X-ray Pathology

Describe fracture

Right mid-shaft clavicle fracture, inferiorly displaced

Acromioclavicular joint dislocation

Anterior shoulder dislocation

What type of fracture is this? Where is the most common location & in what is the common mechanism? What nerve injury is associated with this & how to assess?

Proximal humerus fracture

most common = neck of humerus # in elderly patients after a FOOSH

risk of axillary nerve damage – loss of sensation at regimental badge area + impaired shoulder abduction (deltoid)

What direction is the dislocation & how to identify?

Posterior shoulder dislocation

humerus head is posterior to Y-shaped scapula (R-sided)

Holstein-Lewis fracture - definition & what nerve injury is common

Spiral # of the distal 1/3 humeral shaft with the distal fragment being displaced proximally & radially

Risk of radial nerve injury – wrist drop & numbness at dorsum of hand

What direction is the dislocation?

Posterior elbow dislocation

Proximal 1/3 ulnar # AND dislocation of the radial head

Monteggia fracture

Distal 1/3 radius # AND dislocation of the distal radio-ulnar joint (DRUJ)

Galeazzi fracture

Intra-articular # of the radial styloid process

Chauffeur’s fracture

Ulnar nightstick fracture - describe the fracture shown

What is the traditional mechanism for this injury?

Oblique # of the distal ulnar, lateral displacement

MOI = raise arm to shield from attack

Describe the fracture, how to clinically diagnose & what to watch out for

Scaphoid waist #

clinical = tenderness over the anatomical snuffbox

first XR may not visualise # so repeat after 2 weeks

risk of AVN due to retrograde circulation

Colle’s fracture

Distal radius # with dorsal displacement

Smith’s fracture

Distal radius # with volar displacement

Volar Barton’s fracture - definition & mechanism of injury

Intra-articular fracture of the volar rim (distal radius) AND volar dislocation of the radio-carpal joint

mechanism = direct blow to the back of your wrist

Dorsal Barton’s fracture - definition & mechanism of injury

Intra-articular fracture of the dorsal rim (distal radius) AND dorsal dislocation of the radio-carpal joint

mechanism = FOOSH

Boxer’s fracture

5th metatarsal head #

treat surgically to avoid abnormal displacement of pinky finger when flexed which will cause poor fine motor skills

Comminuted fracture at base of 1st metacarpal – Y or T shaped

Intra-articular fracture (carpo-metacarpal joint)

Rolando’s fracture

Bennett’s fracture

Oblique fracture at the base of 1st metacarpal

Intra-articular fracture (carpo-metacarpal joint)

Mallet fracture - which sports is it common in?

Fracture of the proximal end of the distal phalanx

Common in cricket & basketball

What direction is the dislocation?

Posterior hip dislocation

What direction is the dislocation

Anterior hip dislocation

What type of fracture? What is a serious complication & why does it occur? Treatment?

Neck of femur fracture (intracapsular)

Disrupted medial circumflex femoral artery which gives retrograde blood supply to femoral head leading to AVN

tx = proximal femoral nail (type of intermedullary femoral nail)

What type of fracture? Treatment?

Intertrochanteric fracture

tx = proximal femoral nail (type of intermedullary femoral nail)

What type of fracture? Treatment?

Subtrochanteric fracture

tx = proximal femoral nail (type of intermedullary femoral nail)

What type of fracture? Treatment? Potential blood loss amount?

Oblique mid-shaft femur fracture

tx = ORIF with intramedullary nail insertion

blood loss = 1.5-2L (risk of haemorrhagic shock)

Type of fracture?

Supracondylar femur fracture

What type of injury & direction?

Anterior knee dislocation

What type of injury & direction?

Lateral knee dislocation

What type of injury & direction? What structures are at risk of being injured & what is the consequence?

Posterior knee dislocation

Laceration of popliteal vessels –> LL ischaemia –> dry gangrene & amputation

Common peroneal N injury –> foot drop

Diagnosis?

