bone injury - 2. lékařská fakulta univerzity karlovy · 2014-12-09 · bone injury. x rays in 2...
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Bone injury
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X rays in 2 perpendicular projections!
Colles fracture
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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)
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1.dislocation ad latus
• in short axis, to side
• most common
• degree of dislocation
(portion of bone width)
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2. dislocation ad longitudinem
• in lenght (longitudinal
axis)
cum contractione
(interfragment out of bone
axis or other typey of
dislocation )
cum distractione (risk of
pseudoarticulation)
clavicular fracture
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3. dislokace ad axim
• Angulation (in axis)
Colles fracture of distal
metaphysis of radius
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4.ad periferiam
• Rotation of fragments
supracondylic fr. humerus
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Healing of fracture
• Endostal callus
(filling of hole
between fragments)
• Periostal callus
(overbridging of fr. line
remodelation in future)
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Callus
• endostal
undislocated fracture
• periostal
dislocated fracture
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Neonatal fracture
• clavicle
• trauma during delivery
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Children fractures
1) subperiostal
2) epiphyseolysis
3) ping-pong ball fr. skull
Subperiostal (green-stick)
•most common
•elastic periost
•follow contours of bone
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Epiphyseolysis
Salter-Harris classification
1) through epiphyseal growth plate
2) 1+metaphysis
3) 1+epiphysis
4) 1+ meta + epifýzou
5) comminutive fr.
of epiphysis
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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
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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
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Growing skull fracture
• dura matter gets into
fracture line
• fr. line is not healing
but decalcination around
• osteolytic defect
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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
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Rib fractures
• usually dislocated
• risk of pneumothorax
• fractures of different
age (different degree
of healing)
• susp. Non accidental
trauma
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Acetabular fracture
• anterior edge
• roof
• posterior edge
(most common,
drivers in car)
risk of hip luxation
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Pathologic fracture
• ill formed bone, pathologically
changed bone structure
• osteoporosis (female menopause)
• metastasis
• osteogenesis imperfecta
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Stress (fatigue, march) fracture
• most common II. metatars,
proximal tibia
• without trauma, long
lasting overload
x growth lines
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Stress fracture MRI
• bone marrow edema