19. TRAUMA
Time intervals between Radiographic Study
Initial Diagnostic study
Post reduction and post immobilization
One or Two weeks later, if position has
changed
After approximately six eight weeks for
Primary callus
After each plaster cast or traction change
Before final discharge of patient
20. TRAUMA
Types of Fracture
Closed fracture
Does not break the skin or communicate
with the outside environment
Simple fracture
Open fractur
Penetrates the skin over fracture site
Compound fracture
21. TRAUMA
Comminuted
fracture
Two or more bony fragments have separated
Non Comminuted fracture
Penetrates completely through the bone
Avulsion fracture
Tearing away of a portion of the bone
Impaction fracture
Bone is driven into its adjacent segment
22. TRAUMA
Incomplete Fracture
Broken only one side of the bone
Greenstick (Hickory Stick) fracture
Torus (Buckling) fracture
Fracture Orientation
Oblique fracture
Commonly occurs in the shaft of long
tubular bone
45 to the long axis of the bone
25. TRAUMA
Spiral fracture
Torsion, coupled with axial compression
and angulation
Transverse fracture
Run at a right angle to the lonh axis
Uncommon through healthy bone
Pathologic fracture
27. TRAUMA
Spatial Relationships of Fracture
Alignment
Position of the distal fragment in relation
to the proximal fragment
Apposition
Closeness of the bony contact at the
fracture site
If the ends are pulled referred to as
Distraction
38. INFECTION
Radiologic Features
Bone scan are the earliest means of
diagnosis
Radiographic latent period for plain film
10 days for extremities
21 days for spine
Soft tissue alteration : elevated fat planes,
obliterated fat planes, increased density.
39. INFECTION
Bone changes :
Moth-eaten bone destruction
Usually metaphyseal in origin
Periosteal new bone formation
Solid – Laminated – Codman’s Triangle
Sequestrum
Involucrum
Joint space destruction (ankylosis)
42. INFECTION
Septic Arthritis
General consideration
Single joint involvement in the rule
Most common route is hematogenous
or direct traumatic implantation
Etiology
Most frequently is Staphylococcus Aureus
43. INFECTION
Radiologic Features
The knee and hip are the most common
sites
Joint effusion leads to distortion of the
fat folds
Positive Walden storm's sign
Rapid loss of joint space
Bony ankylosis
46. INFECTION
Radiologic Features
Spinal tuberculosis is most common at L-I
Early sign for spine are :
Lytic endplate destruction
loss of disc height
Anterior “ gouge defect “
Paraspinal swelling
47. INFECTION
Advanced sign for spinal involvement are:
Vertebral body collapse
Gibbus formation and obliteration of the
disc
Tubercular arthritis is common in the hip and
knee
Uniform joint space narrowing, early destruction
of the subchondral cortex, “moth-eaten” bone
destruction and juxtaarticular osteoporosis are
the cardinal sign of tubercular arthritis
50. TUMORS AND TUMORLIKE
PROCESSES
METASTATIC BONE TUMORS
PRIMARY MALIGNANT BONE TUMORS
Multiple myeloma
Osteosarcoma
Ewing’s Sarcoma
PRIMARY QUASIMALIGNANT BONE
TUMOR
Giant Cell Tumor
51. TUMORS
PRIMARY BENIGN BONE TUMORS
Osteochondroma
Osteoma
Bone island
Osteoid osteoma
Simple bone cyst
Aneurysmal bone cyst
52. TUMORS
Metastatic Bone Tumors
General Consideration
The most common malignant tumors
CNS tumors and basal cell Ca rarely
Life threatening complication
Incidence
70% are metastatic, 30% are primary
In females 70% from breast Ca
In males 60% from prostate Ca
53. TUMORS
Radiologic Features
Technetium bone scan
80% of all metastases are located in the
central or axial skeleton
- Spine and Pelvis being a most common
Alteration in bone density and architecture
75% osteolytic, moth eaten or permeative
15% osteoblastic
Periosteal response is rare
55. TUMORS
Primary Malignant Bone Tumors
Multiple Myeloma
Bone scan are cold
Gross Osteoporosis may be the only early
sign
Punched out lesions
Vertebra plana or wrinkled vertebra
Preservation of pedicles
58. TUMORS
Osteosarcoma
75% of cases occurs in the 10 to 25 age
Metaphysis of the distal femur, proximal
humerus are the most common sites
Permeative or ivory medullary lesion in
metaphysis of a long tubular bone
A sunburst or sunray periosteal response
Cortical disruption with soft tissue mass
formation
Sclerotic – Lytic – Mixed lesion
61. TUMORS
Ewing’s Sarcoma
Most cases occur in the 10 – 25 age range
May mimic infection
Diaphyseal permeative lesion
Femur, tibia and fibula
Onion skin periosteal response
Most common primary malignant bone
tumor to metastasize to bone
65. TUMOR
Primary Benign Bone Tumors
Osteochondroma
Painless and hard mass near a joint
Humerus, tibia, femur, ribs
Two types : - sessile
- pedunculated
Coat hanger exostose – cauliflower mass
The cortex and spongiosa blend
imperceptibly
69. TUMOR
Bone Island
Epiphyseal, metaphyseal
Medullary
Round – oval : Long axis oriented
Smooth or radiating border
Opaque
Normal adjacent cortex
May change size
70. TUMOR
Osteoid osteoma
Consists a nidus, that usually 1 cm or less
Target calcification
Most common location is in the cortex
Radiolucent nidus surrounded by perifocal
reactive sclerosis
