Musculoskeletal Radiology of

Fractures
Skull

• Blowout Fracture
Blowout fractures are caused by direct trauma to the globe
which causes an increase in intraorbital pressure and decompression
via fracture of the orbital floor. Radiographically,
fragments may be seen in the maxillary sinus or there may be
opacification of the maxillary sinus with blood. Clinically, there
may be diplopia on upward gaze due to entrapment of the inferior rectus
muscle.
Blowout Fracture

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Mandible Fracture
• Mandible fractures are due to direct trauma. Most are comminuted and
typically involve both sides of the mandible

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Spine Fractures

• Stable injury
• Clay Shoveler’s

The clay-shoveler's fracture is an

oblique fracture of a lower cervical spinous process,
commonly C7.

It results from hyperflexion, commonly from

shoveling snow, although it was originally
named for those who were mining clay.

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Dens Fracture

• Type I
• Type II - unstable
• Type III

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Type I Dens Fracture

Type I: through the tip of the dens: rare

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Type II Dens Fracture

learningradiology.com
Type III Dens Fracture

Type III: extends down into the body of the atlas

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 Hyperextension Tear Drop Fracture
• A stable injury, this fracture results from severe hyperextension and results
in avulsion of the anterior inferior corner of a vertebral body, typically C2.
The teardrop fragment is avulsed and is attached to the anterior
longitudinal ligament.

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Flexion Tear Drop Fracture
• Flexion and compression injury
• Usually MVA
• Anterioinferior aspect of the vertebral body
• Posterior part of vertebral body is retropulsed into canal
• Widened interspinous distances, disk space narrowed
• 70% neurological deficits
• Unstable with complete disruption of
ligaments
• M/C C5
Hangman’s Fracture
• The Hangman's fracture consists of bilateral pedicle or pars fractures
involving the C2 vertebral body (traumatic spondylolisthesis). Associated
with this fracture is anterior subluxation or dislocation of the C2 vertebral
body. It results from a severe extension injury such as from an automobile
accident where the face forcibly strikes the dashboard or from hanging.

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Jefferson Fracture
• A Jefferson fracture consists of a fracture of the C1 ring. This results from an axial
loading injury to the head with compression force to C1 (typically from diving). The
fracture consists of unilateral or bilateral fractures of the anterior and posterior arches
of C1. This is an unstable injury. Other burst type fractures are possible in the spine.
These also result from axial loading injuries (compression) and result in severe
comminution of a vertebral body. Posterior element displacement into the spinal canal
is common.

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 Spondylolysis
Spondylolysis refers to failure of fusion
of the pars interarticularis, most often at
the lower lumbar spine. This is usually a
congenital defect, although it may
occasionally be post-traumatic. The
process may affect one or both sides
of the spine. Oblique radiographs are
best for the detection of this abnormality.

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Compression Fracture
Compression fractures of the spine are
common in elderly and osteoporotic
patients. They result from anterior or
lateral flexion. The typical appearance
is loss of height of the anterior aspect
of the vertebral body with preservation
of the posterior elements and generally
the posterior aspect of the vertebral body.

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 Hill-Sachs Fracture
• The Hill-Sachs fracture results from anterior dislocation of the humeral head
and is located on the posterolateral aspect of the humeral head. 97 % of
shoulder dislocations are anterior in direction. This fracture is produced
when the humeral head strikes the inferior margin of the glenoid.

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 Pathological Fracture - Humerus
Pathologic fractures result from an
underlying abnormality of the bone,
usually either from a primary bone
tumor or from metastatic disease.
However, pathologic fractures may
result from metabolic conditions as
well. A pathologic fracture results
when normal stress is placed onto
abnormal bone.

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 Galeazzi’s Fracture
Also called a reverse Monteggia fracture,
Galeazzi's fracture consists of a fracture
of the radius at the junction of the middle
and distal thirds with distal radioulnar joint
dislocation. This fracture pattern may be
caused by a fall on an outstretched hand
or from a direct trauma to the dorsal
aspect of the wrist. There is a comminuted
fracture of the radius with radioulnar
joint dislocation.

