EASILY MISSED SUBTLE EXTREMITY PROBLEMS

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Presentation transcript:

EASILY MISSED SUBTLE EXTREMITY PROBLEMS LEONARD E. SWISCHUK, M.D. UTMB LOGO

COMPARATIVE VIEWS Invaluable

COMPARATIVE VIEWS Cost? Radiation? Adult training?

COMPARATIVE VIEWS Radiation exposure Expense 10 millirads or less

THE SECRET * Know where to look * Know what to look for * Use fat pads and other clues Utilize soft tissue edema

INFECTION – INFLAMMATION (Deep vs. superficial edema) Osteomyelitis (deep edema) Myositis (deep edema) Cellulitis (superficial edema)

OSTEMYELITIS (LOW GRADE) Flat bones Certain sites

BUCKLE FRACTURES 1. Typical cortical buckle 2. Angulation of cortex only

BUCKLE FRACTURE MECHANISM (Typical cortical buckle fracture)

BUCKLE FRACTURE MECHANISM (Angulation of cortex only)

HAIRLINE FRACTURES Toddler’s spiral fracture of tibia Type I: Dunbar Toddler’s fracture Type II Transverse fracture upper tibia Proximal ulna, longitudinal and transverse Small bones of hands and feet

IMPACTION FRACTURES Cuboid Scaphoid (carpal navicular) Upper tibia (Toddler’s fracture, Type II)

PLASTIC BENDING FRACTURES Long bones Radius, ulna, fibula Clavicle Supracondylar humeral fracture

SALTER-HARRIS EPIPHYSEAL–METAPHYSEAL FRACTURES Usually Salter-Harris I or II Salter-Harris III in ankle Subtle in older patients Epiphysis nearly fused

ULNAR STYLOID FRACTURE (a signal) Radial Salter-Harris or buckle fracture not present

AVULSION FRACTURES

CONCLUSION Know where to look for subtle fractures Know what they look like Comparative views very helpful Indeed indispensable