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What are the four types of hip fractures in order from proximal to distal?

1. Subcapital neck fracture (just below femoral head). 2. Transcervical neck fracture (middle of femoral neck). 3. Intertrochanteric fracture (between greater and lesser trochanters). 4. Subtrochanteric fracture (below lesser trochanter). Think of it like this: Starting at the ball (head) and working down the neck toward the shaft—each type gets progressively lower.

What is a subcapital hip fracture and why is it high risk?

A fracture of the femoral neck immediately below the femoral head. High risk because it can disrupt blood supply to the femoral head, causing avascular necrosis. Think of it like this: Breaking the neck of a flower just below the bloom—the head might die without blood flow.

What is a transcervical hip fracture?

A fracture through the middle of the femoral neck (the narrow "neck" connecting head to shaft). Think of it like this: Snapping a golf club through the middle of the neck—right in the narrowest part.

What is an intertrochanteric hip fracture?

A fracture between the greater and lesser trochanters (the bony bumps where muscles attach). More stable than neck fractures. Think of it like this: Breaking through the thick part where the neck widens—like breaking a tree trunk where it gets thicker.

What is a subtrochanteric hip fracture?

A fracture below the lesser trochanter in the proximal femoral shaft. Often high-energy trauma. Think of it like this: Breaking the upper shaft below all the bony landmarks—closer to the main bone than the joint.

What is an anterior hip dislocation and how does the leg present?

The femoral head dislocates forward out of the acetabulum. Leg appears abducted (out to side) and externally rotated. RARE (10-15% of hip dislocations). Think of it like this: The ball pops forward—leg sticks out and rotates outward, opposite of the more common posterior dislocation.

What is a posterior hip dislocation and how does the leg present?

The femoral head dislocates backward out of the acetabulum. Leg appears adducted (toward midline), internally rotated, and shortened. COMMON (85-90% of hip dislocations). Think of it like this: The ball pops backward—leg crosses inward, rotates inward, and shortens (dashboard injury in car crashes).

What is the difference between a horizontal beam lateral hip and a turned lateral hip?

Horizontal beam lateral: Patient stays supine, X-ray beam is horizontal, IR vertical beside hip. Turned lateral: Patient is turned onto affected side (NOT recommended in acute trauma—can worsen injury). Think of it like this: Horizontal beam = move equipment to patient. Turned lateral = move patient to equipment (dangerous in trauma).

Why is a horizontal beam lateral hip preferred in trauma?

Avoids moving the injured hip, reducing risk of further displacement or damage. Patient stays supine and comfortable. Think of it like this: Don't make the patient move when they have a broken hip—bring the X-ray to them instead.

Is gonad protection needed in pelvic/hip trauma imaging?

Generally NO in acute trauma. Shields can obscure important anatomy and injuries. Diagnostic benefit outweighs minimal radiation risk. Think of it like this: In an emergency, seeing the full injury is more important than shielding—you can't miss a life-threatening fracture to save a tiny radiation dose.

What is a lipohaemarthrosis and what does it indicate?

Blood and fat in a joint that separates into layers (fat floats on top). Indicates an intra-articular fracture with bone marrow exposed. Visible as fat-fluid level on horizontal beam lateral knee. Think of it like this: Like oil and water—they separate. Fat from broken bone floats on top of blood in the joint, creating a visible line.

How do you detect a lipohaemarthrosis on X-ray?

Perform a horizontal beam lateral (HBL) projection. The fat-fluid level will only be visible with a horizontal beam because gravity makes the layers separate horizontally. Think of it like this: Like looking at a bottle of salad dressing from the side—you need a side view with gravity pulling down to see the layers.

What is a tibial plateau fracture?

A fracture involving the flat top surface of the tibia where it articulates with the femur. 80% involve the lateral tibial plateau. Think of it like this: The "tabletop" of the shin bone is crushed or cracked—often from high-impact trauma like falling from height.

What radiographic sign suggests a tibial plateau fracture even without obvious depression?

A sclerotic band (white line) across the tibia. This represents impacted/compressed bone. Think of it like this: When bone gets crushed, it compacts and appears whiter—like pressing chalk into a dense line.

What is a Lisfranc fracture-dislocation?

Fracture at the base of the metatarsals (usually 2nd) with lateral subluxation of the tarso-metatarsal joints. Can occur with or without visible fracture. Think of it like this: The "keystone" of the midfoot shifts—the arch collapses and the front of the foot displaces sideways.

Why is a Lisfranc injury important despite being infrequent?

Easily missed but can cause long-term disability if untreated. Can lead to chronic pain, arthritis, and foot instability. Think of it like this: Like missing a foundation crack in a house—seems minor but the whole structure (foot arch) fails over time.

What mechanism of injury commonly causes Lisfranc fractures?

Direct crush injury to midfoot OR indirect rotational force (e.g., falling from height and landing on plantarflexed foot). Think of it like this: Either something heavy crushes the top of your foot, or your foot gets twisted/torqued while planted—both wreck the midfoot joints.

What is a "Boxer's fracture"?

Fracture of the 5th metacarpal neck (the knuckle of the pinky finger). Caused by punching with a closed fist. Think of it like this: Punch a wall with bad form and you break your pinky knuckle—classic street fight injury.

What is a "Bennett's fracture"?

An intra-articular fracture-dislocation at the base of the 1st metacarpal (thumb). Involves the CMC joint. Think of it like this: The thumb metacarpal breaks at its base where it meets the wrist, and a corner fragment stays attached while the rest dislocates—needs surgery usually.

What is a lunate dislocation?

