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g femoral neck , scaphoid +ve scan may not be seen for 24 hrs after injury
HRUS
Joints Soft tissues Bones e.g rib #
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
FRACTURE
COMPLETE #
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 #
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
Description is according to the direction of displacement of the distal fragment relative to the proximal
Paravertebral soft tissue shadowing (DD PV abscess) due to hemorrhage in thoracic spine #
Soft tissue swelling in retropharyngeal spacecervical spine trauma
Delayed union
Poor apposition or inadequate stabilization Vit C Deficiency Infection Agedecreased osteoblastic activity Underlying skeletal pathology
Non union
Malunion
Healing in unsatisfactory anatomical position Excessive fragment overlap ----shortening Unsatisfactory angulation Displacement
Dislocation
Subluxation
Complete loss of normal articular contact btw the bones comprising the joint Partial loss of articular contact Separation of fibrous jointsSI , pubic symphysis
Diastasis
STRESS #s
Chronic repetitive insufficient forces Sites are characteristic March # of 2nd and 3rd MT heads # of proximal fibula in paratroopers
NM---increase activity before radiographic signs RADIOGRAPH---sign depends upon stage of healing e.g lucent line to new bone formation
Bilateral stress fracture of the distal fibula: Initial radiographs and Bone scintigraphy at 2 weeks follow up.
Pathological #
Femoral neck Proximal pole of scaphoid Necrotic bone is denser Disuse cause surrounding osteopenia
Use of vibrating machines 5-10 yrs usage Degenerative cysts in bones of hand and wrist
Ossification of hematoma or periosteal elements which are displaced into the soft tissue. Commonest site is thigh DD---Parosteal osteosarcoma Radiograph MRI Biopsy
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.
Compartment syndrome
In areas of the limbs surrounded by rigid osseous and fascial planes Skeletal traumahemorrhage / edema--rising pressure Progressive ischemia -----necrosis
Vascular injury
Penetrating trauma / bone fragments Supracondylar #brachial artery Knee 3 / dislocationPopliteal artery Pelvic ring #branches of internal iliac artery
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.
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
Ionizing radiation
Osteonecrosis at the site of insult Patchy sclerosis with spontaneous # secondary malignant degeneration to osteosarcoma after 5 yrs or so
Frost bite
Frostbite > acro-osteolysis of the toes, with almost complete resorption of the distal phalanges.
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
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.
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