Imaging of bone trauma Qais A. Altimimy, DMRD, CABMS-RAD. Lecturer, Radiology Alkindy college of medicine, university of Baghdad 2015
Imaging techniques Plain film: The standard imaging tool Radionuclide scan: increased activity within 2-3 days stress fracture CT: in complex shaped bones; spine, hip & face Assessment of internal organs
MRI Edema and bruise in bone marrow Soft tissue injury; muscle, tendon & ligament
1.Dx fracture or dislocation 2.Underlying bone is normal or abnormal 3.Positions of bone ends before and after Rx 4.Assess healing &complication Role of (two)s Two views Two sites ( in ring bones) Two sides Two occasions Two jointsWhen looking on an X ray of a part of the skeleton, check for: Name of patient Date of examination Side (Rt or Lt): check marker What part the film is centered on Does the film cover the whole area required Include one joint above and one joint below
Is there more than one view (should be two views at right angle) Quality of the film (penetration) Abnormalities: Trace around the bone margins looking for steps or cracks Look for soft tissue swelling Compare how the appearance changed from last film Conclude: Is the diagnosis clear Is further images needed
1. By the direction of the fracture line
Longitudinaloblique
Transverse
spiral
How to describe fracture on x-ray?
Two fragments =Simple More than two fragments=Comminuted
2. By the number of the fracture fragments
Closed Open or compound Best evaluated clinically
3. By the relationship of the fracture to the atmosphereDisplacement Angulation Shortening Rotation impaction Most fractures display more than one of these abnormalities
4. By the relationship of one fracture fragment to another
By convention, abnormalities of position describe the relationship of the distal fragment relative to the proximal fragment
Displacement The amount of antero-posterior or lateral movement of the distal fragment relative to the proximal There is lateral displacement of the distal fracture fragment (femur)
Angulation The abnormal angle that the distal fragment makes with the proximal In this case the distal fragment is angulated medially
Shortening Overlapping of the ends of the fracture fragments Shortening is usually described by the number of centimeters of overlap
fracture of the radius with shortening,angulation and associated dislocation of the distal ulna
Rotation Almost always involves long bones (humerus and femur) Knee joint is in AP position (points forward) but ankle points lateral, in this case
Impaction Bone ends jumped together. Occur with compression. Frequently no loss of function
Stress fracture: due to repeated minor trauma , appear as sclerotic band across the bone e.g. march fracture
Specific fractures
Insufficiency fracture: result from normal activity or minor trauma in a weakened bone commonly from osteoporosis e.g. compression fracture of vertebrae
Pathological fracture: occur through abnormal diseased bone May be the presenting feature in both primary and secondary bone tumors
Salter-Harris fracture classification I: injury through epiphyseal plate only II: injury through epiphyseal plate &metaphysis(70%) III: injury through epiphyseal plate & epiphysis IV: through epiphyseal plate, epiphysis & metaphysis V: crush injury of the epiphyseal plate < 1%
Avulsion fractures: Occur at site of muscles attachment
Usually with angulation incomplete fracture, with cortical breech of only one side of the boneThe fracture resembles the break that results when a supple green branch of a tree is bent and breaks incompletely.
Buckle (torus) fracture
This fracture is very different, and much more common than greenstick fracture It results in buckling of the cortex on the concave side of the bend and an intact concave surface.
Scaphoid fracture
Supracondylar fracture of the humerusThe anterior humeral line passes through the anterior third of the capitellum due to dorsal displacement of the capitellum secondary to the fracture
Humeral head looks like “light bulb”
Intracapsular 1.Subcapital 2.Trancervical 3.Basicervical Extracapsular 1.Intertrochanteric 2.SubtrochantericColle’s fractureFracture of the distal radius with dorsal angulationCaused by a fall on the out stretched hand Common Fracture Eponyms
Dinner Fork Deformity Sign
Smith’s fracture fracture of the distal radius with anterior displacement and palmar angulation Caused by a fall on a flexed handCalcaneal fracture ( lover’s fracture).
Hangman fractureGaleazzi fracture
Monteggia fracture?
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Answers !
Smith fractureBoxer fracture
Reverse Barton’s fracturePosterior dislocation of the right hip. Note the posterior column fracture of the acetabulum.
Fracture of middle third clavicle
Scaphoid waist fracture