therefore very efficient. A screw designed specifically for this purpose, being only partially th… Lateral Literally, of, or toward, the side. The side of the body in the anatomical position is the lateral aspect or surface. If A is nearer the side of the body than B (further from the midline), then A is lateral to B. The opposite is medial. Locking head screw Screws with external threads cut onto the head, which provide a mechanical couple to an internal thread in the screw hole of a plate, thus creating a fixed angle device. Locking plate A plate with threaded screw holes that allow mechanical coupling to a locking head screw. The AO Less Invasive Stabilisation System (LISS) will accept only this type of screw,. whilst AO Locking Compression Plates (LCP) have a combination hole that will accept normal screw heads or threaded screw heads. See Angular Stability Lymphoedema Accumulation of oedema fluid in the tissues as a result of poor drainage of the lymph, usually due to the incompetence, or obstruction, of the lymphatic vessels. Malunion Consolidation of a fracture in a position of deformity. Matrix Literally, a place or medium in which something is bred, produced, or developed. In cartilage, it is the substance between the chondrocytes. It comprises a network of collagen fibres interspersed with a 'jelly' of waterlogged mucopolysaccharide macromolecules (complex organic chemicals in large molecular chains). Medial Literally, of or toward the middle, or median. The inner side of a part with the body in the anatomical position is the medial aspect or surface. If A is nearer the middle, or centre–line, than B, then A is medial to B. The opposite is lateral. Metaphysis The segment of a long bone located between the articular end part (epiphysis) and the shaft (diaphysis). It consists mostly of cancellous bone, within a thin cortical shell. Methylmethacrylate A chemical substance, the monomer of which can be induced to polymerise, producing a hard plastic. It can be a form of bone cement (polymethylmethacrylate – or PMMA), but in a different polymerised form it produces Perspex. Microvascular Pertaining to microscopic blood Midline The centre line of the body in the anatomical position. Minimally invasive plate osteosynthesis (MIPO) reduction and plate fixation without direct surgical exposure of the fracture site, using small skin incisions and sub-muscular insertion of the plate. Monteggia injury A displaced ulnar fracture associated with a dislocation of the radial head from its articulation with the capitellum of the humerus, at the elbow. First described in the 19th century by the Italian physician Giovanni Battista Monteggia. Multifragmentary fracture A term usually reserved for fractures which have one or more dissociated intermediate fragments. Muscle Compartment An anatomical space, bounded on all sides by bone and/or deep fascial envelope, which contains one or more muscle bellies. The relative inelasticity of its walls means that if the muscle tissue swells, the pressure in the osseo–fascial envelope can increase to levels which cut off the flow of blood to the muscle tissue, resulting in its severe comp… Near cortex The bony cortex near the operator and on the side of application of an implant. Usually a term used in relation to plating, interfragmentary screw fixation and tension band wiring. In respect to bending, the convex near cortex contributes little to stability of fixation. When – for example, in wave plate application - the distance between the plate… Neutralization An implant (plate, external fixator, or nail) which functions by virtue of its stiffness. The stiffness is said to 'neutralize' the effect of the functional load. The implant carries a major part of the functional load and thus diverts loads away from the fracture locus and may serve to protect a more vulnerable element of a fixation complex. An ex… Nonunion (or non-union) (see also Union, Pseudarthrosis, Delayed Union) Nonunion is failure of bone healing. A fracture is judged to be ununited if the signs of nonunion are present when a sufficient time has elapsed since injury, during which the particular fracture would normally be expected to have healed by bony union. That period will vary according to age, fracture … NSAIDS non-steroidal inflammatory drugs. See http://www.healthline.com/galecontent/nonsteroidal-anti-inflammatory-drugs-1 Open Fracture Fractures with an overlying, communicating wound of the integument, exposing the fracture site to contamination and the risk of infection. Open fractures are commonly graded according to the severity scale of Gustilo, Mendoza and Williams (J.Trauma 1984) . This scale comprises grades 1, 2, 3A, 3B & 3C, from the least to the most severe soft tissue … Opposition (anatomical) The action of opposing one part to another; if the pulp of the thumb is placed in contact with the pulp of a finger, the movement, or action, of the thumb is that of opposition. ORIF A widely used abbreviation for open reduction and internal fixation (osteosynthesis). Osteoarthritis This is a degenerative condition which affects diarthrodial (synovial) joints and is characterized by loss of articular cartilage, reactive subchondral bone sclerosis (sometimes with subchondral cysts) and the formation of peripheral bony outgrowths – osteophytes. The primary lesion is degeneration of the articular cartilage as a result of infectio… Osteoblast A cell that forms new bone Osteoblastic Producing bone. Osteoclast Cell that destroys bone. Osteoclasts rest in the Howship lacunae (small spaces within the bone surface). They are typically found at the tips of the remodelling osteons, but also in all sites where bone is being removed by physiological processes. Osteolytic Resorbing, destroying or removing bone. Osteomyelitis An acute or chronic inflammatory condition affecting bone and its medullary cavity, usually the result of bacterial (occasionally viral) infection of bone. This may be a blood-borne infection (haematogenous osteomyelitis) – usually in children or in the immunologically