4. • Multislice CT Scan
less time consuming and offer good
assessment of bones in 2d and 3d
manner
Give volume of information
• MRI
mod of choice for inj of and around
joints
soft tissue detail
6. – CLOSED #=== covered with skin
– OPEN #===== obvious protrusion of bone
fragments beyond soft tissue margins
absence of bone pieces
gross soft tissue disruption
extending to bone surface
subcutaneous gas
foreign material within the #
7.
8. • SINGLE # LINE
• Transverse
• Oblique
• Spiral
• MORE THAN 1 # LINE
• Comminuted #-----contains the butterfly
fragment
12. THREE TYPES
• Plastic #---bending or acute angulation of
bone with no cortical disruption
• Torus or buckle #---# of cortex on
compressive side of bone while the cortex on
tension side remains intact
• Greenstick #----converse of torus #
13.
14. AP (A, C) and lateral (B, D) radiographs of the right forearm demonstrate a buckle fracture
(arrows) of the distal radial metaphysis without significant angulation. Buckle fractures (or
torus fractures) are an impaction type of fracture identified by a focal widening (or outward
buckling) of the cortex
15.
16. • SEGMENTAL #
• segment of bone is isolated by #s at
each end
17.
18. APPOSITION
• The position of major fragments with respect
to each other
DISTRACTION
• Non apposed fragments and when the
displacement is along the long axis
19.
20. • Description is according to the
direction of displacement of the
distal fragment relative to the
proximal
21. IMPACTION
• When bone fragments are driven into each
other
ABNORMALITY OF ROTATION
• Of the distal fragment
• Both ends of the same bone should be
checked in the same film
22. • ANGULATION
• Direction of the apex of the angle at the #
site
• Varus angulation --angulation of distal
fragment towards the midline
• Valgus angulation-- angulation of distal
fragment away from the midline
23.
24. CLUES TO #
• Joint effusion / hemarthrosis---#
around a joint----e.g. elbow
• Fat-Fluid level(lipohemarthrosis)-
--knee joint #
25.
26. Paravertebral soft tissue shadowing
(DD PV abscess) due to hemorrhage
in thoracic spine #
Soft tissue swelling in retropharyngeal
spacecervical spine trauma
27.
28. Delayed union
• Poor apposition or inadequate stabilization
• Vit C Deficiency
• Infection
• Age—decreased osteoblastic activity
• Underlying skeletal pathology
29. Non union
• Idiopathic (tibia)
• Poor stabilization
• Infection
• Pathological #
• Massive initial trauma
30. Malunion
• Healing in unsatisfactory anatomical position
• Excessive fragment overlap ----shortening
• Unsatisfactory angulation
• Displacement
31.
32. Dislocation
• Complete loss of normal articular contact btw
the bones comprising the joint
Subluxation
• Partial loss of articular contact
Diastasis
• Separation of fibrous joints—SI , pubic
symphysis
33.
34.
35. Avulsions ----indicator of ligamentous
injury
• Base of proximal fragment of the thumb
• Avulsion of medial lateral maleoli
36.
37. STRESS #s
• Chronic repetitive insufficient forces
• Sites are characteristic
• March # of 2nd and 3rd MT heads
• # of proximal fibula in paratroopers
38. NM---increase activity before radiographic
signs
RADIOGRAPH---sign depends upon stage of
healing e.g lucent line to new bone formation
39. Bilateral stress fracture of the distal fibula:
Initial radiographs and Bone scintigraphy at 2
weeks follow up.
40. Pathological #
• In bones weakened by underlying disease
• E.g. osteoporosis , osteomalacia , bone
tumors
41.
42. Post traumatic AVN
• Femoral neck
• Proximal pole of scaphoid
• Necrotic bone is denser
• Disuse cause surrounding osteopenia
43. Drillers disease / vibration
syndrome
• Use of vibrating machines 5-10 yrs usage
• Degenerative cysts in bones of hand and wrist
44. Post traumatic myositis ossificans
• Ossification of hematoma or periosteal
elements which are displaced into the soft
tissue.
• Commonest site is thigh
• DD---Parosteal osteosarcoma
• Radiograph
• MRI
• Biopsy
45. Post-traumatic myositis ossificans. A well-defined bone density arises from the cortex of the
distal femur and extends into the soft tissues. There was a history of blunt trauma, but even so,
this lesion needs to be differentiated from parosteal osteosarcoma.
46. Compartment syndrome
• In areas of the limbs surrounded by rigid
osseous and fascial planes
• Skeletal trauma—hemorrhage / edema---
rising pressure
• Progressive ischemia -----necrosis
47. Vascular injury
• Penetrating trauma / bone fragments
• Supracondylar #brachial artery
• Knee 3 / dislocationPopliteal artery
• Pelvic ring #branches of internal iliac artery
• Spiral CT –superior to angiography
48. Traumatic avulsion of the right superior gluteal artery (arrow) from pelvic trauma. Bleeding from
branches of the internal iliac artery is also seen (open arrows). Marked diastasis of the right
sacroiliac joint has occurred.
49. Post traumatic reflex dystrophy / reflex
sympathetic dystrophy / Sudecks atrophy
• Injury to limb—intense pain and swelling—
severe disuse osteoporosis
50. Sudeck's atrophy: there was minor trauma to the forearm some weeks earlier. Note gross
osteoporosis of the bones of the hand, wrist and forearm, most marked at the bone ends, but
also causing cortical 'thinning' and resorption
51. Ionizing radiation
• Osteonecrosis at the site of insult
• Patchy sclerosis with spontaneous #
• secondary malignant degeneration to
osteosarcoma after 5 yrs or so
54. Caissons disease
• In deep sea divers and tunnel workers
• Poor decompression----nitrogen bubbles in
blood----capillary blockage
• Avascular necrosis
• Irregular bone densities usually in long bones
• Medullary infarctions
• NM and MRI detect changes earlier
55. Avascular necrosis of the hips. Note mixed sclerosis and lucency of the femoral heads,
with collapse of the weight-bearing surface but maintenance of the joint spaces,
indicating intact articular cartilage.