Scapula

Subtle and Occult Fractures Dr M Mariathas and Dr N Purohit

Department of Radiology, University Hospital Southampton

Distal Radius

Medial Clavicle

Scaphoid

Triquetral Radial Head

Pelvic – Pubic Rami and Acetabulum

Medial Patella

Anterior Calcaneal Process

Dorsal Capsular – Talus and Navicular

Medial Tibial Plateau Posterior Tibial Plateau Lateral Talar Dome

Medial Malleolus

Top Tips 1. Satisfaction of search – in cases of

multiple fractures, always search

hard for the additonal subtle and

hidden fracture.

2. Soft tissue swelling and displaced

fat pads – use these to help guide

you to a subtle fracture.

3. Understanding the mechanism of

injury – and by looking for the

frequently associated fractures.

4. Overlying structures – pay extra

attention to areas where multiple

bony surfaces overlap as fractures

can be easily missed here.

5. Ligamentous/tendinous insertion

points – avulsion injuries can often

be subtle and small.

6. Metalwork – pay extra-attention to

the surrounding bone for subtle peri-

prosthetic fractures.

7. Building ‘Review Areas’ – this can

be done by using the above tips and

knowledge of frequently missed

subtle fractures such as the ones

shown on this poster.