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Introduction to the Radiology ofIntroduction to the Radiology ofFractures and Related InjuriesFractures and Related Injuries
Matthew ChamMedical Student
University of RochesterSchool of Medicine & Dentistry
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Introduction to the Radiology ofFractures and Related Injuries
! Types: location and mechanisms of injury
! Classifications and grading
! Radiologic vs. Clinical features
! Variants
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Types of Fractures! Incomplete vs Complete
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SimpleFractures
! Alignment &displacementof fragments
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! Directions of the fracture lines
Simple Fractures
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Other terms: fracture line not seen
! Impaction, depression, and compression
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Uncommon fractures
! Stress and pathologic etiologies
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Fractures involving the growth plate! Salter-Harris Classification
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Injuries of non-articulating joints
! Acromioclavicular & coracoclavicular separation! Sprain or tears in the AC and (or) CC ligaments, resulting in AC
separation with inferior displacement of the scapula and extremity
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Anterior dislocation of the humeral head
! Depressionfractures
! Hill-Sacks& Bankartlesions
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Proximal HumeralFractures
! Classification bylocation and extentof displacement
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Fracture-dislocation of the humeral head
! Classification by anatomic location and displacement
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Distal Humeral Fractures
! Muller Classification of Extra-articular extension
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DistalDistalHumeralHumeralFracturesFractures
!! MullerMullerClassification ofClassification ofintra-articularintra-articularextensionextension
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! Posteriorelbow
Dislocations
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Radial Headfracture
! MasonClassification
I = undisplacedI = undisplaced
II = displacedII = displaced
III = comminutedIII = comminuted
IV = dislocatedIV = dislocated
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OlecranonFractures
! Horne-TanzerClassification
IA = Oblique proximal 3rdIA = Oblique proximal 3rd
IB = Transverse proximal 3rdIB = Transverse proximal 3rd
IIA = Oblique middle 3rdIIA = Oblique middle 3rd
IIB = Transverse middle 3rdIIB = Transverse middle 3rd
III = Oblique distal 3rdIII = Oblique distal 3rd
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Fractures ofthe forearm
! Monteggiafracture-dislocations
Bado classification of fracturesBado classification of fracturesof the proximal ulna:of the proximal ulna:
I = with anterior radialI = with anterior radialdislocationdislocation
II = with posterior radialII = with posterior radialdislocationdislocation
III = with lateral radialIII = with lateral radialdislocationdislocation
IV = with anterior radialIV = with anterior radialdislocation and fracturedislocation and fracture
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! Colles fracture
Fractures ofthe forearm
Fractures to the distalFractures to the distalradius, usually with lateral orradius, usually with lateral ordorsal displacement of thedorsal displacement of thedistal fragmentdistal fragment
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! Smith fractures (reverse Colle’s fractures)
Type 1Type 1 Type 2Type 2 Type 3Type 3
Fractures of the forearm
Fractures of the distal radius with volar displacementFractures of the distal radius with volar displacementand angulation of the distal fragmentand angulation of the distal fragment
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Fractures of the wrist
! Scaphoid fracturesSecond most common injurySecond most common injuryof the upper limbof the upper limb
normal scaphoid bone G
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! Bennett fracture-dislocationFractures of the hand
Intra-articular fracture of the proximal end of the first metacarpal, withIntra-articular fracture of the proximal end of the first metacarpal, withdorsal and lateral dislocation of the distal segment.dorsal and lateral dislocation of the distal segment.
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Fractures of the Proximal Femur! Intra- and Extracapsular fractures
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Blood supply of the femoral head
! Interruption of this blood supplysecondary to intracapsular fracturemay lead to osteonecrosis
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Fractures of the Proximal Femur
! Impaction of the femoral neck into the femoral head
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! Acetabular fracture ( )
! Posterior dislocation of thefemoral head
patient 1patient 1 patient 2patient 2
Posterior columnPosterior columnfx of acetabulumfx of acetabulum
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Anterior dislocation of the femoral head
patient Cpatient C
patient Cpatient C
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Fractures of the distal femur! Supracondylar, condylar, and intercondylar extension
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Fractures of thedistal femur
! intercondylar fracture
AP viewAP viewlateral viewlateral view
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Summary
! simple vs. comminuted fractures
! stress and pathologic fractures
! intra- vs. extra-articular involvement
! dislocation vs. separation
! depression fractures and associated lesions
! effects of fractures on blood supply