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 Monteggia Fracture-Dislocation
Type 1 characterized by a proximal
ulnar fracture with anterior dislocation
of the radial head.

Type 2 characterized by posterior angulation

of the ulnar fracture site and posterior
dislocation of the radial head.

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Colle’s Fracture
This is a common fracture in
elderly patients, consisting of
a transverse fracture of the
distal radial metaphysis
proximal to the joint with
dorsal displacement of the
distal fragment and volar
dislocation. It results from a
fall on an outstretched hand.
The ulnar styloid is commonly
fractured as well. Another
name is the Pouteau fracture.

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 Smith’s Fracture
Also called a reverse Colle’s fracture,
the Smith fracture is a transverse
fracture of the distal radial metaphysis

with palmar (as opposed to dorsal)

displacement of the distal fracture
fragment. If the fracture is intraarticular,
it is called a reverse Barton fracture.
This fracture results from a backward
fall onto the outstretched hand.

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Torus Fracture
• Also known as a buckle fracture.
• This is a compression fracture of
• a long bone, typically in children.
• This type of fracture usually
• occurs near the metaphysis.
• Both cortical margins are
• affected, but a discreet fracture
• line or trabecular disruption is
• not present. Minimal buckling
• of the cortex is present.

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Greenstick Fracture
The greenstick fracture results from
direct trauma. There is an incomplete
fracture of a long bone (radius or ulna)
with cortical disruption on one side and
deformity on the other, resulting in
bowing of the bone.

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Lunate Dislocation
The lunate dislocation results from a
backwards fall on an outstretched
hand. Here, the capitate is aligned
with the radius on the lateral view
with volar displacement of the lunate.
This is the most severe injury on the
perilunate continuum with the greatest
number of intercarpal ligaments
disrupted.

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Scaphoid Fracture
Scaphoid fractures are the
most common carpal
fractures, resulting from
a fall on an outstretched
hand. 70 % of these occur
at the waist, 20 % at the
proximal pole, and 10 %
at the distal pole. Blood
supply for the proximal pole
enters at the waist. If this
blood supply is interrupted
due to fracture, the proximal
pole is at risk for avascular
necrosis. Special scaphoid
views with the hand in ulnar
deviation may be needed to
detect these fractures.

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 Boxer’s Fracture
So named because of the common
occurrence in prizefighters, the
fracture involves the distal
metacarpal neck, usually of digit
five. The distal fracture fragment
is volarly angulated and may be
externally rotated. The injury
results from direct trauma to the
hand.

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Bennett Fracture
The Bennett fracture is an intraarticular
fracture of the base of the first
metacarpal. The fracture must involve
the first carpometacarpal joint to be
called a Bennett fracture. The action
of the abductor pollicis longus causes
distraction of the fracture fragments.
The volar base of the first metacarpal
stays with the trapezium.

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 Gamekeeper’s Thumb
This condition results when there is partial or total disruption of the ulnar collateral
ligament at the metacarpophalangeal joint of the thumb. It is also often associated
with a fracture at the base of the proximal phalanx. This is also called a skier's thumb
or ski pole fracture.
The original condition was
described in those gamekeepers
who used their hands to kill rabbits.
Special stress views may be
required to see this dislocation ,
if clinically suspected.

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Nail Bed Fracture
• Nail bed injuries are the result of direct trauma. The nail itself may be
avulsed as part of the injury. The usual mechanism of injury involves
crushing. Care must be taken to exclude foreign bodies. This injuries are at
risk for osteomyelitis if not cared for properly.

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 Avulsion Fracture - Pelvis
• Avulsion fractures of the pelvis may affect the anterior superior iliac spine, the
anterior inferior iliac spine, or the ischial tuberosity. The sartoris muscle originates at
the anterior superior iliac spine. The rectus femoris muscle originates at the
anterior inferior iliac spine. The hamstring muscles originate at the ischial
tuberosities. The osseous structures are generally avulsed in young, athletic
individuals. These fractures are also known as sprinter fractures.