Patellar fracture

Diagnosis?

Oblique tibial plateau fracture

Describe the fracture & what is the treatment?

Undisplaced oblique fracture of the mid-shaft tibia

tx = ORIF with intermedullary nail

Pilon fracture - definition & MOI

fracture of the distal end of the tibia that extends directly into the weight-bearing surface of the ankle joint (the tibial plafond)

usually due to high-energy axial load

Trimalleolar ankle fracture - where are the 3 malleoli?

medial & lateral malleoli + posterior end of tibia

What type of fracture?

Bimalleolar ankle fracture

Lisfranc injury

Any injury causing dislocation of the tarsal-metatarsal joint

Jones fracture - definition & why is surgical correction with nails needed?

Proximal end of 5th metatarsal fracture

Peroneal muscles attach to proximal end of 5th metatarsal

Describe the fracture & potential complication

Mid-shaft # at base of talus

risk of AVN

What fracture & tx?

Calcaneal #

tx = calcaneal plate + screws

March fracture

small stress or hairline crack in one of the long metatarsal bones of the foot, most commonly the second or third metatarsal

Name of deformity, presentation & causes

Hallux valgus = angulation of 1st metatarsal + bunion formation

causes = high heels, tight shoes

Lumbar spondylosis

spinal OA (degenerative changes = LOSS) with visible osteophytes

Term for anterior displacement of a vertebrae

Spondylolisthesis

What does winking owl sign indicate?

Spinal metastasis

TB Spine (Pott’s Disease) features on XR

Disc space narrowing, vertebral destruction, paravertebral shadows

Diagnosis & usually which region is affected

Idiopathic scoliosis, usually thoracolumbar

Diagnosis?

Osteomyelitis

Sequestrum = dead bone space (black)

Involucrum = new living bone that the periosteum builds around the dead sequestrum

Diagnosis, potential blood loss capacity & treatment

Open book pelvic fracture (separation of pubic symphysis)

pelvis = 3L capacity

if > 1.5cm = plate fixation

What is an avulsion fracture? 3 most common sites

rapidly contracting muscle pulls a tendon so forcefully that it tears a small piece of bone away from the pelvis

3 most common = ischial tuberosity, AIIS, ASIS

Diagnosis?

ASIS avulsion injury

Malgaigne fracture

unstable, high-energy vertical shear injury of the pelvis characterized by a double break in the pelvic ring

Diagnosis & definition

Straddle fracture – involves superior and inferior pubic rami on both sides of the pelvis, creating a detached or "butterfly" central segment

Diagnosis?

Distal radius osteomyelitis - see sequestrum

Diagnosis?

Chronic osteomyelitis of distal femur - sequestrum + involucrum seen

well-defined collection of pus surrounded by dense, reactive sclerotic bone

Brodie’s abscess

Osteochondroma of distal femur - pedunculated mass

Osteoid osteoma

Benign or malignant tumour?

Giant cell tumour - benign with potential for malignant transformation

Giant cell tumour

Sun burst appearance

Osteosarcoma

Chondrosarcoma

Onion-peel appearance

Ewing’s sarcoma

Enchondroma

Multiple myeloma

multiple well-defined "punched-out" osteolytic lesions across the axial skeleton, generalized osteopenia, and endosteal scalloping

Bone metastasis in Non-Hodgkin Lymphoma

lytic (destructive) lesions with a moth-eaten pattern of bone destruction

associated extra-osseous soft tissue mass visible adjacent to the bone destruction

Osteoporosis of humeral head with associated rotator cuff injury

Type of fracture?

Compression # of L1 vertebrae

Type of fracture?

Burst fracture

Type of fracture

Teardrop # of cervical spine

Type of fracture

Hangman’s fracture of C2 vertebrae

What type of nail?

Interlocking nail with 2 screws at the top & bottom to hold in place

Name of wire & when is it used?

Intramedullary K-wire, used in children & removed once fracture heals

External fixator

Cannulated screw

Plate fixation, common in UL fractures