Skeletal Trauma And Healing Its Radiological Aspects
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This document discusses skeletal trauma and fracture healing from a radiological perspective. It provides an overview of imaging modalities used to evaluate skeletal trauma, including plain films, CT, MRI, nuclear medicine, and others. It describes fracture terminology and features used to classify fractures. It also discusses special fracture types like stress fractures, pathological fractures, epiphyseal injuries, and others. Key radiographic signs of various fractures and injuries are outlined.
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Skeletal Trauma And Healing Its Radiological Aspects
- 25. SPECIAL TYPE OF FRACTURES
- 87. Text book of radiology by David Sutton 7 th ed; Diagnostic radiology by Grainger & Allison 4 th ed; Essential skeletal radiology by Yochum 2 nd ed Orthopaedic imaging by Adam Greenspan 4 th ed; Diseases of bone & joint disorders by Donald Resnick 2 nd ed
Editor's Notes
- Stress fracture of the tibia in a 6- year-old boy, with only minimally increased osseous uptake. stage, Fig.
- double-contrast arthrography of the knee shows a horizontal cleavage tear in the posterior horn of the medial meniscus.
- femoral arteriogram was performed to rule out damage to vascular structures by a fractured femur. Transverse fracture of the distal femur resulted in transsection of the superficial femoral artery
- Closed #-does not break skin or communicate to outside environment. Open #-penetrates the skin and in communication with external environment. Comminuted #-two or more bony fragments separated. Comminuted fractures produce a minor triangular fragment of bone, known as a ` butterfly' fragment Segmental # - segment of bone is isolated by fractures at each end Avulsion #-tearing away of a portion of bone by forceful muscular or ligamentous pulling.
- Buckle 9 yr green stick 7 yr
- Stress#- # result from chronic repetitive forces which by themselves are insufficient to cause fracture, over the course of time lead to classical changes of a stress fracture. Insufficiency #- stress # thro a diseased bone Pathological#-# thro a bone weakened by localized disease process Occult #- # with clinical signs but without any radiological evidence and on follow up reveals fracture due to bone resorption. Bone bruise- MR imaging in trauma represent hemorrhage and edema asso with trabecular micro fractures. Pseudo#- radiologically appear as lucencies but actually uncalcified osteiod. Stable #- does not move or likely to move during the healing phase Unstable#- moving and likely to cause compromise to neighboring structures and healing.
- Dorsoplantar view of the foot reveals prominent soft-tissue swelling localized in the lateral aspect. The radiolucent line at the base of the fifth metatarsal indicates a fracture. (B) A similar radiolucent line separates a bony fragment from the base of the fifth metatarsal in another patient who was suspected of sustaining a fracture of this bone. Note the complete lack of soft-tissue swelling. The finding represents a secondary ossification center, not a fracture.
- Erect anteroposterior view of the shoulder demonstrates the fat-fluid level in the joint, an example of the fat–blood interface (FBI) sign. The fracture line extends from the humeral neck cephalad to the greater tuberosity. To demonstrate the FBI sign, the cassette should be positioned perpendicular to the expected fat–fluid level with the central ray directed horizontally. For example, in the shoulder, an upright radiograph (patient standing or sitting) should be obtained. In the knee (B) , the patient should be supine and a cross-table lateral view should be performed.
- Lateral view of the elbow shows a positive fat-pad sign. The anterior fat pad is markedly elevated and the posterior fat pad is also elevated in this patient. There is a subtle, non displaced fracture of the radial head.
- Pathological ‘banana fracture’. A transverse subtrochanteric fracture of the right femur with varus angulation is demonstrated. A transverse fracture in a long bone, particularly in the subtrochanteric region of the femur, is almost always due to an underlying abnormality. In this case, there is a metastatic lesion in the lateral cortex which led to the fracture
- A 19 year old female athlete who was running 3 miles each day for 3 months developed pain in both calves Typical appearance of a stress fracture in the calcaneus: a vertical band of sclerosis in the posterior aspect of the bone is characteristic of this injury.
- T2 fs coronal
- Fragmentation of the tibial tuberosity with thickening of the ligamentum patellae.
- anterior dislocation of the humeral head. The articular surface of the humerus loses contact with the articular surface of the glenoid. malalignment of the head of the humerus and the glenoid fossa, but some articular contact remains. Note the associated fracture of the surgical neck of the humerus.
