

MSK RADIOLOGY

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 Objectives

 Sign and symptoms of fractures
 Classification of fractures
 Diagnosis of fractures and dislocations

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 Skeletal conditions

 Fractures
 Dislocations
 Osteomyelitis
 Structural anomalies
 Degenerative bone disease
 Bone tumors

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 Basic terminologies


 Sclerotic = increased bone density
 Lytic = bone destruction
 Cortex = compact bone forming the bone cortex
 Medulla = trabecular bone in the bone marrow
 Articular = refers to a joint
 Demineralization = decreased bone density
 Ankylosis = fusion

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 Cont…

 Osteo = prefix meaning bony
 Fibro = prefix meaning fibrous
 Chondro = prefix meaning cartilaginous
 Arthro = prefix meaning joint ( arthritis)
 Spondylo = prefix meaning spinal
 Dactyl= prefix meaning digit

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 ABCs APPROACH

A
◦ Adequacy, Alignment
B
◦ Bones
C
◦ Cartilage
S
◦ Soft Tissues
Apply ABCs approach to every orthopedic film you evaluate

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 ADEQUACY

 All x-rays should have an adequate number of views.
 Minimum of 2 views—AP/PA and lateral
 3 views preferred
 Some bones require 4 views

 Two joints i.e. above & below

 Two sides (for comparison)
 All x-rays should have adequate penetration

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 Hand series
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 Knee and Ankle joints included
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 Cont…


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 ALIGNMENT

 Alignment: Anatomic relationship between bones on x-
ray

 Normal x-rays should have normal alignment

 Fractures and dislocations may affect the alignment on the

x-ray

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 Bone and joint alignment


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 BONES

 Examine bones for fracture lines or distortions

 Examine the entire length of bone

 Fractures may be subtle!

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 Cont…
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 CARTILAGE

 Cartilage implies to examine the joint spaces on x-rays
(you cannot actually see cartilage on x-rays)

 Widening of joint spaces signifies ligamentous injury

and/or fractures

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 Cont…

 Normal Joint Anatomy  Joint space narrowing

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 SOFT TISSUES

 Soft tissues implies to look for soft tissue swelling and
joint effusions

 These can be signs of occult fractures

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 Cont…


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 Fractures


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 Signs or Symptoms of Fractures

 Pain
 Tenderness
 Wound ( with bone sticking out)
 Deformity
 Unnatural movement
 Swelling and bruising

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 

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 Cont…
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 Trauma

Classification of Fractures
 Fracture is complete or incomplete break in the continuity
of a bone
 According to their cause fractures are classified as acute
traumatic, stress and pathological
 Acute traumatic fractures can be further classified as
complete, incomplete, displaced, undisplaced, simple,
compound, etc.

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 Cont…

 Complete — discontinuity between two or more bone

fragments
 Incomplete — portion of cortex remains intact
 Displaced — space between margins of fracture causing
deformity
 Undisplaced — bone fragments closely apposed with
minimal deformity
 Closed/simple — no communication between fracture
and skin surface
 Open/compound — wound extends from skin surface to
fracture
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 Cont…

 Based on their pattern fractures can be transverse,
oblique, spiral, compression, depressed, comminuted
fractures (2 or more fragments) etc.

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 Comminuted Fx with
displacement
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 Spiral Fx with displacement
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 Oblique Fx
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 Transverse Fx
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 Impacted or Buckle Fx


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 Greenstick vs Torus Fx


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 Compression Fx


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 Stress Fx


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 Pathological Fx
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 Dislocation

 Dislocation -is whole displacement of articular surfaces
of a joint from one an other so that apposition between
them is lost
 Subluxation -exists when the articular surfaces are partly
displaced but retain some contact with each other

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 

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 Fractures in Children

o Skeleton is more elastic and less brittle
o Fractures in children are classified as complete, greenstick,
torus(buckle), pipe, bowing injury, epiphyseal etc.
o Greenstick⇨the cortex is broken on one side with a
bending deformity concave to the complete side
o Buckle⇨buckling of the cortex produced by compression
or impaction
o Pipe⇨combination of incomplete transverse on one side
and buckle on the other.

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 Fracture healing


 Can be assessed with serial radiographs
 There are three phases of healing
-Inflammatory Phase -hematoma forms at the site of
fracture
-Reparative Phase -cells lining the cortex start to form new
bone(callus). This is seen as faint calcification around the
fracture
-Remodeling Phase -the immature callus is replaced by
compact(denser) bone in the cortex and cancellous bone
within the medullary cavity.

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 Normal skeletal x-rays
 The hand

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 Wrist Joint
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 Lateral view
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 Fx
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 Fx & dislocation
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 The forearm
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 Forearm
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 Fx
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 Elbow


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 Elbow dislocation


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 The arm

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 The shoulder


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 

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 Anterior vs posterior dislocation


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 Lower Extremities

 Pelvis

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 

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 The hip

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 

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 The thigh


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 

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 Fx of the femur


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 The knee

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 

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 The leg

1. femur
2. fibula-shaft
3. fibular head
4. lateral femoral condyle
5. medial femoral condyle
6. patella
7. distal tibiofibular joint
8. proximal tibiofibular joint
9. talus
10. tibia-shaft
11. tibial tuberosity 7
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 

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 The ankle

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 

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 The foot


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 Skull Fracture

Types
 Linear
 Depressed

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 Linear skull fracture

 Linear skull fracture are usually more radiolucent
than calvarial sutures with straightness and lack of
serration along its edges

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 Linear skull Fx


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 Linear fracture vs suture


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 

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 Depressed skull Fx

 Bone of skull vault being folded or depressed inward
in to the cerebral parenchyma
 Result of high energy impact to the skull
 Associated with conditions such as extra dural
hematoma, sub dural hematoma, cerebral contusion,
subarachnoid hemorrhage

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