Imaging of bone trauma Qais A. Altimimy, DMRD, CABMS-RAD. Lecturer, Radiology Alkindy college of medicine, university of Baghdad 2015

Bone trauma 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

Role of plain film in bone trauma 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 joints

How to comment on x ray of fracture? When 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

How to describe fracture on x-ray? 1. By the direction of the fracture line Longitudinal oblique Transverse spiral

More than two fragments=Comminuted 2. By the number of the fracture fragments Two fragments =Simple More than two fragments=Comminuted

3. By the relationship of the fracture to the atmosphere Closed Open or compound Best evaluated clinically

4. By the relationship of one fracture fragment to another Displacement Angulation Shortening Rotation impaction Most fractures display more than one of these abnormalities 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

Specific fractures Stress fracture: due to repeated minor trauma , appear as sclerotic band across the bone e.g. march fracture

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

Greenstick fractures are incomplete fractures of long bones and are usually seen in young children, more commonly less than 10 years of age. they are commonly mid-diaphyseal affecting the forearm and lower leg. Usually with angulation incomplete fracture, with cortical breech of only one side of the bone The 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 Distal pole (or so-called scaphoid tubercle): 10%, excellent likelihood of union(~100%) Waist of scaphoid: 70-80% , 0-20% chance of non-union Proximal pole: 20%, ~30-40% chance of non-union

Supracondylar fracture of the humerus The anterior humeral line passes through the anterior third of the capitellum due to dorsal displacement of the capitellum secondary to the fracture

Posterior dislocation of the shoulder Humeral head looks like “light bulb”

Hip fractures Intracapsular 1.Subcapital 2.Trancervical 3.Basicervical Extracapsular 1.Intertrochanteric 2.Subtrochanteric

Common Fracture Eponyms Colle’s fracture Fracture of the distal radius with dorsal angulation Caused by a fall on the out stretched hand

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 hand

Calcaneal fracture ( lover’s fracture).

Hangman fracture

? Galeazzi fracture Monteggia fracture

Quiz ?

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Answers !

Smith fracture

Boxer fracture

Reverse Barton’s fracture

Posterior dislocation of the right hip. Note the posterior column fracture of the acetabulum.

Fracture of middle third clavicle

Scaphoid waist fracture

Jones fracture

Fracture of olecranon process

Monteggia fracture

Greenstick fracture