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

2. 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

3. 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

4. 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

5. 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

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

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

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

9. 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

10. 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)

11. Angulation
The abnormal angle that the distal fragment makes with the proximal
In this case the distal fragment is angulated medially

12. 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

13. Rotation Almost always involves long bones (humerus and femur)
Knee joint is in AP position (points forward) but ankle points lateral, in this case

14. Impaction
Bone ends jumped together. Occur with compression. Frequently no loss of function

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

19. Insufficiency fracture: result from normal activity or minor trauma in a weakened bone commonly from osteoporosis
e.g. compression fracture of vertebrae

20. Pathological fracture: occur through abnormal diseased bone
May be the presenting feature in both primary and secondary bone tumors

21. 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%

22. Avulsion fractures:
Occur at site of muscles attachment

23. 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.

24. 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.

25. 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

26. 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

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

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

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

34. Dinner Fork Deformity Sign

35. Smith’s fracture
fracture of the distal radius with anterior displacement and palmar angulation
Caused by a fall on a flexed hand

40. Calcaneal fracture ( lover’s fracture).

41. Hangman fracture

42. ?
Galeazzi fracture
Monteggia fracture

43. Quiz ?

44. 1 ?

45. 2 ?

46. 3 ?

47. ? 4

48. ? 5

49. ? 6

50. ? 7

51. ? 8

52. ? 9

53. ? 10

54. Answers !

55. Smith fracture

56. Boxer fracture

57. Reverse Barton’s fracture

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

59. Fracture of middle third clavicle

60. Scaphoid waist fracture

61. Jones fracture

62. Fracture of olecranon process

63. Monteggia fracture

64. Greenstick fracture