compromised - or follow an open fracture (post-traumatic osteomyelitis). Osteon (osteone)(cutter cone) This is a normal vascular structure concerned with bone remodelling, either as part of physiological bone turnover, or as part of the healing process after fracture. Anosteon comprises a vascular bud, at the tip of which is a cluster of osteoclasts. Behind the osteoclasts, the vessel is cuffed by osteoblasts. As the osteoclasts removed bone, they … Osteopaenia (osteopenia) An abnormal reduction in bone mass. This may be generalized, as in some bone diseases, or localized, as a response to inflammation, infection, disuse, etc. See Osteoporosis Osteoporosis A reduction in bone mass. It is a natural aging process but may be pathological. It can result in pathological fracture (most fractures of the femoral neck in the elderly are due to osteoporosis plus minimal trauma). See Osteopaenia Osteosynthesis A term coined by Albin Lambotte (1907) to describe the “synthesisâ€? (derived from the Greek suntithenai for putting together, or fusing) of a fractured bone by a surgical intervention using implanted material. It differs from “internal fixationâ€? in that it also includes external fixation Osteotomy Controlled surgical division of a bone. Overbending ( of plate) Palmar Pertaining to the palm of the hand, e. g. the palmar fascia, the palmar aspect of the fingers. Pathological fracture A fracture through bone which is abnormal as a result of a pathological process. It may be the result of the application of a force less than that which would be required to produce a fracture in a corresponding normal bone. Periosteal Adjective derived from periosteum Periosteum is the inelastic membrane bounding the exterior surface of a bone. The periosteum plays an active part in the blood supply to cortical bone, in fracture repair and in bone remodeling. It is continuous with the perichondrium – the membrane that bounds the periphery of the physis. Pilon The distal end of the tibia – from the French for a stump, or a pestle. Fractures of the distal tibial metaphysic caused by axial load failure are called “pilon fracturesâ€? Pilot hole If a fully threaded screw is to function as a lag screw, the screw is anchored near its tip, within a threaded hole in the far bone fragment. The original drill hole which is made prior to tapping of the thread in the bone is called the pilot hole. Within the bone fragment near the head of the screw, the thread should not obtain purchase but should… Pin loosening The pins of external fixator frames serve to stabilize the fragments of a fracture by linking the bone to the frame. Stability depends, among other things, upon the contact between pin and bone (pin-bone interface). Pin loosening occurs when bone surface resorption at the pin-bone interface takes place due to excessive cyclical loading of the bone.… Plafond (Fr.) Literally “ceilingâ€?: used to denote the horizontal portion of tge distal tibial articular surface. See Pilon Plantar Pertaining to the sole of the foot, i.e., the surface of the foot which is 'planted' on the ground. Examples are the plantar fascia, and the plantar surfaces of the toes. Plantar flexion is a movement at the ankle which moves the foot downward, or in a plantar direction. Plastic Deformation If an object is deformed within those limits which allow it to regain its original form, once the deforming force is removed, it is said to have undergone elastic deformation. If the force is increased above the upper level for elastic deformation, permanent deformity (known in engineering terms as “setâ€?) is produced – this is plastic deformation.… Polytrauma Multiple injuries to one or more body systems. An Injury Severity Score (ISS) of more than 16 is usually taken to indicate polytrauma. Posterior The back of the body in the anatomical position is the posterior surface. If A is nearer to the back of the body in the anatomical position than B, then A is posterior to B. Equivalent to dorsal, except in the foot, where the dorsum is anterior in the anatomical position – see Dorsal Prebending of plate: Exactly contoured plates, when loaded using either the external compression device or the DCP principle, produce asymmetrical compression, i.e. the near cortex is more compressed than the far cortex. Indeed, the latter may not be compressed at all and can be distracted in certain cases. To achieve stabilization against both torque and ben… Precise reduction see Anatomical reduction Preload The application of interfragmentary compression keeps the fragments together until a tensile force is applied, exceeding the compression (preload). Pronation The movement of rotating the forearm so that the palm of the hand faces backward from the anatomical position. Pronation is also sometimes used to describe a movement of the foot into inclination away from the midline, otherwise called eversion; so that a pronated foot would bear more weight on its medial border than onits lateral border Prophylactic Preventive. Protection While the term 'neutralization' has often been used in plate and screw fixation, the term 'protection' should replace it. In reality nothing is neutralized. In plate fixation the plate reduces the load placed upon the interfragmentary screw fixation. It therefore protects the screw fixation from overload – see Neutralization. Proximal Nearer to the centre of the body in the anatomical position. The opposite of distal. Thus, the elbow is proximal to the wrist. In certain instances, it means nearer the beginning than the end; for example, in the digestive system the stomach is proximal to the ileum, or in the urinary tract the kidney is proximal to the bladder. Pseudarthrosis (see also Delayed Union Pure depression An articular fracture in which there is depression alone of the articular surface without split – see Impacted fracture Pure split An articular fracture in which there is a longitudinal metaphyseal and articular split, without any additional osteochondral lesion. Radial preload To prevent external fixator pin loosening, the