MSK Trauma

Prof.Dr.Hesham Kotb.Professor of Radiodiagnosis, Alex. University.

Osseous Trauma1) Acute Osseous Trauma:

1- Complete Fractures.

2- Incomplete Fractures

3- Radiologically Occult Fractures:

a) Bone contusions

b) Avulsion Fractures.

2) Chronic Osseous Trauma: a) Insufficiency Fractures.

b) Fatigue Fractures.

Radiologically Occult FracturesImaging Modalities:

1) Conventional Radiography: Mostly negative in many acute and chronic osseous injuries ( Occult injuries)ز

2) Radioisotope Scanning : It has Limitations - Can be falsely negative foe 24-72 hours after injury. - Positive scan is non-specific. - Examination requires 4-6 hours , so delay diagnosis.3) MRI: is highly sensitive. A normal MRI excludes the presence

of an osseous injury.• Linear low signal T1 with low signal edema.• High signal (edema) T2 with linear low signal (fracture line)

Acute Osseous Trauma

A) Impaction Injuries:

1- Contusion: bone contusion or bruises.

STIR or fat Sat T2 == focal areas of increased signal- easily missed on non-fat Sat spin echo T2 as edema and surrounding fat display similar intensities.

• Sites: ACL tear –Patellar Dislocation

Acute Osseous Trauma

• 2- Avulsion Injuries: Occur when excessive tensile forces result in a piece of bone or cartilage being pulled away from the host bone by ligament , tendon or capsular structures.

• Common sites:• Knee , femur , humerus , elbow ,Ankle & Foot.

Chronic Osseous Trauma: • Fatigue fractures –abnormal stress

across normal bone.• Insufficiency fractures—normal stress

across abnormal bone. - Femoral neck - Sacrum - Supraacetabular - Pubic bones, superior and inferior

pubic rami

Recognizing Fractures(And describing them)

A disruption in all or part of the cortex of a bone.

• All = Complete.

• Part = Incomplete.

Incomplete Fractures

Greenstick- Facture through one cortex

Buckled – Fracture with buckling of the cortex.

Description of Fractures

By direction of fractures line. By the relationship of the fragments. By the number of the fragments. By communication with the atmosphere. Age of fracture (recent-healing- healed ) Type of union ( normally aligned-

malaligned).

Description of Fractures

By direction of fractures line.

= Transverse.

= Oblique.

= Longitudinal.

= Spiral

Description of Fractures

By the relationship of the fragments.

- Displacement.

- Shortening.

- Angulation.

- Rotation. Most fractures display more than one of

these abnormalities of position.

Description of Fractures

Number of fragments:

1- Simple: Two fragments.

2- Comminuted : More than two fragments.

Description of Fractures

Open Or closed fracture.

Gas lucency at the soft tissue.

Diagnosis Please??

Common Fracture Eponyms

-Colle's Fracture.

-Smith's Fracture.

-Jones Fracture.

-Boxer's Fracture.

Common Fracture Eponyms

• Colle's Fracture.

Fracture of the distal radius with a dorsal angulation

Common Fracture Eponyms

• Smith's Fracture.

- Fracture of the distal radius with a palmar angulation.

- Fall on a flexed hand.

Common Fracture Eponyms

• Jones Fracture.

Fracture base of the fifth metatarsal

Common Fracture Eponyms

Boxer's Fracture.

Fracture head of the fifth metacarpal with palmar angulation.

Fracture Healing

1. Indistinctness of Fracture line.

2. Bony callus formation.

3. Bridging of fracture and obliteration of fracture line.

4. Remodeling of bone.

Fracture Healing