Skeletal Trauma

Skeletal TraumaDr G.Jayaraman

IntroductionProper history & thorough examination, do not ignore patients symptomsTrauma imaging constitute major bulk of the of workDiagnosis starts with plain x ray -most cases At least 2views required

Radiological examination permits assessment ofPresence of FractureType & position of fractureSimple, comminuted, segmental, etcAsso. Joint injuryEpiphyseal injuryAsso. Soft tissue involvementAge & healing of fracture

COMPLICATION OF FRACTUREDelayed unionNonunionMalunionAVNTraumatic subperiosteal ossificationMyositis osificansSudecks osteodystrophy

Delayed Union

Nonunion

Malunion

AVN

Traumatic subperiosteal reaction

Myositis ossificans

Sudecks osteodystrophy

TRAUMATIC LESION IN CHILDRENFracture of lower arm & forearm- more common than adultsGreenstick fracture commonHeals fastRemodeling effects leads to good alignment without deformityCompressed vertebral body in children may get fully reconstructed as the child grows

Greenstick fracture

Salter & Harris type of epiphseal injury

Slipped Femoral capital Epiphysis Common children & young adolescents having limited internal rotationAge 10 to 14Obese personH/o fracture may be present or notEarly diagnosis is importantRadiological SignsBlurring of metaphysisDislocation of femoral head from acetabulumGrowth plate wideningProlongated superior neck lineReduction of epiphyseal height

Non Accidental InjuryBattered child SyndromeMultiple fracture at different stages of healingMarginal metaphyseal fracture with or without epiphyseal injuryExuberant subperiosteal ossificationSuch injures results` from vigorous shaking of the child

Type of FracturesTraumaticPathologicalStressFatigue

Stress FractureTibial shift commonNeck of the metatarsals March fractureSpondylolisthesis results from stress fracture of one & both neural arch through the weakened pars interarticulars

Regional Skeletal TraumaChest injuryRib fractureHemothorax(Pleural effusion)HemopneumothoraxSubcutaneous emphysemaLung contusion/laceration

Regional Skeletal TraumaClavicular FractureCommonMiddle/ Lateral shaft commonMay asso. with Acromio clavicular joint dislocationDeformed clavicle with focal sclerosis Old fractureSternoclavicular joint dislocation asso with vascular injury

Shoulder jointSurgical neck fracture on fall on outstretched handAnterior dislocation commonPosterior 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.

Hill sachs defectV shaped defect in posterio lateral aspect of humeral head.

Bankarts lesion Impaction fracture in anteroinferior glenoid labrum margin.

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

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 rotatedHence 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

For determing bone age around elbowCapitellum 1yrRadial head 5yrsMedial epicondyle 7yrsTrochlea -10yrsLateral epicondyle 11yrsOlecranon 11yrs

Can Radiology make trauma less obscure90% of elbow dislocation are posterior & lateral displacedMyositis ossificans common

Monteggia fracture dislocationFracture upper 1/3 of ulna with dislocated superior radio ulnar joint.

Galeazzi fractureLower 1/3rd radial shaft fracture with associated dislocation of the distal radioulnar joint

Colles fracturedistal fractureof theradiusin the forearm with dorsal (posterior) displacement of the wrist and hand

Smiths FractureReverse Colles fracturedistal fracture fragment is displaced volarly (ventrally)

Scaphoid fracturePA & oblique viewCommenest # at wristProximal pole may undergo AVN.

Lunate & Perilunate dislocationIn lunate dislocation lunate becomes triangular in AP. Other carpals appear normal. (less common)

Perilunate common except lunate other carpals are displaced dorsally.

Spine FractureWedge compression fractureVertebral end plate often intactDisc spaces maintainedHeight reduced

Pelvic FractureInvolves superior & inferior pubic ramiU/L or B/LSymphysis pubis may be dislocatedLook for any SI jont dislocationUrethra or bladder injuryVascular injury pelvic hematoma

Hip InjuryFemoral head fracture:SubcapitalMid cervicalBasal cervicalPertrochantericSubtrochantericAcetabular fractureSymphysis pubis dislocation

Hip Dislocation:Posterior dislocationAnterior dislocationCentral dislocation

Femoral shaft fractureMid shaft commonSupracondylar region with intracondylar extensionTranscondylar fracture

Patellar fractureFracture: Simple(horizontal) Communited(vertical)Dislocation lateralView- Knee AP/Lateral/Skyline Vertical # seen well with Skyline view

Knee injuryMRI indicated to study the integrity of cruciate & collateral ligaments, hyaline cartilage menisci capsule any marrow edemaUseful when plain x rays are non contributory but patient has pain during locking and unlocking movements

Ankle injuryBoth malleolar fractureFracture tarsal bones especially talus and calcaneum.Any H/O fall from a height look for calcaneal fracture

Head injuryClinical examination is importantRule out cervical spine injury while turning the pt for lateral skullViews: 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 viewTranslateral view is taken for cervical spine injury.Taken without turning the patient

Contd..C1 arch fracture unilateral or bilateralJefferson fracture

C2 fracture odontoid process , fracture bodyFracture of pedicles/lamina Hangmans fractureClay shovellers fracture - # of lower C spine spinous processVertical stableHorizontal unstable

Contd..Jefferson fracture

Hangmans fracture

Clay shovellers fracture

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.

Skull Fracture on Plain x rayMore lucent than vascular markingLinear, Doesnt branchSimple or depressedPneumocephaly occur in asso. with sinus injuryMastoid fracturePenetrating InjuryPlain CT of head is advisedView in brain & bone window setting

Intracranial bleedExtradural Biconvex, asso with vault #

Intracranial bleedSubdural Semilunar in shapeMidline shift & mass effect.

Intracranial bleedIntracerbral irregular dense collection

Intracranial bleedSubarachnoid between sulci , cistern

Intracranial bleedIntraventricular bleed

Facial bone injuriesLe 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

Zygomatic and mandibular fractureTripod fracture of zygomaMandibular fracture

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