contact zone (interface) between the implant and bone can be preloaded, i.e. a static compressive force is applied. Hitherto, preloading was achieved by applying a permanent bending moment to the pins, within their elastic range. Currently, the pins are designed with a thread and shank that automatical… Radiotherapy Treatment of pathological conditions, usually malignant, with ionizing radiation. It has been recommended in low dosage to discourage heterotopic bone formation. Recurvatum an angular deformity , usually of a long bone, in which the distal part is angulated anteriorly, so that the apex of the angle is posterior. Reduction The realignment of a displaced fracture or a dislocated joint. Reflex Sympathetic Dystrophy (RSD): – one of the names given to Algodystrophy. One of the chronic regional pain syndromes. Usually follows an injury, not always a fracture. Characterised by chronic pain that fails to resolve within the time commensurate with the injury, swelling of the part, joint stiffness, alteration in skin colour, texture and/or temperature and associated … Refracture A fracture occurring at a former fracture site, after the bone has solidly bridged, at a load level otherwise tolerated by normal bone. The resulting fracture line may coincide with the original fracture line, or it may be located remote from the original fracture, but within the area of bone that has undergone changes as a result of the fracture a… Relative Stability – see Stability of fixation Remodelling (of bone) The process of transformation of external bone shape (external remodelling), or of internal bone structure (internal remodelling, or remodelling of the Haversian system). Resorption (of bone) The process of bone removal includes the dissolution of mineral and matrix and their uptake into the cell (phagocytosis). The cells responsible for this process are osteoclasts. Rheumatoid arthritis a crippling, aseptic, synovial inflammatory disease, usually involving many joints (polyarthritis). Results in an intense synovitis that eventually erodes the articular cartilage and the underlying subchondral (beneath the cartilage) bone. Rigid fixation A fixation of a fracture which allows little or no deformation under load – see Stability of fixation. Rigid implants In general implants are considered to be rigid when they are made of metals. The implant Rigidity This term is often used synonymously with stiffness. Some (Timoshenko 1941) feel that its use should be confined to considerations of shear (e.g. at the interface of plate and bone). Rotator cuff . A musculo-tendinous 'hood', or cuff, comprising the muscle bellies and the aponeurotic tendons of the supraspinatus, infraspinatus and subscapularis muscles, passing from their origins from the scapula to their insertions into the tuberosities of the upper humerus. Sagittal Literally, it means pertaining to an arrow (sagitta is Latin word for arrow). Bisection of the body in the sagittal plane would divide it into left and right halves, so-called because an arrow fired into the body would normally strike from the front and would pass in a sagittal direction. Scarf test A test for acromio-clavicular dysfunction: the patient experiences pain in the acromio-clavicular joint when bringing the forward flexed arm across the front of their body, as if to “toss a scarfâ€? over the opposite shoulder (this movement is called horizontal adduction) Scoliosis a spinal deformity in which there is one, or more, curvature in the coronal plane – may be postural or structural. The latter is often associated with rotational deformity. See also Kyphosis. Second look Surgical inspection of a wound or injury zone, 24 to 72 hours after the initial management of a fracture or wound. Segmental If the shaft of a bone is broken at 2 levels, leaving a separate shaft segment between the two fracture sites, it is called a 'segmental' fracture complex. Sequestrum A piece of dead bone lying alongside, but separated from, the osseous bed whence it came. It is formed when a section of bone is deprived of its blood supply and the natural processes create a cleavage between the dead and the living bone. A sequestrum may be aseptic (sterile), as for example beneath a plate when there has been massive periosteal s… Shear A shearing force is one which tends to cause one segment of a body to slide upon another, as opposed to tensile forces, which tend to elongate, or shorten, a body. Shock A state of reduced tissue perfusion, usually due to a fall in blood pressure secondary to hypovolaemia, overwhelming sepsis (gram negative shock, or “redâ€? shock), or allergic anaphylaxis Shoulder examination - see http://www.usask.ca/cme/articles/fmse/index.php Simple (single) fracture A disruption of bone with only two main fragments. Formerly used to denote a fracture that was not “compoundâ€? (or open) Splinting Reducing the mobility at a fracture locus by coupling a stiff body to the main bone fragments. The splint may be external (plaster, external fixators) or internal (plate, intramedullary nail). Split depression A combination of split and depression in an articular fracture – see Pure split Spondylolisthesis forward slip of one vertebral body on the one below it. This may be due to congenital elongation of the pars interarticularis of the vertebra, spondylolysis Spondylolysis the presence of a loss of continuity of the pars interarticularis of a vertebral body. This can lead to instability and forward slip of one vertebral body on the one below it - spondylolisthesis Spondylosis degenerative change at one or more levels in the spinal column: degenerative intervertebral disc disease Spontaneous fracture One that occurs without adequate trauma, usually in abnormal bone – see Pathological fracture. Spontaneous healing The healing pattern of a fracture without treatment. Solid healing is observed in most cases, but malunion frequently results. This is how animal fractures normally heal in the wild | SearchTyp a word and hit `Search`.
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