This document provides an overview of radiological examination of fractures and traumatic injuries. It discusses how radiology can be used to assess fracture type, location, complications, and associated soft tissue injuries. Specific fractures and injuries of the skull, spine, pelvis, hip, knee, ankle, shoulder and forearm are examined. Radiological signs of non-accidental injuries in children are also reviewed. The document emphasizes the importance of radiology in the diagnosis and management of skeletal trauma.

1. Dr G.Jayaraman

2. Introduction
 Proper history &
thorough examination,
do not ignore patients
symptoms
 Trauma imaging
constitute major bulk
of the of work
 Diagnosis starts with
plain x ray -most cases
 At least 2views
required

3.  Radiological examination permits assessment of
 Presence of Fracture
 Type & position of fracture
 Simple, comminuted, segmental, etc
 Asso. Joint injury
 Epiphyseal injury
 Asso. Soft tissue involvement
 Age & healing of fracture

4. COMPLICATION OF FRACTURE
 Delayed union
 Nonunion
 Malunion
 AVN
 Traumatic subperiosteal ossification
 Myositis osificans
 Sudeck’s osteodystrophy

5. Delayed Union

6. Nonunion

7. Malunion

8. AVN

9. Traumatic subperiosteal reaction

10. Myositis ossificans

11. Sudecks osteodystrophy

12. TRAUMATIC LESION IN CHILDREN
 Fracture of lower arm & forearm- more common than
adults
 Greenstick fracture common
 Heals fast
 Remodeling effects leads to good alignment without
deformity
 Compressed vertebral body in children may get fully
reconstructed as the child grows

13. Greenstick fracture

14. Salter & Harris type of epiphseal injury

15. Slipped Femoral capital Epiphysis
 Common – children & young adolescents
having limited internal rotation
 Age – 10 to 14
 Obese person
 H/o fracture may be present or not
 Early diagnosis is important
 Radiological Signs
 Blurring of metaphysis
 Dislocation of femoral head from acetabulum
 Growth plate widening
 Prolongated superior neck line
 Reduction of epiphyseal height

16. Non Accidental Injury
 Battered child Syndrome
 Multiple fracture at different
stages of healing
 Marginal metaphyseal
fracture with or without
epiphyseal injury
 Exuberant subperiosteal
ossification
 Such injures results` from
vigorous shaking of the child

17. Type of Fractures
 Traumatic
 Pathological
 Stress
 Fatigue

18. Stress Fracture
 Tibial shift – common
 Neck of the metatarsals –
March fracture
 Spondylolisthesis results from
stress fracture of one & both
neural arch through the
weakened pars interarticulars

19. Regional Skeletal Trauma
 Chest injury
 Rib fracture
 Hemothorax(Pleural
effusion)
 Hemopneumothorax
 Subcutaneous
emphysema
 Lung
contusion/laceration

20. Regional Skeletal Trauma
 Clavicular Fracture
 Common
 Middle/ Lateral shaft – common
 May asso. with Acromio clavicular joint dislocation
 Deformed clavicle with focal sclerosis – Old fracture
 Sternoclavicular joint dislocation – asso with vascular injury

21.  Shoulder joint
 Surgical neck fracture on
fall on outstretched hand
 Anterior dislocation –
common
 Posterior dislocation rare
and ass. Epileptics or
severe muscular spasm.
Light bulb appearance
with loss of parallelism.
 In some case recurrent
dislocation occurs due to
capsular tear & joint
instability.

22.  Hill sach’s defect
 V shaped defect in
posterio lateral aspect
of humeral head.

23.  Bankarts lesion –
Impaction
fracture in
anteroinferior
glenoid labrum
margin.

24. Rotator Cuff injury
 Sustained in fractures
and dislocation at the
shoulder joint.

25.  Supracondylar fracture of humerus –
common in children.
 Accounts for 60% of all fractures
occurring in children caused by fall on
outstretched hand.
 Distal fragment is displaced posteriorly
and rotated
 Hence anterior humeral line passes
anterior to capitellum – Normally should
pass through the centre.
 Fat pad sign ant and post due to fluid
collection in elbow joint - haemarrthrosis

26. For determing bone age around
elbow
 Capitellum – 1yr
 Radial head – 5yrs
 Medial epicondyle – 7yrs
 Trochlea -10yrs
 Lateral epicondyle – 11yrs
 Olecranon – 11yrs

27. Can Radiology make trauma less
obscure
 90% of elbow dislocation are posterior & lateral
displaced
 Myositis ossificans – common