- Unusual fracture in the pediatric age group. Fracture across the metaphysis (corresponds to the Salter-Haris type II fracture), together with a subchondral fracture of the epiphysis (cartilage intact), a Unremarkable radiograph, b sagittal T1-weighted SE sequence, c axial T2-weighted sequence at the level of the femoral metaphyses.
- Healing fractures are seen in both proximal humeri. multiple rib fractures at different stages of healing, probably the result of repeated compression
- occurs in adolescent children, probably related to chronic trauma. Represents Salter-Harris Type I fracture of the epiphyseal plate. commonly seen in boys approaching puberty, particularly overweight and sexually immature. The incidence in girls however is rising, possibly as a result of an increase in sporting and physical activity. It may be bilateral (30-40%). The epiphysis is displaced from the metaphysis, usually in a posterior and slightly inferior direction reflecting an anterior and superior slip of the femoral neck with respect to the epiphysis. ' Frog's-leg' views as well as AP views of both hips should be examined.
- Slipped capital femoral epiphysis: Radiographic abnormalities. A Anteroposterior view. Subtle findings include mild osteoporosis of the proximal portion of the femur and an indistinct metaphyseal margin. B Frog-leg view. The degree of posterior slippage is readily apparent. Note the widened growth plate. C Frog-leg view. Bilateral slipped epiphyses are present, with the right side being involved more severely
- acro-osteolysis of the toes, with almost complete resorption of the distal phalanges.
- Caisson disease of both shoulders. Medullary infarcts are larger and irregular. demonstrated. These are well defined. There is a split cortex on the right. The The fragment may become completely separated and form an humeral heads are flattened and irregular. Secondary osteoarthritic change is -articular loose body. If entirely cartilaginous in content, the shown. Widespread metaphyseal infarction is demonstrated. The infarcted ntra areas have well-defined margins that are symmetrically metaphyseal
- Fragmentation and flattening of the lunate due to avascular necrosis is typical of Kienbock's disease, accompanied by extensive cystic changes in the surrounding bones. These abnormalities occurred in a worker using compressed-air drills, who had been exposed to this repeated trauma for many years.
- gross osteoporosis of the bones of the hand, wrist and forearm, most marked at the bone ends, but also causing cortical 'thinning' and resorption.
- A 52-year-old man sustained injury to the lateral aspect of the left thigh 6 months previously. He was concerned about a hard mass he had palpated. (A) Radiograph shows an ossific mass adherent to the lateral cortex of the left femur ( arrow ). (B) CT scan demonstrates the classic zonal phenomenon of myositis ossificans. Note radiolucent center surrounded by mature cortex. A 52-year-old man sustained injury to the lateral aspect of the left thigh 6 months previously. He was concerned about a hard mass he had palpated. (A) Radiograph shows an ossific mass adherent to the lateral cortex of the left femur ( arrow ). (B) CT scan demonstrates the classic zonal phenomenon of myositis ossificans. Note radiolucent center surrounded by mature cortex. A 52-year-old man sustained injury to the lateral aspect of the left thigh 6 months previously. He was concerned about a hard mass he had palpated. (A) Radiograph shows an ossific mass adherent to the lateral cortex of the left femur ( arrow ). (B) CT scan demonstrates the classic zonal phenomenon of myositis ossificans. Note radiolucent center surrounded by mature cortex. A 52-year-old man sustained injury to the lateral aspect of the left thigh 6 months previously. He was concerned about a hard mass he had palpated. (A) Radiograph shows an ossific mass adherent to the lateral cortex of the left femur ( arrow ). (B) CT scan demonstrates the classic zonal phenomenon of myositis ossificans. Note radiolucent center surrounded by mature cortex.
- Oblique radiograph of the ankle shows a completely united fracture of the distal fibula. Disuse juxta-articular osteoporosis is evident from the thinning of the cortices associated with decreased bone density
- The frog-lateral view of the left hip shows the crescent sign ( arrow ) in a 45-year-old woman who sustained hip dislocation 5 weeks earlier. 52-year-old woman sustained a fracture of the scaphoid bone, treated conservatively in a cast. (A) Conventional radiograph shows sclerotic changes in the scaphoid, which may be due to healing process or osteonecrosis. (B) Coronal reformatted CT shows incompletely healed fracture of the scaphoid complicated by osteonecrosis.