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21. Imaging of musculoskeletal trauma (bones and soft tissue). Radiologic signs of fracture healing. Terminology.
- Imaging of musculoskeletal trauma
- X-ray first
- 2 directions are always needed!
- Fractures are often visible in only one direction, so we need 2 x-rays from different perpendicular directions to evaluate
- Evaluation of x-ray
- Anatomical shape, form and alignment
- Cortex and medullary structure
- Medulla should have trabecular pattern
- Surface of joint
- Surrounding soft tissues
- In children
- Fracture
- -> one part of the bone is displaced compared to the rest of the bone
- If the distal part of the bone is displaced dorsally compared to the proximal part due to a fracture, it’s a dorsal fracture
- Fat blood interface sign (FBI sign)
- Horizontal fluid level outside the bone that forms as blood and bone marrow fat escapes during a fracture
- Rule of 2s
- Get 2 x-rays with perpendicular directions
- Image 2 joints (proximal and distal to the injury)
- Get images at 2 occasions
- Get images of 2 limbs – for comparison
- Then US/CT/MRi
- CT
- For complex fractures/tumors
- Interverterbral discs
- MRi
- Best for soft tissue
- Bone does not give signal on MRi, but fatty bone marrow is visible
- For inflammatory processes, tumors, sports injuries (often involve ligaments and not bones)
- Sesamoid bones
- Can be present as a variant of normal anatomy or as a response to strain
- Often embedded in tendons
- Specific pathologies
- Meniscus tear
- Polytrauma
- Weber fracture (types of ankle fracture)
- Weber A – Fibula fracture under the syndesmosis with tibia
- Weber B – Fibula fracture at the level of the syndesmosis with tibia
- Weber C – Fibula fracture above the syndesmosis with tibia
- Don Juan fracture
- Shoulder
- Fracture often accompanies dislocation
- Dislocation -> head of the humerus ends up behind the coracoid process
- Fracture of surgical head of the humerus is the most common
- AP front-facing position
