Skeletal Trauma

Dr G.Jayaraman

Introduction
Proper history &

thorough
examination, do not
ignore patients
symptoms
Trauma imaging
constitute major
bulk of the of work
Diagnosis starts
with plain x ray
-most cases
At least 2views

Radiological examination permits assessment of

Presence of Fracture
Type & position of fracture
Simple, comminuted, segmental, etc
Asso. Joint injury
Epiphyseal injury
Asso. Soft tissue involvement
Age & healing of fracture

COMPLICATION OF
FRACTURE
Delayed union
Nonunion
Malunion
AVN
Traumatic subperiosteal ossification
Myositis osificans
Sudecks osteodystrophy

Delayed Union

Nonunion

Malunion

AVN

Traumatic subperiosteal reaction

Myositis ossificans

Sudecks osteodystrophy

TRAUMATIC LESION IN CHILDREN

Fracture of lower arm & forearm- more

common than adults

Greenstick fracture common
Heals fast
Remodeling effects leads to good alignment
without deformity
Compressed 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 rotation

Age 10 to 14
Obese person
H/o fracture may be present or not
Early diagnosis is important
Radiological Signs
Blurring of metaphysis
Dislocation of femoral head from

acetabulum
Growth plate widening
Prolongated superior neck line
Reduction of epiphyseal height

Non Accidental Injury

Battered child Syndrome
Multiple fracture at
different stages of
healing
Marginal metaphyseal
fracture with or without
epiphyseal injury
Exuberant subperiosteal
ossification
Such injures results`
from vigorous shaking of
the child

Type of Fractures
Traumatic
Pathological
Stress
Fatigue

Stress Fracture
Tibial shift common
Neck of the metatarsals

March fracture
Spondylolisthesis results
from stress fracture of one
& both neural arch
through the weakened
pars interarticulars

Regional Skeletal Trauma

Chest injury
Rib fracture
Hemothorax(Pleural
effusion)
Hemopneumothorax
Subcutaneous
emphysema
Lung
contusion/laceration

Regional Skeletal Trauma

Clavicular Fracture
Common
Middle/ Lateral shaft common
May asso. with Acromio clavicular joint dislocation
Deformed clavicle with focal sclerosis Old fracture
Sternoclavicular joint dislocation asso with vascular
injury

Shoulder joint
Surgical

neck fracture on
fall on outstretched hand
Anterior dislocation
common
Posterior 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 defect

V

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 rotated
Hence 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

elbow
Capitellum 1yr
Radial head 5yrs
Medial epicondyle 7yrs
Trochlea -10yrs
Lateral epicondyle 11yrs
Olecranon 11yrs

Can Radiology make trauma less

obscure
90% of elbow dislocation are posterior &

lateral displaced
Myositis ossificans common

Monteggia fracture

dislocation

Fracture upper 1/3

of ulna with
dislocated superior
radio ulnar joint.

Galeazzi fracture

Lower 1/3rd radial shaft

fracture with
associated dislocation
of the distal radioulnar
joint

Colles fracture

distal fractureof theradiusin the forearm with

dorsal (posterior) displacement of the wrist and hand

Smiths Fracture
Reverse Colles
fracture
distal fracture
fragment is displaced
volarly (ventrally)

Scaphoid fracture
PA & oblique view
Commenest # at
wrist
Proximal pole
may undergo
AVN.

Lunate & Perilunate dislocation

In lunate dislocation lunate becomes triangular in AP.

Other carpals appear normal. (less common)

Perilunate common except lunate other carpals are

displaced dorsally.

Spine Fracture
Wedge compression

fracture
Vertebral end plate
often intact
Disc spaces
maintained
Height reduced

Pelvic Fracture
Involves superior &

inferior pubic rami

U/L or B/L
Symphysis pubis may be
dislocated
Look for any SI jont
dislocation
Urethra or bladder injury
Vascular injury pelvic
hematoma

Hip Injury
Femoral head

fracture:
Subcapital
Mid cervical
Basal cervical
Pertrochanteric
Subtrochanteric
Acetabular fracture
Symphysis pubis
dislocation

Hip Dislocation:
Posterior dislocation
Anterior dislocation
Central dislocation

Femoral shaft

fracture
Mid shaft
common
Supracondylar
region with
intracondylar
extension
Transcondylar
fracture

Patellar fracture
Fracture:
Simple(horizontal)
Communited(vertical)
Dislocation lateral
View- Knee
AP/Lateral/Skyline
Vertical # seen well with
Skyline view

Knee injury
MRI

indicated to study the integrity of

cruciate & collateral ligaments, hyaline
cartilage menisci capsule any marrow
edema
Useful when plain x rays are non
contributory but patient has pain
during locking and unlocking
movements

Ankle injury
Both malleolar

fracture
Fracture tarsal bones
especially talus and
calcaneum.
Any H/O fall from a
height look for
calcaneal fracture

Head injury
Clinical examination is important
Rule out cervical spine injury while turning the

pt for lateral skull

Views: 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 view
Translateral view is taken for cervical spine
injury.
Taken without turning the patient

Contd..
C1 arch fracture unilateral or bilateral
Jefferson fracture
C2 fracture odontoid process , fracture body
Fracture of pedicles/lamina Hangmans

fracture
Clay shovellers fracture - # of lower C spine
spinous process
Vertical stable
Horizontal 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 ray

More lucent than vascular marking
Linear, Doesnt branch
Simple or depressed
Pneumocephaly occur in asso. with sinus

injury
Mastoid fracture
Penetrating Injury
Plain CT of head is advised
View in brain & bone window setting

Intracranial bleed
Extradural

Biconvex, asso with

vault #

Intracranial bleed
Subdural Semilunar in

shape
Midline shift & mass
effect.

Intracranial bleed
Intracerbral

irregular dense
collection

Intracranial bleed
Subarachnoid between

sulci , cistern

Intracranial bleed
Intraventricular bleed

Facial bone injuries

Le 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 fracture

Tripod fracture of zygoma
Mandibular fracture

THAN
K
YOU!!