FRACTURE REPORTING TECHNIQUES FOR MEDICOS
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1. This document provides guidance on identifying and interpreting various bone fractures and variants in radiology reports. It describes normal anatomical variants that can be mistaken for fractures. 2. Key points discussed include classifications of common fractures like Colles' fractures of the wrist and Schatzker fractures of the tibial plateau. It also outlines imaging views needed to properly identify different fractures. 3. The document emphasizes that more than two views are sometimes needed to accurately diagnose a fracture and that subtle fractures can be missed on any single imaging modality. It stresses the radiologist's responsibility to report important findings to avoid issues of medical negligence.
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FRACTURE REPORTING TECHNIQUES FOR MEDICOS
- 5. Upper humeral notch a normal developmental variant which may be seen in children between the age of 10 and 16 years
- 8. C R I T O L - MNEMONIC 1,3,5,7,9,11
- 9. Normal developmental notch and hook in the scaphoid
- 12. In a 15-year-old boy. There is a secondary ossification centre at the lower pole of the patella
- 13. Osgood–Schlatter disease Normal tibial tuberosity
- 14. Os trigonum simulating fracture of posterior process of the talus The calcaneal apophysis appears sclerotic and fragmented but this is normal
- 15. Os supranaviculare can be mistaken for an avulsion fracture of the navicular bone
- 16. Nutrient vessel in the tibial diaphysis
- 17. Thirteen-year-old boy presenting with spiral fractures of the diaphyses of metacarpal 2 and 3. Overlapping soft tissues of the fingers may simulate additional fracture lines at the phalanges of the fourth and fifth finger
- 18. Step II
- 20. STEP IN CORTEX
- 22. Increased density of trabeculae
- 26. Subtle distal radial torus (or buckle) fracture
- 27. Bowing and green stick fracture
- 28. Greenstick fractures of the mid-radius and ulna
- 29. Compression fracture of only the anterior part of a vertebra
- 30. A Avulsion of the right ischial tuberosity; hamstring tendon
- 32. Salter harris classification of physeal injuries
- 33. oblique fracture line in the diaphysis of the right tibia in a 2-year-old boy ( toddler fracture)
- 36. Fractures of the neck of humerus and greater tuberosity. The humeral head is subluxed inferiorly and this subluxation is likely to be caused by distension of the joint by joint effusion
- 37. Crush injury
- 38. Spiral fracture
- 47. Malunion. Nonunion. Infection. Growth retardation in case of physeal injuries Myositis Soft tissue swelling any. Compartment syndrome. Carpal tunnel syndrome.
- 48. Old fracture of the waist of the scaphoid , non-union of the fracture and AVN
- 49. Non union types
- 50. The radial shortening resulting in the ulna abutting the lunate
- 52. One view is no view
- 53. Many fractures are not detected on single view. Two standard projections at right angles to each other is minimum requirement in trauma radiography. At times we may require more than two projections for coming to conclusion. RADIOGRAPHIC VIEWS
- 55. Radial styloid fracture not demonstrated on regular two views
- 56. Lateral tibial plateau fracture – Schatzkers type I better demonstrated in oblique view
- 61. SHOULDER
- 69. ELBOW
- 70. Abnormal anterior humeral line
- 73. WRIST
- 83. Calcaneum
- 84. > 30 degrees < 30 degrees
- 87. FAT PAD SIGN
- 91. knee joint effusion - Fracture patella
- 92. Air within the soft tissues consistent feature with open wounds ,warrants open reduction
- 98. Additional views. CT and MR. Scintigraphy. ADVISE ON FURTHER IMAGING
- 99. Fracture /dislocation Classifications Scapular fractures zdravkovic Clavicle Allman Elbow Morey Olecranon Mayo’s Radial head Masons Colles Frykman’s pelvis Tiles Acetabular Judet and Letournel Femoral neck Garden /Pauwel Tibial plateau Schatzkers Calcaneum Rowe ‘s /Sanders CLASSIFICATIONS
- 100. LEGAL ASPECTS
- 101. Should be reported with operative details. Post operative changes Name of the implant /prosthesis used should be mentioned. POST OPERATIVE RADIOGRAPHS /INSURANCE REPORTING
- 102. Despite of all efforts taken fractures can be still be easily missed on any modality. Legally error in judgement will be classified as. Justfied – on opinion of expertise in the field of radiology. Errors other wise will be prosecuted under medical negligence act. Responsibility of informing important findings lies with radiologist.
- 103. Dr Santhosh kumar kemminje MDRD
- 104. LIGAMENTOUS ANATOMY OF THE CERVICAL SPINE.
- 106. MULTIPLE VIEWS
- 112. Summary slide. IDEAL COMBINATION FOR MINIMIZING FRACTURE REPORTING ERRORS
Editor's Notes
- AP (a) and axial (b) views of the proximal humerus showing the normal lucent proximal humeral epiphysis, sometimes m a istaken for a fracture
- Normal coracoid process
- Separate ossifi cation centres for the olecranon in an adolescent boy
- Normal apparent separation of the ossification centre for the lateral epicondyle
- in a 15-year-old boy. There is a secondary ossifi cation centre at the lower pole of the patella
- Bowing fracture. There is an apex volar bowing fracture of the radial diaphysis (arrow), along with a greenstick fracture of the distal ulnar diaphysis. Chapter 4: Pediatric trauma 88
- Avulsion of the right ischial tuberosity; hamstring tendon. No.
- Radiologically invisible fractures. (a) When the X-ray beam is parallel to the fracture line ¡ 15°, then a lucent line appears on the radiograph. (b) When the incident X-ray beam is perpendicular to the fracture then, th
- In hypertrophic nonunion, seen here in the shafts of the tibia and fibula, there is flaring of the bone ends, marked sclerosis, and periosteal response, but no evidence of endosteal callus formation. The gap between the bony fragments persists.
- here have been studies investigating the correlation between the fat pad sign and bony injury. These studies have reported an anterior fat pad sign indicates a probability of intra-articular fracture of approximately 70-80%, whereas a posterior fat pad sign indicates a 90% chance of intra-articular fracture. The anterior fat pad can be seen in a normal elbow. The posterior fat pad sign is never visible in a normal elbow.
- This 38 year old male was referred for radiography of his forearm as part of a workup for MR imaging. He had a history of a previous compound fracture of his left forearm associated with an industrial accident.There is evidence of an old fracture of the distal third of the ulna. It is unclear if the adjacent opacities are foreign bodies of artifacts. The radiography was performed with a CR system. A virtually identical demonstration of the small dense artifacts was achieved confirming the presence of foreign bodies which were likely to be metal fragments. The metallic foreign bodies were considered to represent contra-indications for 3 Tesla MR imaging.