The lunate bone (moon-shaped wrist bone) dislocates forward (volar direction) out of position. Other carpal bones stay aligned. Think of it like this: The lunate "pops out" forward like a watermelon seed squeezed between fingers—isolated dislocation.

What is a perilunate dislocation?

All carpal bones except the lunate dislocate backward (dorsally). The lunate stays in place. More common than lunate dislocation. Think of it like this: Everything around the lunate moves backward, but the lunate itself stays put—like everyone leaving a room except one person.

How do you tell lunate vs perilunate dislocation on lateral wrist X-ray?

Lunate dislocation: lunate tilts forward, looks like a "spilled teacup". Perilunate: lunate normal position, capitate displaced dorsally. Think of it like this: If the lunate looks like a tipped-over cup, it's dislocated. If it looks normal but everything else is out of place, it's perilunate.

What is a torus (buckle) fracture?

A compression fracture in children where one side of the bone buckles but doesn't break completely. Looks like a bump or wrinkle in the bone cortex. Think of it like this: Like denting a soda can—the metal buckles inward but doesn't snap through.

Where do torus fractures commonly occur?

Distal radius (wrist) in children after FOOSH (fall on outstretched hand). Think of it like this: Kids' bones are softer and more pliable—they buckle instead of snapping clean like adult bones.

What is a patella dislocation and how does it typically occur?

The patella (kneecap) slides out of the femoral groove, usually laterally (to the outside). Often from twisting injury with knee flexed. Think of it like this: The kneecap jumps the track—slides off to the side like a train derailing.

How do you tell if a patella is subluxed vs dislocated on X-ray?

Subluxed: partially displaced but still overlapping femur. Dislocated: completely off to the side with no overlap. Think of it like this: Subluxed = halfway out of the groove. Dislocated = completely jumped off the track.

What positioning adaptations are needed for lower limb trauma?

Use horizontal beams to avoid moving injured limb. Support with pads/sandbags. Don't rotate fractured limbs. Include both joints for long bone fractures. Consider pain management before positioning. Think of it like this: The golden rule—adapt equipment and technique to the patient, never force the patient into standard positions.

What are the Ottawa Ankle Rules and why are they important?

Clinical decision rules to determine if ankle X-rays are needed. Check for: bone tenderness at specific points, inability to bear weight. Reduces unnecessary radiation. Think of it like this: A checklist that tells you "does this ankle really need an X-ray or is it just a sprain?"—saves time and radiation.

What is the Schatzker classification?

A system for classifying tibial plateau fractures (Types I-VI) based on location and pattern. Guides surgical planning. Think of it like this: A "fracture map" of different ways the tibial plateau can break—each type needs different treatment.

What is a Maisonneuve fracture?

Proximal fibula fracture with distal ankle injury (medial malleolus or deltoid ligament). The ankle injury transmits force up the leg. Think of it like this: Twist your ankle badly and the force travels up to break the fibula near the knee—always X-ray the whole leg in ankle trauma.

What is the Weber classification for ankle fractures?

Classifies lateral malleolus (fibula) fractures based on level relative to syndesmosis: Type A (below), Type B (at level), Type C (above). Determines stability. Think of it like this: How high up the fibula breaks tells you how unstable the ankle is—higher = worse.

Why must you include both joints when imaging a long bone fracture?

Fractures can cause injuries at adjacent joints. Force transmission can cause fracture-dislocations (Monteggia, Galeazzi, Maisonneuve). Think of it like this: The injury force travels through bone—might break the middle but also damage the joints at both ends.

What is a femoral shaft fracture and what causes it?

A break in the long middle portion of the femur. Requires high-energy trauma (car crash, fall from height). Significant blood loss risk. Think of it like this: The thighbone is the strongest bone—it takes massive force to break it, and when it does, you can bleed internally into the thigh.

What are the signs of significant blood loss in femoral shaft fractures?

Thigh swelling (can hold 1-2 liters of blood), shock, decreased blood pressure. Requires urgent treatment. Think of it like this: The thigh is like a big internal balloon—a broken femur tears vessels and the blood pools inside, hidden from view but life-threatening.

What is a Segond fracture?

A small avulsion fracture of the lateral tibial plateau. Highly associated with ACL tear (75-100% of cases). Think of it like this: A tiny chip fracture that's actually a huge red flag—when you see it, the ACL is almost always torn too.

What is a stress fracture and where do they commonly occur in the lower limb?

A hairline crack from repetitive stress rather than acute trauma. Common in: metatarsals (march fracture), tibia, femoral neck. Think of it like this: Like bending a paperclip back and forth—not one big break but tiny cracks from repeated stress.

What radiographic views are essential for ankle trauma?

AP, lateral, and mortise (15-20° internal rotation). The mortise view opens up the joint space to assess the ankle mortise. Think of it like this: Three views show different angles of the "slot" (mortise) that the talus sits in—you need all three to see if it's intact.

What is the "fat pad sign" in the knee (similar to elbow)?

Elevated fat pads around the knee joint suggesting effusion/haemarthrosis. Less reliable than elbow fat pad sign. Think of it like this: Same principle as elbow—fluid pushes fat away from bone making it visible, but harder to see in the knee.

What is a hip fracture-dislocation?

A hip fracture combined with dislocation of the femoral head from the acetabulum. High-energy trauma. Requires urgent reduction. Think of it like this: The worst of both worlds—the bone breaks AND pops out of the socket. Surgical emergency.

What special considerations exist for imaging pediatric lower limb trauma?

Growth plates can mimic fractures (Salter-Harris fractures). Lower radiation doses needed. More greenstick/torus fractures. Compare to opposite limb if unsure. Think of it like this: Kids' bones are still growing—the growth plate lines can look like fractures, and their bones bend rather than snap.