OR2.14-16 | Fracture Complications and Special Situations — Glossary

An intraoperative assessment framework for distinguishing viable from devitalised muscle during debridement: Colour (healthy = pink/red; devitalised = grey/green), Consistency (healthy = elastic; devitalised = friable), Contractility (healthy muscle contracts when pinched), Capacity to bleed (cut surface should bleed briskly).

Palsy of the anterior interosseous nerve manifesting as isolated inability to flex the thumb interphalangeal joint and the index distal interphalangeal joint (unable to form an OK sign), with intact sensation; the most common nerve injury in supracondylar humerus fractures; most cases recover spontaneously within 3 months.

The ratio of systolic blood pressure at the ankle to that at the brachial artery, measured by Doppler probe; a value <0.9 indicates peripheral arterial insufficiency and mandates further vascular investigation in the context of an open fracture.

The fibrous band encircling the radial head that holds it in the proximal radioulnar joint; in pulled elbow it slips over the smaller radial head of young children and becomes trapped between the radial head and the capitellum.

A line drawn along the anterior cortex of the humerus on a lateral elbow radiograph; normally passes through the middle third of the capitellum; posterior shift in displaced supracondylar fractures is a reliable radiological indicator of posterior displacement.

The motor branch of the median nerve arising in the proximal forearm, supplying flexor pollicis longus, pronator quadratus, and the index finger flexor digitorum profundus; tested by the 'OK sign' (tip-to-tip pinch); AIN palsy is the most common nerve injury in supracondylar fractures.

Administration of antibiotics before or immediately after surgery to prevent infection; in open fractures, antibiotics must be given within 1 hour of presentation -- not deferred until the operating theatre -- to suppress the initial bacterial inoculum.

Biologically inactive non-union characterised by absent callus, sclerotic or tapered fracture ends, and poor vascularity; requires both mechanical stabilisation and biological stimulation (bone graft or BMPs).

The angle between the physeal line of the lateral condyle and the long axis of the humerus on an AP elbow radiograph; normally 70-76 degrees; used to assess varus/valgus alignment and adequacy of reduction in supracondylar fractures.

A penicillin antibiotic with activity against Clostridium species; added to the standard regimen when farm soil, faecal, or agricultural contamination is present to prevent gas gangrene.

A structured community of bacteria adherent to a surface (implant or dead bone), enclosed in a self-produced polysaccharide matrix that provides resistance to both antibiotics and host immune defences; the fundamental reason infected non-union cannot be cured without surgical debridement.

A family of growth factors (TGF-β superfamily) that stimulate osteoblast differentiation and bone formation; rhBMP-2 and rhBMP-7 are commercially available adjuncts used in atrophic non-union and spinal fusion when autograft alone is insufficient.

An acute-phase protein produced by the liver in response to inflammation; rises rapidly with infection and normalises with effective treatment, making it the preferred marker for monitoring response to therapy in infected non-union.

A first-generation cephalosporin antibiotic with excellent Gram-positive (especially staphylococcal) coverage; the first-line antibiotic for Grade I and Grade II open fractures administered at 1-2 g IV.

A limb-threatening condition caused by elevated pressure within a fascial compartment, impairing perfusion; diagnosed by clinical signs (pain on passive stretch is earliest) and pressure monitoring; threshold for fasciotomy is compartment pressure >30 mmHg or delta P (diastolic BP minus compartment pressure) <30 mmHg.

In both adults and children, a compartment pressure >30 mmHg, or a differential pressure (diastolic BP minus compartment pressure) <30 mmHg, is the accepted indication for emergency fasciotomy; a present pulse does NOT exclude compartment syndrome -- serial neurovascular assessment is mandatory after supracondylar fractures.

A planned surgical division of the bone at the apex of a deformity (malunion), allowing the fragments to be repositioned in correct alignment before fixation; used to restore mechanical axis, rotation, and limb length.

A cross-sectional imaging technique using intravenous contrast and rapid CT acquisition to visualise arterial anatomy; the first-choice investigation for suspected arterial injury in haemodynamically stable open fracture patients.

