MUSCULOSKELETAL RADIOGRAPH

TRAUMA
dr. Siti Fatima Azzahra, SpRad, M.Sc
 Soft Tissue
Dislocation
Injury

Fracture

Modalities
MODALITIES

Radiography Interventional Bone Mineral

Radiology Densitometry

CT Scan Nuclear
Medicine

Ultrasonography MRI
FRACTURE
Disruption in the continuity of all or
part of the cortex of a bone

Mostly happen in long bones

Easily visualized by radiograph

CLASSIFICATION
SHAPES
 CLASSIFICATION
CONTINUITY

Complete Fracture

Fracture line along the both

side of the cortex

the parts of the bone that

have been fractured are
completely separated from
each other
 CLASSIFICATION
CONTINUITY

Incomplete Fracture
Fracture line on one
side of the cortex

­ Greenstick fracture
­ Buckle/Torus fracture
CLASSIFICATION
FRAGMENTS

Simple Fracture Comminuted Fracture

fractures where more

than 2 bone components
are created.
CLASSIFICATION
FRAGMENTS Butterfly Fracture

Segmental Fracture results from two

oblique fracture lines
meeting to create a
a fracture composed of large triangular or
at least two- fracture wedge
lines that together shaped fragment loc
isolate a segment of ated between the
bone, proximal and
usually a portion of the distal fracture fragm
diaphysis of a long ents,
bone. and resembles
a butterfly
 CLASSIFICATION
FRACTURE LINES

Transverse Oblique

traverse the bone occur at a plane

perpendicular to oblique to the long
the axis of the axis of the bone
bone.
Involves the cortex
circumferentially prone
and there may be to angulation in the
displacement. plane of the
fracture
 CLASSIFICATION
FRACTURE LINES
Spiral Longitudinal
(Intraarticular)
that result from a
rotational force
applied to the occur along (or
bone.
nearly along)
the axis of the
Spiral fractures are bone
usually the result of
high energy trauma
and are likely to be
associated with
displacement.
CLASSIFICATION
LOCATION

Supracondylar Intraarticular

(femur / humerus)
bone fracture in
which the break
crosses into the
surface of a joint.
This always results
in damage to the
cartilage.
CLASSIFICATION
LOCATION

Femur :

­Subcapital
­Transcervical
­Base (Cervicotrochanter)
­Intertrochanter
­Subtrochanter
 CLASSIFICATION
OTHERS

Impaction

occurs when two pieces

of a fractured bone are
driven into each other.
 CLASSIFICATION
OTHERS

Depression/
Impression

bone of the
skull vault
being folded
(depressed)
inward into the
cerebral
parenchyma
TYPES

Stress
Fracture
Pathological
Fracture
Physeal
Plate
Avulsion Fracture
Fracture
AVULSION FRACTURE

Fracture with avulsed

fragment pulled from its
parent bone by contraction of
a tendon/ligament

Common in younger age

engaging athletic activities

Segond Fracture
AVULSION FRACTURE
Gamekeeper / Jones Fracture
Skier Fracture
 AVULSION FRACTURE
Osgood-Schlatter Dancer Fracture /
Fracture Pseudo-Jones
 PHYSEAL PLATE FRACTURE
SALTER-HARRIS
v Type I & II = Heal
v Type III =
degenerative
change,
asymmetrical
growth plate fusion
v Type IV & V = early
growth plate fusion,
deformity &
shortening
Separation Above Lower Through Rammed
PHYSEAL PLATE FRACTURE
SALTER-HARRIS
PHYSEAL PLATE FRACTURE
SALTER-HARRIS
 PATHOLOGICAL FRACTURE

vUnderlying pathological process

vInfection
vTumor

vKey: no significant traumatic event

 STRESS FRACTURE
insufficiency = fatigue = march

vmicrofracture due to repeated

stretching & compression forces
vdue to insufficient/weak bony
structures
vmostly due to osteoporosis
THE POPULAR NAMES YOU SHOULD BE FAMILIAR WITH..
COLLES FRACTURE
distal radius with dorsal
displacement & volar angulation
SMITH FRACTURE
distal radius with volar
displacement
GALEAZZI FRACTURE
distal radius with radioulnar
dislocation
MONTEGGIA FRACTURE
Proximal ulna with radial head
dislocation
CHAUFFEUR FRACTURE
Radial styloid fracture
WHAT SHOULD WE ASSESS ?