28.  Monteggia fracture
dislocation
 Fracture upper 1/3 of
ulna with dislocated
superior radio ulnar
joint.

29.  Galeazzi fracture
 Lower 1/3rd radial shaft
fracture with associated
dislocation of the distal
radioulnar joint

30.  Colles fracture
 distal fracture of the radius in the forearm with dorsal
(posterior) displacement of the wrist and hand

31.  Smith’s Fracture
 Reverse Colles fracture
 distal fracture fragment
is displaced volarly
(ventrally)

32.  Scaphoid fracture
 PA & oblique view
 Commenest # at
wrist
 Proximal pole may
undergo AVN.

33.  Lunate & Perilunate dislocation
 In lunate dislocation lunate becomes triangular in AP. Other
carpals appear normal. (less common)
 Perilunate common except lunate other carpals are displaced
dorsally.

34. Spine Fracture
 Wedge compression
fracture
 Vertebral end plate
often intact
 Disc spaces maintained
 Height reduced

35. Pelvic Fracture
 Involves superior & inferior
pubic rami
 U/L or B/L
 Symphysis pubis may be
dislocated
 Look for any SI jont
dislocation
 Urethra or bladder injury
 Vascular injury – pelvic
hematoma

36. Hip Injury
 Femoral head fracture:
 Subcapital
 Mid cervical
 Basal cervical
 Pertrochanteric
 Subtrochanteric
 Acetabular fracture
 Symphysis pubis
dislocation

37.  Hip Dislocation:
 Posterior dislocation
 Anterior dislocation
 Central dislocation

38.  Femoral shaft fracture
 Mid shaft – common
 Supracondylar region
with intracondylar
extension
 Transcondylar
fracture

39.  Patellar fracture
 Fracture: Simple(horizontal)
– Communited(vertical)
 Dislocation – lateral
 View- Knee
AP/Lateral/Skyline
 Vertical # seen well with
Skyline view

40. Knee injury
 MRI indicated to study the integrity of
cruciate & collateral ligaments, hyaline
cartilage menisci capsule any marrow edema
 Useful when plain x rays are non contributory
but patient has pain during locking and
unlocking movements

42. Ankle injury
 Both malleolar fracture
 Fracture tarsal bones
especially talus and
calcaneum.
 Any H/O fall from a
height look for calcaneal
fracture

43. Head injury
 Clinical examination is important
 Rule out cervical spine injury while turning the pt for
lateral skull
 Views: AP /Lateral Skull
Towns, Basal view now a days not taken due to
availability of CT which gives more information
 For cervical spine injury – AP & Lat view
 Translateral view is taken for cervical spine injury.
 Taken without turning the patient

44. Contd..
 C1 arch fracture unilateral or bilateral
 Jefferson fracture
 C2 fracture odontoid process , fracture body
 Fracture of pedicles/lamina – Hangmans fracture
 Clay shovellers fracture - # of lower C spine spinous
process
 Vertical – stable
 Horizontal – unstable

45. Contd..
 Jefferson fracture
 Hangmans fracture
 Clay shovellers fracture

46. Contd..
 Cervical vertebrae compression fracture in
hyperflexion injuries.
 Look for associated dislocation.
 Facettal dislocation/location.
 Spinous process gets widened at the site of vertebral
fracture or dislocation.

47. Skull Fracture on Plain x ray
 More lucent than vascular marking
 Linear, Doesn’t branch
 Simple or depressed
 Pneumocephaly occur in asso. with sinus injury
 Mastoid fracture
 Penetrating Injury
 Plain CT of head is advised
 View in brain & bone window setting

48. Intracranial bleed
 Extradural – Biconvex,
asso with vault #

49. Intracranial bleed
 Subdural – Semilunar in shape
 Midline shift & mass effect.

50. Intracranial bleed
 Intracerbral – irregular
dense collection

51. Intracranial bleed
 Subarachnoid – between sulci
, cistern

52. Intracranial bleed
Intraventricular bleed

53. Facial bone injuries
 Le Fort fractures
 Type 1: low horizontal fracture involving nasal septum
and alveolus of maxilla(floating hard palate)
 Type 2: pyramidal fracture crossing nasal
bone,septum,medial oribtal wall,floor of orbit
extending into roof of maxillary antrum(floating
maxilla)
 Type 3: High transverse fracture crossing nasal bone
medial and lateral orbital wall extending into zygoma

54. Zygomatic and mandibular fracture
 Tripod fracture of zygoma
 Mandibular fracture

55. THANK
YOU!!