1. Bone Trauma Imaging techniques -Plain films -Radionuclide bone scan -CT-MRI

2. Plain Films Dx fracture or dislocation. Dx fracture or dislocation. Underlying bone is normal or abnormal (path.#) Underlying bone is normal or abnormal (path.#) Position of bone ends before & after Rx. Position of bone ends before & after Rx. Assess healing & complication. Assess healing & complication.

3. Rule of (two)s Two views …& further views; oblique…stress views, flex. & exten. Two views …& further views; oblique…stress views, flex. & exten. Two sites ……..ring bones Two sites ……..ring bones Two sides Two sides Two occasions. Two occasions. Two joints. Two joints.

4. Fracture # line usually lucent line, occasionally dense. # line usually lucent line, occasionally dense. A step in the cortex. A step in the cortex. Interruption of the bony trabeculae in impacted # Interruption of the bony trabeculae in impacted # Bulging or bucking of cortex in greenstick # Bulging or bucking of cortex in greenstick # Soft tiss. swelling… a valuable guide. Soft tiss. swelling… a valuable guide. Joint effusion. In knee an & Elbow, effusion often indicates a # Joint effusion. In knee an & Elbow, effusion often indicates a # Dislocation: joint surfaces no longer maintain their normal relationship to each other. normal relationship to each other. May be associated # May be associated #

5. Radionuclide bone scan Increased activity within 2 to 3 days. Increased activity within 2 to 3 days. Stress #........march fracture Stress #........march fracture

6. CT in bone trauma In complex shape bones; spine, face and hips In complex shape bones; spine, face and hips Better assessment of the extent of soft tissue damage & hematomas and of internal visceral injuries. Better assessment of the extent of soft tissue damage & hematomas and of internal visceral injuries. Exam of severely injured patient because of less manipulation. Exam of severely injured patient because of less manipulation.

7. MRI in bone trauma # is seen as a dark line across the bright signal of the fat in BM in T1 # is seen as a dark line across the bright signal of the fat in BM in T1 Oedema & bruise in the bone. Oedema & bruise in the bone. Soft tiss. injury such as muscles, tendons & ligaments. Soft tiss. injury such as muscles, tendons & ligaments.

8. Specific injuries Stress # due to repeated, often minor, trauma occurs in tibia & fibula in athletics. Also march # ….. Stress # due to repeated, often minor, trauma occurs in tibia & fibula in athletics. Also march # ….. A stress # may appear as a sclerotic band across the bone and a fracture line may not necessarily be visible. A stress # may appear as a sclerotic band across the bone and a fracture line may not necessarily be visible.

9. Insufficiency # Results from normal activity or minimal trauma in a weakened bone commonly from osteoporosis or ostemalacia e.g. compression #s of the verteb bodies and femoral necks, pubic rami & sacrum Results from normal activity or minimal trauma in a weakened bone commonly from osteoporosis or ostemalacia e.g. compression #s of the verteb bodies and femoral necks, pubic rami & sacrum

10. Path. # Through an abnormal bone Through an abnormal bone May be the presenting feature of both primary and secondary bone tumors May be the presenting feature of both primary and secondary bone tumors

11. Salter-Harris Classification I: injury through the epiphyseal plate only I: injury through the epiphyseal plate only II: # through epiph. plate & metaphysis. 70% II: # through epiph. plate & metaphysis. 70% III: # epiph plate & epiphysis. III: # epiph plate & epiphysis. IV: #epiph plate, epiphysis & metaphysis. IV: #epiph plate, epiphysis & metaphysis. V : Crush # of epiphyseal plate. <1% V : Crush # of epiphyseal plate. <1% Growth arrest in IV & V

12. Non accidental injury (child abuse) Multiplicity of #s of different ages. Multiplicity of #s of different ages. Metaphyseal #s from twisting & pulling Metaphyseal #s from twisting & pulling Metaphyseal sclerosis due to repeated injury and repair Metaphyseal sclerosis due to repeated injury and repair Epiphyseal separation freq. associated with metaphyseal # Epiphyseal separation freq. associated with metaphyseal # Periosteal reaction due to hemorrhage under the periostem Periosteal reaction due to hemorrhage under the periostem CT or US may show subdural hemorrhage or brain damage CT or US may show subdural hemorrhage or brain damage