MUSCULOSKELETAL SYSTEM

II
 X-ray
• INDICATIONS:
• Truama.
• Infection.
• Systemic diseases, endocrine ( hyper parathyr,,,,,),
renal.
• Degenerative diseases ( knee, spine,,,etc).
• Malignancy.
 TRAUMA
• Used to asses intergrity of the bone
– Fractures, fracture,, fractures,,,,,,,,,,,,,,,,,,,,,,,,,,fractures.
– Dislocation,,, joints.
– Joint effusion.
– Spine and skull fractures.
• describe the film
• describe the fracture
• what type of fracture?
– complete: tend to happen in adults
– incomplete: tend to happen in children
– Salter-Harris: fractures that involve the growth
plate
• Complete fractures
– transverse: straight across the bone
– oblique: oblique line across the bone
– spiral: looks like a cork-screw 3D Fx .

– comminuted: more than 2 parts to the fracture

=ed .

• Incomplete fractures
– bowing: the long bone has been bent
– buckle: the fracture is of the concave surface
F- I

– greenstick: the fracture is on the convex surface

-
F-
• Transverse Fracture:
– A fracture in which the break is across the bone, at
a right angle to the long axis of the bone.
Adjoining figure would illustrate.
trans Fx
. .

mid shalt I

the tibia

☐ no dislocation or

angulation
:÷
"

A
angulation
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• Oblique Fracture:
– Instead of break being at right angle, it goes in
oblique direction to the long axis of the bone.The
fracture is confined to one plane. In other words

I
the bone has broken at an angle.

no dislocation
or
angulation
• Spiral Fracture : 3D fracture .

– This fracture is easily confused with the oblique fracture. Instead

of a straight break as in oblique fracture that is only in one plane,
the break in this case traverses both the planes. To understand
this you need to imagine a _ three dimensional view- of the bone.
– If you take a stick and slice it at an angle so that it is divided in
two, it is similar to oblique fracture. But if you twist and break
that stick it would result in a break pattern that would start from
one point, move obliquely in on direction, reach the other end
and then continue in other side of the stick in a spiral fashion to
meet the original point.
– Adjoining diagram would give you rough idea of what I am trying
to say. Compare it with the oblique fracture diagram and you
would be able to appreciate the difference.
F- e-
• Comminuted Fracture : ④⇐÷ .
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– If the injury results in multiple breaks in the bone,

=
they are visible as different fragments. These kind of
fractures are called comminuted fractures.
– Apart from this, fracture can be displaced or
undisplaced. If bone fragments stay together
maintaining structural alignment of the bone , it is
called an undisplaced fracture. A hairline fracture is an
example of an undisplaced fracture.
– But fragment of the bone may move from their
original position resulting separation of the fragments.
Such a fracture is called a displaced fracture. (See

_open
• what bone and where?
– diaphysis: the shaft of the bone
– metaphysis: the widening portion adjacent to the
growth plate
– epiphysis: the end of the bone adjacent to the joint
b-
o is it displaced?
– angulation Gnpx osteoarthritis
.

– translocation
– rotation
&
selling
 ②
• is the joint involved?
• is there another fracture?
 Examples
• Transverse fracture of the mid-to-distal third of
the right tibia. No significant angulation, but
ventral (80%) and lateral (10%) translocation.
• Spiral fracture of the distal third of the left tibia.
Mild varus angulation, lateral translocation and
angulation. The fracture does not extend to the
joint surface.
• Buckle fracture of the left distal radius with no
significant displacement.
 +
translation
µ +
translocation
comminuted Fx .
Transverse Fx .
 "
after IX. spiral fracture Transverse Fx . + displacement
-

Intra
medley nailing .
 Disturbed fracture healing Factors
*
age
• delayed union + neath
– fracture healing takes about twice as long as expected for a specific location* comorbidities

qÉ÷Éomd
* stress on
• non-union (pseudoarthrosis) .

– fracture healing does not occur within 6-9 months

-
Fx .

– common sites: scaphoid bone, femoral neck, tibial shaft stress

µ
• malunion ←
– healing in the wrong position
-

– can be partially compensated for by remodeling of the bone (except for rotational
malunion)
• refracturing
O
– as a rule of the thumb, fixation material should be removed within about 18 months
-
after consolidation of the fracture
– leaving it in place may lead to cortical atrophy and a higher risk of refracturing

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• Malunited fracture : there is _

callus formation
at the boney end of the the fracture, but with
abnormal aligment, deformity, displacement.
-
• Always ask for two veiws.
 -
Malunited fracture

maturing 0
angulated
ma /
union

÷
Reduction

÷
 ( min ]

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8
•-
Un united fracture ther si no healing of the
-

fracture, still seeing the gap between the

boney ends, sclerosis in both bone ends with
no obviouus healing and caluus connecting
the two parts.
 ununited

In -
gap
-
"
CAIUS s
fibula united
↳ 1, I • tibia

13
↳ ,

six

⇐
Unijniled
Fx .

↳
Iéo
sclerotic
ends -0
(dense)
*
no

callus
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Scaphoid Non-Union Fracture - The
-

Hand

0.* un

Fx
united
.

sclerotic
ends .
 ②
• Scaphoid fracture usually involve the waist of
the bone.
• Can be missed and appear after weeks as
sclerosis.
• Associated with -avascular necrosis of the
proximal part ( artery enter the bone from
←←

distal part).
[µ , ,
 Scaphoid Bone

→
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AVI
 Elbow fracture
• Usually the posterior fat pad of elbow not
seen in lateral film,, if it appears mean joint
fluid.
• Another sign is bulge of the• anterior fat pad.
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Posterior fat Pad should not be seen

Ant Fat Pad

Pat① Bulged .

I Post Fat Pad .

.
Bulge At '

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fat Pad

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Pad
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hem.at#is
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Fat Pad

a Bit fat
Pad

Fx d Radial
.
head .
 Subtle fractures
↳
OcaltFa
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subtle
Fx .

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-
:
Talus 0
traits
Fibula
Fx .
 another vein

fibula Fx .

the
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reaching
article

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E. in Post
tibia
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medial °
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femoral
reek a

ostespenia
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femoral Neck
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Fx

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DMs
'^j Cortex

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-
• To fracture look for the boney ◦cortex, for any
disruption or loss of continuity.
• Check the •cancellous bone of disturbed fibers.
• Carfull with osteopenia/oeteoprosis ,, because
it is difficult to see fractures.
• Osteoporosis seen as decreased bone density,,
thinned cortex.
Fai
~
W
MT
to seat line

1 206 I
osteoporosis
the Fx line
.

is
sclerotic
Bone Fibers It 48
ix. 84
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+ Clavicle .

* Contusion 0 0
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try
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+
opaciliolim
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+ hemotworax .

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1% .

*,
• Be carful to look for -1st and 2nd ribs
fractures,,,,, mean high energy trauma.
-
=

• Look for associated lung contusion, pleural

-
-

fluid, ,, these type of injury are associated with

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major vessels injury.

at the isthmus I Aorta

⑦-
& .
do fixed
g-
• Check position of chest tubes.
– Tubes inserted for pneumthorax are directed
apical and anterior.
– Tubes inserted for pleural fluid directed posterior
and inferior.
• Endotracheal tube should be within 2cm frm
the carina.
• Central line should be at upper RT atrium.
• NG tube in stomach vc
⇐
 extensive subcutaneous
hot tubes
emphysema

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