image interpretation of the upper limbsscapula fractures violent force type injury associated with...
TRANSCRIPT
Imelda Williams
Image Interpretation of the upper limbs
& Shoulder girdle
Shoulder: Common trauma
▪ Fracture of the clavicle
▪ Fracture of the humeral head
▪ Fracture of the scapula
▪ Anterior dislocation of the humeral head - over 90%
▪ Posterior dislocation of the humeral head – less 5%
▪ Dislocation of the acromio-clavicular joint
Slide 2
Scapula Fractures
Violent force type injury
Associated with avulsion fractures of acromion or ACJ dislocations
Associated rib or clavicle fractures
Exclude damage to lungs
Slide 3
Monash Image
Anterior Humeral dislocations
▪ Antero-inferior dislocation
▪ Most common shoulder
dislocation: 90%
Slide 4
Monash Image
Posterior Humeral Dislocation
▪ Postero-lateral
rotation of humeral
head produces “Light
bulb” appearance
▪ Less common: ± 5%
Slide 5
Monash Image
Acromioclavicular joint
▪ Common sports injuires
▪ Direct fall or FOOSH
▪ Normal ACJ= 3-5mm
▪ Comparison views:
difference between 2
sides should not exceed
2m
ASSESSMENT OF ACJ
Elbow trauma
▪ Mechanism of injury includes:
• FOOSH• Direct blow
▪ Common fractures:
– Radial head / neck fracture
– Dislocation – Adults vs. paediatric
fractures
▪ Image interpretation criteria of the elbow:
▪ Dislocation assess:
– Anterior humeral line position– Radiocapitellar line position
▪ Fat pad elevation
Slide 7
Elevated fat pads: “Sail Sign”
▪ A visible anterior fat pad can be normal.
▪ A posterior fat pad is never normal and
always signifies fluid in the intra-articular
space.
▪ A positive sail sign in trauma setting is a
reliable indication of an intra-articular fracture
Slide 8
Monash Image
Anterior humeral line: AHL
▪ Accurate with true lateral elbow
▪ Line drawn along anterior
humerus must intercept
capitellum at middle third
▪ Indication of dislocation or
supracondylar fracture
Slide 9
Normal
Abnormal AHL
Supracondylar fracture
Monash Image
Radio-capitellar line: RCL
▪ True AP & lateral of elbow
▪ Indication of joint alignment
▪ Line drawn through centre of
proximal radius should pass
through centre of capitellum
Slide 10
Normal
Abnormal
Monash Image
Wrist traumatic pathology
▪ Typical wrist fractures
– Colle’s
– Smith’s
– Scaphoid
▪ Wrist alignment:
– Lunate dislocation
– Perilunate dislocation
Slide 11
Wrist dislocation
▪ Perilunate dislocation
– Capitate dislocated from lunate
▪ Lunate dislocation
– Dislocated volarly
Slide 12
Perilunate dislocation Lunate dislocation
Monash Image
Colle’s fracture
▪ COMMENT:
– Transverse fracture of
distal of radius with
dorsal displacement
of distal fragments.
Slide 13
Monash Image
▪ COMMENT:
– Transverse fracture of
the distal radius with
palmar/anterior
displacement of the
distal fragment.
Slide 14
Smith’s Fracture
Monash Image
Scaphoid fractures
▪ Fractures across scaphoid
waist has risk of Avascular
Necrosis (AVN) of proximal pole
▪ Only blood supply to scaphoid is
via distal pole.
Slide 15
Monash Image
Metacarpals and fingers
▪ Important to distinguish between extra- vs. intra-
articular fractures.
▪Fractures are common in the 1st & 5th metacarpals.
Slide 16
Bennett’s Fracture
• COMMENT:
• Common two piece
intra-articular fracture
of the base of the
thumb
Slide 17
Monash Image
Boxer’s fracture
▪ Commonly known as a punch injury or “brawler’s fracture”.
▪ The most common sight for a boxer’s fracture is either the neck or the shaft of the 4th or 5th
metacarpal.
18 Monash Image
Paediatric fractures
▪ Joint effusion is a useful sign e.g. supracondylar fracture
▪ Assessing alignment:
– Anterior Humeral Line (AHL)
– Radio-Capitellar Line (RCL)
▪ Periosteal reaction indicates healing fracture
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Common fractures
Torus / Buckle fracture
▪ Can be subtle
▪ Greenstick Variation
▪ Step in cortex
▪ Minimally impacted with intact cortex
Greenstick fracture
▪ Incomplete fracture
▪ Involves one side of the cortex
▪ Opposite side bends
5/1/2019 20
2
1
Greenstick Fracture
Monash Image
Take home principles
▪ Consider mechanism of injury.
▪ Apply a search strategy when interpreting radiographs.
▪ Know the common fractures and dislocations.
Slide 22