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Straddle Fracture
• Bilateral superior and inferior rami fractures are known as a straddle injury.
This was originally described in horseback riders and is the result of direct
trauma. Urethral injury is a known complication.

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Acetabular Fracture
Acetabular fractures are usually
the result of major direct
trauma to the pelvis and
femur. The acetabulum
may be classified into the
anterior (iliopubic) column,
the posterior (ilioischial)
column, and the dome
of the acetabulum.
Posterior wall fracture is
usually the result of
posterior hip dislocation.

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 Dashboard Fracture
The name dashboard fracture
refers to a fracture which
typically occurs in automobile
accidents with impaction of
the knee upon the
dashboard. This results
in fracture of the posterior
rim of the acetabulum by
the femoral head.. This
type of fracture is associated
with patellar fractures and
posterior cruciate ligament
fractures.

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 Intertrochanteric Fracture
Extra capsular fractures which
involve the femoral trochanters
include intertrochanteric and
subtrochanteric fractures. The
intertrochanteric fracture is by
far the most common and is
classified according to the status
of the lesser and greater
trochanter. If neither of these
is fractured, the fracture is
termed a two part fracture. If
either the lesser or greater is
fractured, then the fracture
consists of three parts. If both
are fractured, the fracture is
termed a four part fracture.
These fractures generally result from
a fall and typically occur in
postmenopausal women.

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 Femoral Shaft Fracture
• Much force is required to produce fractures
• of the shaft of the femur. They tend to be
• displaced due to muscle action upon the
• fracture fragments. The superficial femoral
• artery may be injured with complex
• fractures of the distal femur.

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 Tillaux Fracture
The tillaux fracture consists of avulsion of
the anterior lateral margin of the distal
tibia. It is caused by a twisting injury.
The anterior tibiofibular ligament
avulses a small portion of the tibia.

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 Charcot Joint
Charcot joint or neuropathic joint
typically affects the ankle and tarsal
joints due to diabetes. Tabes causes
this phenomenon in the knees
while syringomyelia leads to Charcot
changes at the shoulder. This
condition is characterized by the
"six D's" of: (1) destruction, (2)
density (increased), (3)
disorganization, (4) dislocation,
(5) distension (fluid), (6) debris.
The typical appearance is that of
severe hypertrophic changes and
sclerosis due to ischemic necrosis.

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Jones Fracture
• Fractures of the fifth metatarsal of the foot are surprisingly
controversial among radiologists, particularly concerning proximal
metatarsal fractures. Some term these fractures Jones fractures,
others dancers fractures, while others simply term them proximal
metatarsal fractures. According to Orthopedic Radiology (Adam
Greenspan, 3rd edition), a "true Jones" fracture occurs one inch
distal to the base of the fifth metatarsal. It is not due to peroneus
brevis tendon avulsion but rather a twisting inversion injury to the
foot. Greenspan states that more proximal injuries are frequently
misinterpreted as Jones fractures but really are avulsion fractures
by the peroneus brevis tendon. These latter fractures heal quickly,
while more distal fractures may undergo fibrous union only.

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March Fracture
The march fracture is a type of stress
fracture. It occurs in one of the
metatarsals. The name refers to
military recruits who developed
stress fractures after long marches.

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Freiberg’s Infarction
This is a form of avascular necrosis. It is
idiopathic (possibly post-traumatic).
The process typically affects the second
metatarsal head and is unilateral.

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References

Yokum TR, Rowe LJ. Essentials of Skeletal

Radiology. Baltimore: Williams &
Wilkins, 1996: 373–545.
MRI site (shoulder, knee)

• http://www.info-radiologie.ch/shoulder-
mri.php
Plain Film Normal Anatomy and
Fracture Sites
• http://www.info-radiologie.ch
• http://www.med-
ed.virginia.edu/courses/rad/cspine/
• http://www.med-
ed.virginia.edu/courses/rad/ext/
• http://www.gentili.net/fracturemain1.asp#