presentation2. radiological film reading for fractures

Dr/ ABD ALLAH NAZEER. MD.

Radiological Film Reading of Fracture.

Colle's fracture:Transverse and partially comminuted fracture of the distal radiusDistal component dorsally displaced and angulatedAssociated transverse fracture of the ulnar styloid

Salter-Harris fracture - APThe AP view shows the displaced articular surface of the distal radial epiphysis en-faceA fracture of the ulnar styloid is revealed on this view.

Salter-Harris fracture - Lateral'Salter-Harris' injuries involve the growth plate of the unfused skeleton, Here the epiphysis of the distal radiusis markedly displaced dorsally

Avulsion fracture example - fingerA bone fragment has been avulsed from the distal phalanx due to hyperflexion at the distal interphalangeal joint (DIPJ)The tendon remains intact.

Pathological fracture example - Multiple myelomaThere is a transverse fracture of the humerus with anterior displacement and angulationThe bone appears 'moth-eaten'

Pathological fracture in benign bone lesionA fracture line passes through a well defined benign bone lesion - in this case a non-ossifying fibroma.

Dislocation example - FingerMiddle phalanx of the little finger dislocated dorsally and laterally from the proximal phalanx.

Fracture-dislocation example – Ankle.Highly comminuted fracture of the distal fibulaTalus dislocated from the tibia - these bones are no longer aligned at the ankle joint (white lines not parallel -compare with normal)The combined injuries are termed 'fracture-dislocation'

Unfused apophysis example - 5th metatarsalThe normal apophysis runs lengthways along the boneThe fracture runs across the boneNote the corticated and rounded edge of the apophysis compared with the sharpand non-corticated edge of the fracture fragment

Fracture mimic example - Shoulder growth platesOblique distal clavicle shaft fracture with inferior displacementWidening of the acromio-clavicular joint (arrowheads) indicating dislocationLines passing through the acromion and proximal humerus are growth plates - not fractures.

Elbow X-ray - Supracondylar fractureVisible fracture of the distal humerusA joint effusion (hemoarthrosis) raises the fat pads away from the humerusThe powerful triceps muscle posteriorly displaces the ulna - taking the capitulum (C) with itThe capitulum therefore lies well behind the anterior humerus lineAt least one third of the capitulum should lie in front of the anterior humerus line

Monteggia fracture-dislocation - LateralA 'Monteggia' injury comprises a fracture of the ulnar shaft with dislocation of the radial head at the elbowThe radiocapitellar line should pass through the middle of the capitulum of the humerus

Galeazzi fracture-dislocation - APA 'Galeazzi' injury is a fracture of the radial shaft with dislocation of the ulna from its articulation with the radius at the distal radio-ulnar jointThe dislocation is not appreciated on this AP view The lateral view shows dorsal displacement of the distal ulna.

A greenstick injury comprises a bend in the bone on one side and a visible break in the bone cortex on the other side.

Anterior shoulder dislocation - AP viewHumeral head and glenoid surfaces are not alignedThe humeral head lies below the coracoid

Anterior shoulder dislocation - Y viewThe humeral head lies anterior to the glenoid and inferior to the coracoid process.

Anterior shoulder dislocation - Axial viewThe humeral head surface is no longer aligned with the glenoidThe humeral head lies anterior to the glenoid.

Posterior shoulder dislocation - AP viewThe glenohumeral joint is widenedCortical irregularity of the humeral head indicates an impaction fractureFollowing posterior dislocation the humerus is held in internal rotation and the contour of the humeral head is said to resemble a 'light bulb’

Posterior shoulder dislocation - Y viewThe humeral head (blue line) no longer overlies the glenoid (red line)The correct position of the humeral head is shown (green line)

Scapula fractureDisplaced fracture of the scapula lateral borderFracture line passing through the scapula body.

Neck of femur - Subcapital fracture - APA fracture immediately below the femoral head separates it from the femoral neckThere is complete displacement of the neck from the head

Neck of femur - Subcapital fracture - LateralNeck of femur fractures are often more difficult to see on the lateral imageLook for a step in the cortical edge or overlapping bone.

Face - Tripod fracture - OM viewA 'tripod' fracture has 4 visible components - not always all visible1 - Orbital floor fracture2 - Fracture of the lateral wall of the maxillary antrum3 - Zygomatic arch fracture4 - Widening of the zygomatico-frontal sutureIncreased density of the maxillary antrum is due to it filling with blood.

Face - Blowout fracture - OM viewBlowout fractures are caused by increased pressure in the orbit -the orbit gives way at its weakest point, which is the orbital floorThe classic 'teardrop' sign is due to herniation of soft tissue into the maxillary antrumThe air/fluid level in the maxillary antrum is due to the presence of blood.

Face - Blowout fracture -OM 30 viewHere is another example of a blowout fracture.

Mandibular Views

Mandible - Fracture - OPG(Same case as image below)This image shows an irregular fracture line passing across the mandible on the leftCareful inspection of the mandibular outline shows a second fracture at the mental symphysis

C-spine - C2/Axis -Normal v fracture

The C2 (axis) lateral masses form a ring appearance when viewed on a lateral imageIf this ring is incomplete then it may indicate a fracture.

C-spine - Extension teardrop + second fractureTeardrop fractureIf you see one fracture - don't forget to look for another

C-spine - C5 and C7 vertebral body fracturesFractures are seen at both C5 and C7There is loss of alignment at several levels.

Thank You.