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


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 foot� 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).

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.

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 “synthesis� (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 fixation� 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 fractures�

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 “ceiling�: 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 “set�) 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 scarf� 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 “red� 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 “compound� (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

Stability of fixation
This is characterized by the degree of residual motion at the fracture site after fixation (i.e., very little or no displacement between the fragments of the fracture). In technical terms, stability describes the tendency to revert to a condition of low energy, but this strict definition is not adhered to in lingua franca of fracture surgery.

Stability, absolute
The compressed surfaces of the fracture do not displace under applied functional load. The definition of absolute stability applies only to a given time and at a given site: some areas of a fracture may displace in relation to each other whilst other areas of the same fracture locus may not; different areas may also exhibit different displacements …