bone injury - 2. lékařská fakulta univerzity karlovy · 2014-12-09 · bone injury. x rays in 2...

Bone injury

X rays in 2 perpendicular projections!

Colles fracture

Fracture dislocation

1. ad latus (in short axis, to side)

2. ad longitudinem (in long axis)

cum contractione

cum distractione

3. ad axim (axis)

4.ad periferiam (rotation)

1.dislocation ad latus

• in short axis, to side

• most common

• degree of dislocation

(portion of bone width)

2. dislocation ad longitudinem

• in lenght (longitudinal

axis)

cum contractione

(interfragment out of bone

axis or other typey of

dislocation )

cum distractione (risk of

pseudoarticulation)

clavicular fracture

3. dislokace ad axim

• Angulation (in axis)

Colles fracture of distal

metaphysis of radius

4.ad periferiam

• Rotation of fragments

supracondylic fr. humerus

Healing of fracture

• Endostal callus

(filling of hole

between fragments)

• Periostal callus

(overbridging of fr. line

remodelation in future)

Callus

• endostal

undislocated fracture

• periostal

dislocated fracture

Neonatal fracture

• clavicle

• trauma during delivery

Children fractures

1) subperiostal

2) epiphyseolysis

3) ping-pong ball fr. skull

Subperiostal (green-stick)

•most common

•elastic periost

•follow contours of bone

Epiphyseolysis

Salter-Harris classification

1) through epiphyseal growth plate

2) 1+metaphysis

3) 1+epiphysis

4) 1+ meta + epifýzou

5) comminutive fr.

of epiphysis

Skull fracture (CT better than X-ray)

dif. dg. fracture straight/lomená, narrow, sharp margins

suture meander shape, sclerotic margins

vessel coiled, wider, ill defined margins

Blow out fracture

• fracture of bottom of orbit

• dense drop like opacity

bellow roof of maxillary

sinus

• protrusion of m. rectus inf.

incl. fatty tissue into

maxillary sinus

• CT

Growing skull fracture

• dura matter gets into

fracture line

• fr. line is not healing

but decalcination around

• osteolytic defect

Vertebral fractures

• Vertebral columns

1. anterior (ant. half of body)

2. middle (post.half of body)

3. posterior (spinal canal,

spinal processes)

unstable 2 or more columns

propagation into spinal canal

Rib fractures

• usually dislocated

• risk of pneumothorax

• fractures of different

age (different degree

of healing)

• susp. Non accidental

trauma

Acetabular fracture

• anterior edge

• roof

• posterior edge

(most common,

drivers in car)

risk of hip luxation

Pathologic fracture

• ill formed bone, pathologically

changed bone structure

• osteoporosis (female menopause)

• metastasis

• osteogenesis imperfecta

Stress (fatigue, march) fracture

• most common II. metatars,

proximal tibia

• without trauma, long

lasting overload

x growth lines

Stress fracture MRI

• bone marrow edema