Fracture Mimics

DR MUHAMMAD BIN ZULFIQARPGR III FCPS Services institute of Medical

Sciences/ Services Hospital Lahore

Special thanks to Learning Radiology

Aim

• To differentiate between fracture mimics and fractures

Accessory Ossicle• Multiple ossification

centers are common in epiphyses and aresmooth and well-corticated

Apophysis

• Apophysis of the 5th MT runs in alongitudinal direction; fractures areusually transverse

Normal Epiphyseal Plate

• Don't confuse the undulationsof the humeral epiphyseal platefor a fracture

Bipartite Patella

• Bipartite patella almost always affects the upper outer pole of patella; 57% are bilateral

Nutrient Channel (Canal)

• Nutrient channels or canals rundiagonally only in the cortices ofcertain bones

Normal Excrescence

• Radial spur is normal variantoccurring on the lateral aspect of the radius at the site of the physis

Normal Apophysis

• The apophysis of the tibial tubercle(tuberosity) fuses at age 14-18 years

Limbus Vertebra

• Most commonly affects anterosuperior border of single vertebrain lumbar spine

Normal Excresence

• This is a normal bonyexcresence from the scaphoid that can be mistaken for a fracture

Sesamoids

• Sesamoids are ossicles embedded in a tendon that aid in movement; they are common in the feet and hands

Skin Laceration

Air beneath lacerations may superimposeon the bone simulating fractures; look at multiple projections

Apophysis

• The greater and lesser trochanters are apophyses which fuse at 15-20years of age -

Lack of Fusion

• Hyoid Bone fuse later in lifeusually by age 40; it is thereforecommon to see and unfused hyoid

Mach Lines

• "Mach Lines“ are optical illusions which produce a black line where none exists; they are common at the base of the dens

Accessory Epiphyses

• In a child, when in doubt, think of obtaining the opposite side.

• Synchondrosis• 3 main temporary J oints in pelvis: ilio-pubic,

ischio-pubic and ilio-ischial; bilateral and usually symmetric

Costovertebral Junction

• Every rib attaches to the spine at the costo-vertebral junction; not to beconfused with a fracture

Accessory Ossicle

• Os Acetabuli Marginalis SuperiorNormal variantMay be bilateral

Multiple Ossification Centers

• The calcaneal apophysis frequently has multiple centers of ossification and appears denser than rest of calcaneus

Sesamoids

• There are almost always sesamoids of the thumb; they are well-corticated and smooth-edged, unlike fractures

Accessory Ossicle

• Os Trigonum-accessory ossicle just posterior to the talus normally found in 5-15% of people

Os Trigonum-accessory ossicle

THANKS