2.  Plain Radiographs
First modality
 NM Bone Scan
Occult # e.g femoral neck , scaphoid
+ve scan may not be seen for 24 hrs
after injury

3.  HRUS
Joints
Soft tissues
Bones e.g rib #

4. • Multislice CT Scan
less time consuming and offer good
assessment of bones in 2d and 3d
manner
Give volume of information
• MRI
mod of choice for inj of and around
joints
soft tissue detail

5. • FRACTURE
–Break in the continuity of the bone

6. – CLOSED #=== covered with skin
– OPEN #===== obvious protrusion of bone
fragments beyond soft tissue margins
absence of bone pieces
gross soft tissue disruption
extending to bone surface
subcutaneous gas
foreign material within the #

8. • SINGLE # LINE
• Transverse
• Oblique
• Spiral
• MORE THAN 1 # LINE
• Comminuted #-----contains the butterfly
fragment

11. COMPLETE #
INCOMPLETE #
• In bones having greater resilience in children

12. THREE TYPES
• Plastic #---bending or acute angulation of
bone with no cortical disruption
• Torus or buckle #---# of cortex on
compressive side of bone while the cortex on
tension side remains intact
• Greenstick #----converse of torus #

14. AP (A, C) and lateral (B, D) radiographs of the right forearm demonstrate a buckle fracture
(arrows) of the distal radial metaphysis without significant angulation. Buckle fractures (or
torus fractures) are an impaction type of fracture identified by a focal widening (or outward
buckling) of the cortex

16. • SEGMENTAL #
• segment of bone is isolated by #s at
each end

18. APPOSITION
• The position of major fragments with respect
to each other
DISTRACTION
• Non apposed fragments and when the
displacement is along the long axis

20. • Description is according to the
direction of displacement of the
distal fragment relative to the
proximal

21. IMPACTION
• When bone fragments are driven into each
other
ABNORMALITY OF ROTATION
• Of the distal fragment
• Both ends of the same bone should be
checked in the same film

22. • ANGULATION
• Direction of the apex of the angle at the #
site
• Varus angulation --angulation of distal
fragment towards the midline
• Valgus angulation-- angulation of distal
fragment away from the midline

24. CLUES TO #
• Joint effusion / hemarthrosis---#
around a joint----e.g. elbow
• Fat-Fluid level(lipohemarthrosis)-
--knee joint #

26.  Paravertebral soft tissue shadowing
(DD PV abscess) due to hemorrhage
in thoracic spine #
 Soft tissue swelling in retropharyngeal
spacecervical spine trauma

28. Delayed union
• Poor apposition or inadequate stabilization
• Vit C Deficiency
• Infection
• Age—decreased osteoblastic activity
• Underlying skeletal pathology

29. Non union
• Idiopathic (tibia)
• Poor stabilization
• Infection
• Pathological #
• Massive initial trauma

30. Malunion
• Healing in unsatisfactory anatomical position
• Excessive fragment overlap ----shortening
• Unsatisfactory angulation
• Displacement

32. Dislocation
• Complete loss of normal articular contact btw
the bones comprising the joint
Subluxation
• Partial loss of articular contact
Diastasis
• Separation of fibrous joints—SI , pubic
symphysis

35. Avulsions ----indicator of ligamentous
injury
• Base of proximal fragment of the thumb
• Avulsion of medial lateral maleoli

37. STRESS #s
• Chronic repetitive insufficient forces
• Sites are characteristic
• March # of 2nd and 3rd MT heads
• # of proximal fibula in paratroopers

38.  NM---increase activity before radiographic
signs
 RADIOGRAPH---sign depends upon stage of
healing e.g lucent line to new bone formation

39. Bilateral stress fracture of the distal fibula:
Initial radiographs and Bone scintigraphy at 2
weeks follow up.

40. Pathological #
• In bones weakened by underlying disease
• E.g. osteoporosis , osteomalacia , bone
tumors

42. Post traumatic AVN
• Femoral neck
• Proximal pole of scaphoid
• Necrotic bone is denser
• Disuse cause surrounding osteopenia

43. Drillers disease / vibration
syndrome
• Use of vibrating machines 5-10 yrs usage
• Degenerative cysts in bones of hand and wrist

44. Post traumatic myositis ossificans
• Ossification of hematoma or periosteal
elements which are displaced into the soft
tissue.
• Commonest site is thigh
• DD---Parosteal osteosarcoma
• Radiograph
• MRI
• Biopsy

45. Post-traumatic myositis ossificans. A well-defined bone density arises from the cortex of the
distal femur and extends into the soft tissues. There was a history of blunt trauma, but even so,
this lesion needs to be differentiated from parosteal osteosarcoma.

46. Compartment syndrome
• In areas of the limbs surrounded by rigid
osseous and fascial planes
• Skeletal trauma—hemorrhage / edema---
rising pressure
• Progressive ischemia -----necrosis

47. Vascular injury
• Penetrating trauma / bone fragments
• Supracondylar #brachial artery
• Knee 3 / dislocationPopliteal artery
• Pelvic ring #branches of internal iliac artery
• Spiral CT –superior to angiography

48. Traumatic avulsion of the right superior gluteal artery (arrow) from pelvic trauma. Bleeding from
branches of the internal iliac artery is also seen (open arrows). Marked diastasis of the right
sacroiliac joint has occurred.

49. Post traumatic reflex dystrophy / reflex
sympathetic dystrophy / Sudecks atrophy
• Injury to limb—intense pain and swelling—
severe disuse osteoporosis

50. Sudeck's atrophy: there was minor trauma to the forearm some weeks earlier. Note gross
osteoporosis of the bones of the hand, wrist and forearm, most marked at the bone ends, but
also causing cortical 'thinning' and resorption

51. Ionizing radiation
• Osteonecrosis at the site of insult
• Patchy sclerosis with spontaneous #
• secondary malignant degeneration to
osteosarcoma after 5 yrs or so

52. Frost bite
• Acro-osteolysis
• Premature epiphyseal closure and growth
arrest in children

53. Frostbite > acro-osteolysis of the toes, with almost complete resorption of the distal
phalanges.

54. Caissons disease
• In deep sea divers and tunnel workers
• Poor decompression----nitrogen bubbles in
blood----capillary blockage
• Avascular necrosis
• Irregular bone densities usually in long bones
• Medullary infarctions
• NM and MRI detect changes earlier

55. Avascular necrosis of the hips. Note mixed sclerosis and lucency of the femoral heads,
with collapse of the weight-bearing surface but maintenance of the joint spaces,
indicating intact articular cartilage.

56. THANKS