A series of CT scout images used to measure true limb lengths and rotational alignment; more accurate than plain radiography for both shortening and rotational malunion quantification.

Surgical removal of all devitalised tissue, foreign material, and contaminated bone from an open fracture wound, performed zone by zone (skin, subcutaneous tissue, fascia, muscle, periosteum, bone) to create a clean bed for healing.

Slow but still-progressing fracture healing beyond the expected time; the fracture process has not ceased but the timeline is prolonged, often due to soft-tissue damage, infection, or inadequate immobilisation.

The difference between the diastolic blood pressure and the measured compartment pressure; a value <30 mmHg is a widely used threshold for fasciotomy, particularly useful in hypotensive patients where absolute compartment pressure alone may not trigger the 30 mmHg threshold.

A technique of paediatric fracture fixation using flexible titanium nails (Nancy nails) inserted retrograde from both ends of the bone to provide internal splintage without crossing the physis; used for unstable both-bones forearm fractures and femoral shaft fractures in children aged 5-12 years.

The most florid form of hypertrophic non-union, where abundant callus produces a smooth dome-shaped swelling around the fracture ends resembling an elephant's foot on AP radiograph.

The rate at which red blood cells settle in a calibrated tube over one hour; sensitive but non-specific for chronic infection; useful as a screening test alongside CRP in suspected infected non-union.

A method of skeletal stabilisation using pins inserted into bone above and below the fracture, connected by an external frame; preferred for Grade II-III open fractures because it maintains alignment and allows repeated wound inspection without metalwork in the contaminated zone.

Surgical release of the fascial envelope of a compartment to relieve elevated pressure in compartment syndrome; in the lower leg, all four compartments (anterior, lateral, superficial posterior, deep posterior) must be decompressed through two standard incisions.

A grading system for extension-type supracondylar humerus fractures: Type I (non-displaced); Type II (displaced with intact posterior cortex, hinged); Type III (completely displaced with no cortical contact); directly guides management from conservative to operative.

A rapidly progressive, life-threatening soft-tissue infection caused by Clostridium perfringens (and other clostridia) producing gas within muscle; classically associated with soil-contaminated wounds; prevented by high-dose penicillin and thorough debridement.

An aminoglycoside antibiotic with broad Gram-negative coverage added to cefazolin for Grade III open fractures; requires monitoring for nephrotoxicity and ototoxicity, and dose adjustment for renal impairment.

An open fracture associated with an arterial injury requiring surgical repair for limb salvage, regardless of wound size; the defining criterion is the vascular injury, not wound dimensions; carries amputation rates of 25-50%.

An incomplete fracture of immature (paediatric) bone in which one cortex cracks while the other remains intact but plastically deformed, resulting from a bending force; the intact cortex must be broken during reduction to allow full correction.

A widely used grading system for open fractures based on wound size, degree of soft-tissue contamination and devitalisation, periosteal stripping, and presence of vascular injury; Grade I (smallest, clean) to Grade IIIC (arterial injury requiring repair).

The preferred technique for reducing a pulled elbow: with the elbow held at 90 degrees, the forearm is firmly and rapidly hyperpronated; a palpable click confirms reduction of the annular ligament; has a first-attempt success rate of approximately 90%, higher than the supination-flexion method.

Biologically active non-union with abundant callus at the fracture ends but persistent fracture mobility; the blood supply is intact and treatment requires rigid mechanical stabilisation alone without bone graft.

Cancellous or corticocancellous bone harvested from the iliac crest; the gold-standard bone graft because it provides all three components — osteogenic cells, osteoinductive proteins, and osteoconductive scaffold.

A non-union in which the fracture site is superinfected, typically with Staphylococcus aureus or Gram-negative organisms; characterised by a draining sinus, failed prior grafting, and the need for staged debridement before reconstruction.

New reactive bone formed by the elevated periosteum around a focus of osteomyelitis; it encases the infected area and, together with the sequestrum within it, gives chronic osteomyelitis its characteristic radiological appearance.

A measurable difference between the lengths of the two lower limbs; causes include malunion with shortening, growth disturbance, or prior surgery; clinically assessed with a tape measure in the supine position and on long-leg standing radiograph.

