Presentation on theme: "Terminology, Images & Stuff"— Presentation transcript:
1Terminology, Images & Stuff FRACTURESTerminology, Images & StuffJeannean Rollins, MRC, BSRT, (R)(CV)Associate Professor, Medical Imaging & Radiation SciencesArkansas State UniversityJonesboro, AR
2Objectives Define fracture Define the 5 descriptors used to classify fractures in long bonesDiscuss the fractures with “special” names, i.e., eponymsReview the classifications for fractures of the vertebral columnReview sample images of fractures
3Why do we have to study pathology? We not even allowed to mention diagnosis on images!!An understanding of pathology makes us better care providers and more productive contributors to the healthcare team.
4Fracture Definition“A disruption of bone caused by mechanical forces applied either directly to the bone or transmitted along the shaft of a bone.” (Eisenberg 131)Eisenberg, R. & Johnson, N. Comprehensive Radiographic Pathology, 5th Edition. Elsevier, St. Louis
5Radiographic Manifestations Radiolucent line crossing the bone & interrupting cortical marginsRadiopaque line or area due to overlapping bone fragments
6Secondary Signs of Fracture Joint effusionSoft tissue swellingInterruption of normal pattern of bony trabeculae
15Direction of Fracture Line(s) TransverseRuns at right angle to long axis; Usually results from direct blow or pathologyObliqueRuns about 45 degrees to long axis; Results from angulation forceSpiralEncircles shaft; Caused by torsional force
21Position of Fracture Fragments UndisplacedNo angulation or separation of fragmentsDisplacedBone fragments separated; Described in relation of distal fragment in relation to proximalAngulationIndicates angular deformity between axes of major fragments
41Bennett FractureDefined as a fracture at the base of the 1st metacarpal that extends into the CMC jointAlso called an intraarticular fracture or a fracture/dislocationMechanism of Injury: Axial load on a partially flexed thumb
42Bennett FractureCritical because incorrect or delayed diagnosis can result in:Early arthritis and painLoss of some thumb mobility
44Colles Fracture Most common fracture of the distal radius Osteoporosis is a risk factorUsually results from a fall on an outstretched handDorsal displacement of the distal fragment is characteristicSmith fracture (reverse Colles) has volar displacement
49Hill-Sachs & Bankart Caused by frequent anterior shoulder dislocations Often occur simultaneouslyOften requires CT or MRI to diagnoseHill-SachsPosterorlateral humeral head compression fractureBankartFx of inferior glenoid
56Charcot JointAKA: Charcot (Charcot’s) foot, neurotrophic joint, neuropathic jointProgressive degenerative/destructive joint disorder in patients with abnormal pain sensation and proprioception 1Diabetes is the most common cause in western societies1- Dähnert W. Radiology review manual. Lippincott Williams & Wilkins. (2007) ISBN:
5846 y/o male. Peripheral neuropathy in type I diabetes mellitus 46 y/o male. Peripheral neuropathy in type I diabetes mellitus. Foot deformity and gait disturbance with minor pain.
59MaisonneuveAn unstable fracture typically involving the medial tibial malleolus and/or disruption of the distal tibiofibular syndesmosis along with a fracture of the proximal fibula shaft.The deltoid ligament can be frequently disrupted.
60Disruption of the distal tibiofibular syndesmosis along with a fracture of the proximal fibula, consistent with a Maisonneuve fracture.
61Undisplaced spiral fracture through the proximal fibula Undisplaced spiral fracture through the proximal fibula. Undisplaced transverse fracture through the medial malleolus. Distal tibiotalar joint appears intact.
62Toddler Fracture Minimally or undisplaced spiral fracture of the tibia Thought to occur due to new stresses on the bone due to recent ambulationNOT suspicious of child abuse when present in isolation and in the correct age group (9 mos. – 3 yrs.)
64Classifications and Common Types Spine Fractures
65Classification of Spine Fractures Mechanism of InjuryHyperflexionHyperextensionAxial compressionLateral compressionComplex injuries4 Line MethodThree Column (Denis)All of these determine stability of spine fracture
664 Line MethodLines A, B and C should have a smooth curve with no steps or discontinuities.Rotation may cause greater malalignment Line B as compared to Line A> 3.5mm translation anywhere is significantSpinal canal (SC) diameter should be 18mm or greater.Stenosis 14mm or less.
73Jefferson Fracture C1 burst fracture Typical cause – axial load (diving into shallow water)Stable, non-neurologic injury if ligaments are intactAP open- mouthAsymmetry of lateral massesCT &/or MR often needed
74Hangman Fracture Bilateral lamina and pedicle fracture at C2 Usually associated with anterolisthesis of C2 on C3Most common cause - MVALateral c-spine demo’sCT &/or MR often needed
75Clay-shoveler Fracture A fracture of the spinous process of a lower cervical vertebra (most commonly, C7)Usually a stress fracture, but acute causes are:Direct forceMVA
76Flexion-Teardrop Fracture Most severe fracture of the c-spine, often causing anterior cervical cord syndrome and quadriplegiaCauses:DivingMVA decelerationCT &/or MR required
77Odontoid FractureType I: fracture of the upper part of the dens; rare and potentially unstableType II: fracture at the base; unstable, and has a high risk of non-union; most commonType III: through the odontoid and into the lateral masses of C2; best prognosis for healing because of the larger surface area of the fracture~20% of c-spine fractures
78Burst (Compression) Fracture A type of compression fractureThe posterior vertebral body cortex is disrupted and is pushed backward into the spinal canalIn the T/L region, tends to occur between T9 and L5 levels Burst fractures may be stable or unstable
80Chance FractureBony injuries that extend all the way through the spinal columnThe most common history is a MVA or fall from a heightBack seat passenger w/ a lap seatbeltThe middle and posterior columns are typically disruptedHigh incidence of associated intra-abdominal injuries