Bone injury

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 )
clavicular fracture
cum distractione (risk of
pseudoarticulation)
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