1. EASILY MISSED SUBTLE EXTREMITY PROBLEMS
LEONARD E. SWISCHUK, M.D.
UTMB LOGO

2. COMPARATIVE VIEWS
Invaluable

3. COMPARATIVE VIEWS
Cost?
Radiation?
Adult training?

4. COMPARATIVE VIEWS Radiation exposure Expense 10 millirads or less

5. THE SECRET * Know where to look * Know what to look for *
Use fat pads and other clues
Utilize soft tissue edema

6. INFECTION – INFLAMMATION (Deep vs. superficial edema)
Osteomyelitis (deep edema)
Myositis (deep edema)
Cellulitis (superficial edema)

16. OSTEMYELITIS (LOW GRADE)
Flat bones
Certain sites

42. BUCKLE FRACTURES 1. Typical cortical buckle
2. Angulation of cortex only

43. BUCKLE FRACTURE MECHANISM (Typical cortical buckle fracture)

60. BUCKLE FRACTURE MECHANISM (Angulation of cortex only)

90. HAIRLINE FRACTURES Toddler’s spiral fracture of tibia
Type I: Dunbar
Toddler’s fracture Type II
Transverse fracture upper tibia
Proximal ulna, longitudinal and transverse
Small bones of hands and feet

107. IMPACTION FRACTURES Cuboid Scaphoid (carpal navicular)
Upper tibia (Toddler’s fracture, Type II)

128. PLASTIC BENDING FRACTURES
Long bones
Radius, ulna, fibula
Clavicle
Supracondylar humeral fracture

139. SALTER-HARRIS EPIPHYSEAL–METAPHYSEAL FRACTURES
Usually Salter-Harris I or II
Salter-Harris III in ankle
Subtle in older patients
Epiphysis nearly fused

161. ULNAR STYLOID FRACTURE (a signal)
Radial Salter-Harris or buckle fracture not present

174. AVULSION FRACTURES

191. CONCLUSION Know where to look for subtle fractures
Know what they look like
Comparative views very helpful
Indeed indispensable