Radiology 5th year, 4th lecture (Dr. Ameer)

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The lecture has been given on May 5th, 2011 by Dr. Ameer.

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Radiology 5th year, 4th lecture (Dr. Ameer)

  1. 1. Bone Trauma Imaging techniques -Plain films -Radionuclide bone scan -CT -MRI
  2. 2. Plain Films <ul><li>Dx fracture or dislocation. </li></ul><ul><li>Underlying bone is normal or abnormal (path.#) </li></ul><ul><li>Position of bone ends before & after Rx. </li></ul><ul><li>Assess healing & complication. </li></ul>
  3. 3. Rule of (two)s <ul><li>Two views …& further views; oblique…stress views, flex. & exten. </li></ul><ul><li>Two sites ……..ring bones </li></ul><ul><li>Two sides </li></ul><ul><li>Two occasions. </li></ul><ul><li>Two joints. </li></ul>
  4. 4. Fracture <ul><li># line usually lucent line, occasionally dense. </li></ul><ul><li>A step in the cortex. </li></ul><ul><li>Interruption of the bony trabeculae in impacted # </li></ul><ul><li>Bulging or bucking of cortex in greenstick # </li></ul><ul><li>Soft tiss. swelling… a valuable guide. </li></ul><ul><li>Joint effusion. In knee an effusion often indicates a # </li></ul><ul><li>Dislocation: joint surfaces no longer maintain their </li></ul><ul><li>normal relationship to each other. </li></ul><ul><li>May be associted # </li></ul>
  5. 5. Radionuclide bone scan <ul><li>Increased activity within 2 to 3 days. </li></ul><ul><li>Stress #........march fracture </li></ul>
  6. 6. CT in bone trauma <ul><li>In complex shape bones; spine, face and hips </li></ul><ul><li>Better assessment of the extent of soft tissue damage & hematomas and of internal visceral injuries. </li></ul><ul><li>Exam of severely injured patient because of less manipulation. </li></ul>
  7. 7. MRI in bone trauma <ul><li># is seen as a dark line across the bright signal of the fat in BM in T1 </li></ul><ul><li>Oedema & bruise in the bone. </li></ul><ul><li>Soft tiss. injury such as muscles, tendons & ligaments. </li></ul>
  8. 8. Specific injuries <ul><li>Stress # due to repeated, often minor, trauma occurs in tibia & fibula in athletics. Also march # ….. </li></ul><ul><li>A stress # may appear as a sclerotic band across the bone and a fracture line may not necessarily be visible. </li></ul>
  9. 9. Insufficiency # <ul><li>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 </li></ul>
  10. 10. Path. # <ul><li>Through an abnormal bone </li></ul><ul><li>May be the presenting feature of both primary and secondary bone tumors </li></ul>
  11. 11. Salter-Harris Classification <ul><li>I: injury through the epiphyseal plate only </li></ul><ul><li>II: # through epiph. plate & metaphysis. 70% </li></ul><ul><li>III: # epiph plate & epiphysis. </li></ul><ul><li>IV: #epiph plate, epiphysis & metaphysis. </li></ul><ul><li>V : Crush # of epiphyseal plate. <1% </li></ul><ul><li>Growth arrest in IV & V </li></ul>
  12. 12. Non accidental injury (child abuse) <ul><li>Multiplicity of #s of different ages. </li></ul><ul><li>Metaphyseal #s from twisting & pulling </li></ul><ul><li>Metaphyseal sclerosis due to repeated injury and repair </li></ul><ul><li>Epiphyseal separation freq. associated with metaphyseal # </li></ul><ul><li>Periosteal reaction due to hemorrhage under the periostem </li></ul><ul><li>CT or US may show subdural hemorrhage or brain damage </li></ul>

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