Fracture healing in a position of unacceptable angulation, rotation, or shortening that impairs function or predisposes to joint degeneration; threshold varies by bone and functional demand.

A staged two-step bone-defect reconstruction: first, a cement spacer is implanted to induce formation of a vascularised membrane; second, the spacer is removed and the membrane-lined cavity is filled with autologous cancellous bone graft.

In the lower limb, the line connecting the centre of the femoral head to the midpoint of the ankle joint; normally passes through or close to the centre of the knee; deviation indicates angular deformity contributing to altered joint loading.

Failure of a fracture to heal within the expected timeframe (conventionally >6 months for most long bones) with cessation of the healing process, requiring intervention to achieve union.

Any fracture in which the overlying skin is breached, allowing the fracture haematoma to communicate with the external environment; the wound need not show protruding bone -- even a 1 cm puncture wound classifies as open.

Loss of periosteum from the cortical bone surface, typically from high-energy trauma; devascularises the underlying cortex and is a major determinant of non-union risk; one of the key criteria distinguishing Grade IIIB from IIIA open fractures.

A bony bridge forming across a damaged physis (growth plate) after Types III, IV, or V Salter-Harris injuries; the bar tethers growth, causing angular deformity as the unaffected physis continues to grow; may require operative resection or be managed by epiphysiodesis of the opposite limb.

The cartilaginous zone of proliferating and hypertrophying cells between the epiphysis and metaphysis responsible for longitudinal bone growth; mechanically the weakest region of the paediatric skeleton; injuries here can cause premature growth arrest.

A clinical scenario in supracondylar humerus fractures where the hand appears pink and warm due to collateral arterial flow but the radial pulse is absent, indicating compromise of the brachial artery; requires urgent operative exploration after reduction, NOT conservative observation.

A subluxation of the radial head caused by axial traction on the extended pronated forearm in children aged 1-5 years; the annular ligament is trapped between the radial head and capitellum; presents as the child holding the arm pronated and flexed, refusing to supinate; treated by hyperpronation or supination-flexion reduction without anaesthesia.

A five-type classification of physeal (growth plate) injuries based on the relation of the fracture line to the physis, epiphysis, and metaphysis; SALTR mnemonic: I (Straight through physis), II (Above into metaphysis -- most common), III (Lower into epiphysis), IV (Through all layers), V (Rammed compression -- worst prognosis, normal X-ray initially).

A planned return to the operating theatre 48 hours after initial debridement of an open fracture to reassess tissue viability, obtain further cultures, perform additional debridement if needed, and make definitive wound-closure or reconstruction decisions.

A fragment of devitalised cortical bone within an infected bone cavity; separated from the blood supply, it acts as a nidus for infection and is not resorbed, persisting until surgically removed.

The most common elbow fracture in children (peak age 5-8 years), caused by a fall on the outstretched hand producing hyperextension at the elbow and fracture through the thin supracondylar region; the extension type (Gartland) accounts for 95-97% of cases.

Prevention of tetanus (Clostridium tetani toxin-mediated disease) after contaminated wounds; includes tetanus toxoid booster (for partially immunised patients) and tetanus immunoglobulin (for unknown or incomplete immunisation history).

The triangular metaphyseal bony fragment that is characteristic of Salter-Harris Type II injuries; it represents the corner of metaphysis that remains attached to the epiphysis when the fracture exits through the metaphysis, rather than continuing through the physis.

A compression fracture of the paediatric metaphysis where the cortex buckles (wrinkles) without a discrete fracture line; most common at the distal radius; treated with a removable splint for 3-4 weeks; very stable, does not require reduction.

A late complication of untreated or inadequately treated compartment syndrome of the forearm, resulting in fibrotic replacement of the ischaemic flexor compartment muscles with a fixed flexion deformity of the wrist and fingers and a classic 'intrinsic-minus' hand posture.

A classification of non-union that divides cases into vascular (hypertrophic) and avascular (atrophic) subtypes based on biological activity, as inferred from the radiological callus pattern; directly guides treatment.