Radiology

Skeletal Trauma
Dr B.B.Gosai
July 2013
 TRAUMA X-rays
 The process of reading a bone radiograph should be an
active one, looking at cortical margins and bone
alignment and looking for typical fracture patterns.
Therefore, the habit of looking for abnormalities is more
valuable than a passive look at the x-ray.
 Most radiographic exams of the extremities are normal.
 Soft tissue abnormalities are valuable indirect signs of
injury which can lead to diagnosis when osseous injuries
are not apparent, especially in the elbow. Look at the
soft tissues!
 Obtain at least two orthogonal projections of an injured
area. Additional views should be pursued when there are
uncertainties or in areas with complex anatomy.
 TRAUMA X-rays
 The human skeleton contains 206 bones. All of these bones can be
classified into five groups based on shape. Below are the definitions
and a few examples of the five bone classifications.
 Long bones - bones of the extremities that have a length greater
than the width (e.g., femur).
 Short bones - bones of the wrist, ankle and foot that are cuboidal in
shape (e.g., carpals and tarsals).
 Flat bones - diploic bones of the vault of the skull (e.g., parietal and
frontal) and the iliac bone.
 Sesamoid bones - small, rounded bones located in tendons (e.g.,
metatarsophalangeal joint of the great toe).
 Irregular bones - as the name implies, these bones have irregular
shapes (e.g., vertebrae, sacrum, coccyx).
 Review the parts of a long bone in a child with the open epiphyses.
In an adult, the epiphyses would either be closed and not seen or
evidenced by a sclerotic scar.
Types of Fractures
 Here are the definitions for the
fracture patterns shown above
 Simple Transverse Fracture - a fracture in which the fracture line is perpendicular to
the long axis of the bone and that results in two fracture fragments.
 Oblique Fracture - a fracture in which the fracture line is at an oblique angle to the
long axis of the bone.
 Spiral Fracture - a severe form of oblique fracture in which the fracture plane rotates
along the long axis of the bone. These fractures occur secondary to rotational force.
 Longitudinal Fracture - a fracture in which the fracture line runs nearly parallel to the
long axis of the bone. A longitudinal fracture can be considered a long oblique
fracture.
 Comminuted Fracture - a fracture that results in more than two fracture fragments.
 Impacted Fracture - a fracture in which the end of the bone is driven into the
contiguous metaphyseal region without displacement. This type of fracture occurs
secondary to axial or compressive force.
 Depressed Fracture - a form of an impacted fracture that involves the articular
surface of a bone and results in joint incongruity.
 Avulsion Fracture - (not pictured above) a fracture in which the tendon is pulled away
from the bone, carrying a bone fragment with it.
 Fractures are also described in
terms of alignment
 Fractures are also described in terms of alignment. Below are the definitions of the
various types of alignment that result from the fracture patterns just described. The
different alignments can also be seen in the above images.
 Varus vs Valgus - varus and valgus deformities are both angulations, which are
described according to the direction of the apex or the direction in which the distal
fragment is angled. In varus deformity, there is apex angulation away from the
midline and the distal structure moves medially (i.e., bowleggedness). In valgus
deformity, there is apex angulation toward the midline and the distal structure moves
laterally (i.e., knock-kneed).
 Internal vs External Rotation - rotation is described according to the direction of
movement of the distal fragment.
 Bayonet Apposition - overlap of fracture fragments.
 Distraction - longitudinal separation of fracture fragments.
 Medial vs Lateral Displacement - occurs when the cortices are out of alignment.
Displacements are described according to the direction of movement of the distal
fragment relative to the proximal fragment.
 When describing a fracture, one should describe the location, pattern and alignment.
Remember, the alignment is described for the distal fragment relative to the proximal,
with the patient in anatomical position.
When long bones fracture, there are specific
terms for the different patterns.
 Child X-ray show developing bones and
hence should not be mistaken for fracture or
displacement
AP view with shoulder in
external rotation-Normal
 Bony components of the shoulder
include the humerus, scapula and
clavicle, which form the
glenohumeral and
acromioclavicular (AC) joints.
 The anatomical neck of the
humerus and rim of the glenoid
cavity serve as attachment sites
for the joint capsule.
 Radiographic examination of the
shoulder typically includes AP
views of the shoulder with the
humerus in internal and external
rotation. Certain shoulder injuries
require additional views such as
axillary and/or transscapular "Y"
views for proper diagnosis.
Normal Shoulder-AP view
AP view with shoulder in
internal rotation-Normal
Fracture Clavicle-Common site: junction of
Medical two third and lateral one third
Scapular fractures are the most difficult fracture to diagnose in the
shoulder region. Fractures can sometimes be seen on AP view
Common site of Fracture of
Humerus

Surgical Neck
Fracture
Shoulder Dislocation
 Normal Elbow-AP View
Structures Seen:
1. Humerus-Lower end of
Shaft
1
2. Medial Epicondyle
3. Lateral Epicondyle
4. Olecranon Process
5. Head of Radius
2
4
3

5
 Normal Elbow-Lateral View
Structures Seen:
1. Humerus-Lower end of Shaft
2. End on View of Epicondyles
(Superimposed on each other) 1
3. Olecranon Process
4. Coronoid Process
5. Head of Radius
6. Radius-Shaft 5 2
6 4
7. Ulna-Shaft 3
7
 Supracondylar fracture.
In this plate even normal unfused epiphysis is also
seen at label 1

1
Radial Head fracture
Forearm-Normal
Normal Hand-AP View
Normal-Wrist Joint-AP View
Normal Hand
Colles fracture at lower end of
Radius
Colle’s Fracture-Lower end of Radius Dinner fork deformity
Scaphoid Fracture
Bennet’s fracture: Fracture of
Base of first metacarpal
Boxer’s fracture of fifth
metacarpal
Normal Pelvis-AP View
Important Radiological lines in
AP view of Pelvis
 1

2
3
4

Normal Hip on one side with 1. Hip bone, 2. Head of femur, 3. Neck of femur,
4. Greater trochanter, 5. Lesser trochanter
Hip arthritis on another side with reduction of joint space between femur and
hip bone.
 Fracture neck femur

Shenton’s line
(Normally make a arch
between margin of
Fracture neck femur: obturator foramen and
Shenton’s line is lower border of neck
disrupted of femur)
Most common site of fracture of
femur: Fracture Neck Femur
Normal Knee Joint
Patellar fracture
Patellar fracture
Knee Joint
Tibial Condyler fracture
Normal Foot-Lateral View
Normal Foot:
AP View
Normal Foot
Tibia fibula fracture
First metatarsal fracture
Fracture – dislocation of Right
foot bones
 Ankle Swelling Following
ligamental tear but no fracture
 Thoracic Vertebra compression

Arrow shows
compression of
thoracic vertebra
Multiple Rib Fractures
….Thanks….