Bone TraumaBone TraumaImaging techniquesImaging techniques

-Plain films-Plain films

-Radionuclide bone scan-Radionuclide bone scan

-CT-CT

-MRI-MRI

Plain FilmsPlain Films

Dx fracture or dislocation.Dx fracture or dislocation. Underlying bone is normal or Underlying bone is normal or

abnormal (path.#)abnormal (path.#) Position of bone ends before & after Position of bone ends before & after

Rx.Rx. Assess healing & complication.Assess healing & complication.

Rule of (two)sRule of (two)s

Two views …& further views; Two views …& further views; oblique…stress views, flex. & exten.oblique…stress views, flex. & exten.

Two sites ……..ring bonesTwo sites ……..ring bones Two sidesTwo sides Two occasions.Two occasions. Two joints.Two joints.

FractureFracture # line usually lucent line, occasionally dense.# line usually lucent line, occasionally dense. A step in the cortex.A step in the cortex. Interruption of the bony trabeculae in impacted #Interruption of the bony trabeculae in impacted # Bulging or bucking of cortex in greenstick #Bulging or bucking of cortex in greenstick # Soft tiss. swelling… a valuable guide.Soft tiss. swelling… a valuable guide. Joint effusion. In knee an & Elbow, effusion often Joint effusion. In knee an & Elbow, effusion often

indicates a #indicates a #

Dislocation:Dislocation: joint surfaces no longer maintain their joint surfaces no longer maintain their normal relationship to each other. normal relationship to each other. May be associated #May be associated #

Radionuclide bone scanRadionuclide bone scan

Increased activity within 2 to 3 days.Increased activity within 2 to 3 days.

Stress #........march fractureStress #........march fracture

CT in bone traumaCT in bone trauma

In complex shape bones; spine, face In complex shape bones; spine, face and hipsand hips

Better assessment of the extent of Better assessment of the extent of soft tissue damage & hematomas soft tissue damage & hematomas and of internal visceral injuries.and of internal visceral injuries.

Exam of severely injured patient Exam of severely injured patient because of less manipulation.because of less manipulation.

MRI in bone traumaMRI in bone trauma

# is seen as a dark line across the # is seen as a dark line across the bright signal of the fat in BM in T1bright signal of the fat in BM in T1

Oedema & bruise in the bone.Oedema & bruise in the bone. Soft tiss. injury such as muscles, Soft tiss. injury such as muscles,

tendons & ligaments.tendons & ligaments.

Specific injuriesSpecific injuries

Stress # due to repeated, often Stress # due to repeated, often minor, trauma occurs in tibia & fibula minor, trauma occurs in tibia & fibula in athletics. Also march # …..in athletics. Also march # …..

A stress # may appear as a sclerotic A stress # may appear as a sclerotic band across the bone and a fracture band across the bone and a fracture line may not necessarily be visible.line may not necessarily be visible.

Insufficiency #Insufficiency #

Results from normal activity or Results from normal activity or minimal trauma in a weakened bone minimal trauma in a weakened bone commonly from osteoporosis or commonly from osteoporosis or ostemalacia e.g. compression #s of ostemalacia e.g. compression #s of the verteb bodies and femoral necks, the verteb bodies and femoral necks, pubic rami & sacrumpubic rami & sacrum

Path. #Path. #

Through an abnormal boneThrough an abnormal bone

May be the presenting feature of May be the presenting feature of both primary and secondary bone both primary and secondary bone tumorstumors

Salter-Harris ClassificationSalter-Harris Classification

I: injury through the epiphyseal plate I: injury through the epiphyseal plate onlyonly

II: # through epiph. plate & metaphysis. II: # through epiph. plate & metaphysis. 70%70%

III: # epiph plate & epiphysis.III: # epiph plate & epiphysis. IV: #epiph plate, epiphysis & IV: #epiph plate, epiphysis &

metaphysis.metaphysis. V : Crush # of epiphyseal plate. <1%V : Crush # of epiphyseal plate. <1%

Growth arrest in IV & VGrowth arrest in IV & V

Non accidental injury (child Non accidental injury (child abuse)abuse) Multiplicity of #s of different ages.Multiplicity of #s of different ages. Metaphyseal #s from twisting & pullingMetaphyseal #s from twisting & pulling Metaphyseal sclerosis due to repeated Metaphyseal sclerosis due to repeated

injury and repairinjury and repair Epiphyseal separation freq. associated Epiphyseal separation freq. associated

with metaphyseal #with metaphyseal # Periosteal reaction due to hemorrhage Periosteal reaction due to hemorrhage

under the periostemunder the periostem CT or US may show subdural hemorrhage CT or US may show subdural hemorrhage

or brain damageor brain damage