Intraarticular or Relationship
Type of fracture between
not fragments

Second (other) Relationship with

abnormality surroundings
(neurovascular)
RELATIONSHIP BETWEEN
FRAGMENTS?
ØDisplacement

ØAngulation
ØDeviation of the distal fragment
relatively to its proximal part
ØShortening/distraction
ØRotation : internal/external
COMPLEX BONE
Radiography :
­Too many superimposition Spine Facial
­Need special projection

Pelvis
MSCT is mandatory
COMPLEX BONE
FACIAL
ØSpecial positioning
ØWaters view
ØParanasal sinus
ØOrbits view (Rheese)

ØCranium (Schaedel)
 COMPLEX BONE
PELVIS
ØFracture of
pelvic ring :

ØStable
ØUnstable
COMPLEX BONE
PELVIS
COMPLEX BONE
PELVIS
COMPLEX BONE
SPINE
 COMPLEX BONE
SPINE FRACTURE

Burst fracture of C7

Fracture of vertebral body with

retropulsion to spinal canal
 COMPLEX BONE
SPINE FRACTURE

C1 – C2 Fracture :

AP open-mouth view
 COMPLEX BONE
SPINE FRACTURE

Jefferson

Fracture of atlas (C1)

 COMPLEX BONE
SPINE FRACTURE

Odontoid fracture

Fracture of dens
 COMPLEX BONE
SPINE FRACTURE

Hangman Fracture

Fracture of pars
interarticularis C2
 COMPLEX BONE
SPINE FRACTURE

Spondylolysis

Fracture of pars
interarticularis
SMALL BONES

The Gilula’s Arch

SMALL BONES
SCAPHOID FRACTURE
Most common in carpals
Retrograd vascular supply to
proximal
can lead to avascular necrosis
SMALL BONES
SCAPHOID FRACTURE
SMALL BONES
BOXER FRACTURE
Fracture of the head of 5th
metacarpal, due to punching
SMALL BONES
BENNETT FRACTURE
Intraarticular fracture of the base of 1st
metacarpal
INDIRECT SIGNS SUGGESTIVE FOR FRACTURES

Soft tissue swelling

Loss of fat stripes
Loss of fat pad (joint effusion)
Periosteal reaction / callus formation
INDIRECT SIGNS SUGGESTIVE FOR FRACTURES
 PITFALLS
Ossification centres
Sesamoid bone
Accessory bone
PITFALLS
DISLOCATION
Bone that formed the joint are no longer in apposition to
each other.

SUBLUXATION
Bone that formed the joint are in partial contact with
each other.
DISLOCATION
SHOULDER
Anterior dislocation Posterior dislocation
DISLOCATION
HIP
Anterior dislocation Posterior dislocation
DISLOCATION
SMALL BONE
Scaphoid dislocation Lunate dislocation
HOW SHOULD I REPORT THEM?
vStructured, systematic
vMost important first

vRule of Two
vTwo view
vTwo joints
vTwo abnormalities (or more)
WHAT SHOULD WE THINK ABOUT IN
EMERGENCY SETTING?
Far from ideal

Reason for imaging

­What is the information do you need?
­Is there any clinical confusion in terms of diagnosis and
management?
HOW TO OBTAIN OPTIMAL BENEFIT ?

Well-prepared patients

Good relationship between clinicians &

radiology
­Clear & completely-filled request form
­Direct communication
Any question?

@saraazzahra