Image Interpretation of the upper limbsScapula Fractures Violent force type injury Associated with...
Transcript of Image Interpretation of the upper limbsScapula Fractures Violent force type injury Associated with...
Imelda Williams
Image Interpretation of the upper limbs
& Shoulder girdle
Shoulder: Common trauma
▪ Fracture of the clavicle
▪ Fracture of the humeral head
▪ Fracture of the scapula
▪ Anterior dislocation of the humeral head - over 90%
▪ Posterior dislocation of the humeral head – less 5%
▪ Dislocation of the acromio-clavicular joint
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Scapula Fractures
Violent force type injury
Associated with avulsion fractures of acromion or ACJ dislocations
Associated rib or clavicle fractures
Exclude damage to lungs
Slide 3
Monash Image
Anterior Humeral dislocations
▪ Antero-inferior dislocation
▪ Most common shoulder
dislocation: 90%
Slide 4
Monash Image
Posterior Humeral Dislocation
▪ Postero-lateral
rotation of humeral
head produces “Light
bulb” appearance
▪ Less common: ± 5%
Slide 5
Monash Image
Acromioclavicular joint
▪ Common sports injuires
▪ Direct fall or FOOSH
▪ Normal ACJ= 3-5mm
▪ Comparison views:
difference between 2
sides should not exceed
2m
ASSESSMENT OF ACJ
Elbow trauma
▪ Mechanism of injury includes:
• FOOSH• Direct blow
▪ Common fractures:
– Radial head / neck fracture
– Dislocation – Adults vs. paediatric
fractures
▪ Image interpretation criteria of the elbow:
▪ Dislocation assess:
– Anterior humeral line position– Radiocapitellar line position
▪ Fat pad elevation
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Elevated fat pads: “Sail Sign”
▪ A visible anterior fat pad can be normal.
▪ A posterior fat pad is never normal and
always signifies fluid in the intra-articular
space.
▪ A positive sail sign in trauma setting is a
reliable indication of an intra-articular fracture
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Monash Image
Anterior humeral line: AHL
▪ Accurate with true lateral elbow
▪ Line drawn along anterior
humerus must intercept
capitellum at middle third
▪ Indication of dislocation or
supracondylar fracture
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Normal
Abnormal AHL
Supracondylar fracture
Monash Image
Radio-capitellar line: RCL
▪ True AP & lateral of elbow
▪ Indication of joint alignment
▪ Line drawn through centre of
proximal radius should pass
through centre of capitellum
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Normal
Abnormal
Monash Image
Wrist traumatic pathology
▪ Typical wrist fractures
– Colle’s
– Smith’s
– Scaphoid
▪ Wrist alignment:
– Lunate dislocation
– Perilunate dislocation
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Wrist dislocation
▪ Perilunate dislocation
– Capitate dislocated from lunate
▪ Lunate dislocation
– Dislocated volarly
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Perilunate dislocation Lunate dislocation
Monash Image
Colle’s fracture
▪ COMMENT:
– Transverse fracture of
distal of radius with
dorsal displacement
of distal fragments.
Slide 13
Monash Image
▪ COMMENT:
– Transverse fracture of
the distal radius with
palmar/anterior
displacement of the
distal fragment.
Slide 14
Smith’s Fracture
Monash Image
Scaphoid fractures
▪ Fractures across scaphoid
waist has risk of Avascular
Necrosis (AVN) of proximal pole
▪ Only blood supply to scaphoid is
via distal pole.
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Monash Image
Metacarpals and fingers
▪ Important to distinguish between extra- vs. intra-
articular fractures.
▪Fractures are common in the 1st & 5th metacarpals.
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Bennett’s Fracture
• COMMENT:
• Common two piece
intra-articular fracture
of the base of the
thumb
Slide 17
Monash Image
Boxer’s fracture
▪ Commonly known as a punch injury or “brawler’s fracture”.
▪ The most common sight for a boxer’s fracture is either the neck or the shaft of the 4th or 5th
metacarpal.
18 Monash Image
Paediatric fractures
▪ Joint effusion is a useful sign e.g. supracondylar fracture
▪ Assessing alignment:
– Anterior Humeral Line (AHL)
– Radio-Capitellar Line (RCL)
▪ Periosteal reaction indicates healing fracture
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Common fractures
Torus / Buckle fracture
▪ Can be subtle
▪ Greenstick Variation
▪ Step in cortex
▪ Minimally impacted with intact cortex
Greenstick fracture
▪ Incomplete fracture
▪ Involves one side of the cortex
▪ Opposite side bends
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2
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Greenstick Fracture
Monash Image
Take home principles
▪ Consider mechanism of injury.
▪ Apply a search strategy when interpreting radiographs.
▪ Know the common fractures and dislocations.
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