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Chris Colton - Orthopaedic Trauma Terms
Category: Health and Medicine > Orthopaedic Trauma
Date & country: 24/11/2007, UK
Words: 239


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 “compound� fractures, the opposite being “simple� fractures. No fracture should be regarded as simple, and the use of the archaic word “compound� 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 “place�. 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 Monteggia�

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