Você está na página 1de 12

CD B [RADIO]: IMAGING OF THE UPPER AND LOWER EXTREMITIES

MARCH 2018

TYPES OF FRACTURE  Above


 ~75% (by far the most common)
 Fracture passes across most of the growth plate and up through
the metaphysis
 Good prognosis

Type III
 Lower
 7-10%
 Fracture plane passes some distance along the growth plate and
down through the epiphysis
 Poorer prognosis as the proliferative and reserve zones are
interrupted

Type IV
 Transverse fracture: A fracture that is at a right angle to the  Through or transverse or together
bone's long axis.  Intra-articular
 Oblique fracture: A fracture that is diagonal to a bone's long  10%
axis.  Fracture plane passes directly through the metaphysis, growth
 Spiral fracture: A fracture where at least one part of the bone plate and down through the epiphysis
has been twisted.  Poor prognosis as the proliferative and reserve zones are
 Comminuted fracture: A fracture in which the bone has broken interrupted
into a number of pieces.
Type V
 Impacted fracture: A fracture caused when bone fragments are
 Ruined or rammed
driven into each other.
 Uncommon <1%
 Crushing type injury does not displace the growth plate but
SALTER HARRIS FRACTURE
damages it by direct compression
 Worst prognosis

 Can be remembered by the mnemonic SALTR


 Important to recognize in children

Type I
 Slipped
 5-7%
 Fracture plane passes all the way through the growth plate, not
involving bone
 Cannot occur if the growth plate is fused
 Good prognosis

Type II

Page 1 of 12
“Vitanda est improba siren desidia”
CD B: RADIO | IMAGING OF THE UPPER AND LOWER EXTREMITIES
MARCH 2018

CLAVICLE
 Between sternoclavicular and acromioclavicular joints
 Chest x-ray
 Clavicle overlies the lung apices
 Distance of the medial end of the clavicle and spinous
process of the vertebra is equal on both sides unless patient
is rotated

BONES OF THE UPPER LIMB


 Scapula
 Clavicle
 Humerus
 Radius
 Ulna
 Carpals
 Metacarpals  Clavicular fracture
 Phalanges  Most common is the middle 3rd clavicle which can be
complete and incomplete fracture

SCAPULA
 Flat, triangular bone with 3 processes
 Glenoid process
 Spine
 Separates the supraspinous from the infraspinous
fossae
 Extends laterally as the acromion
 Coracoid process
 Radiologic features:
 Plain x-ray
 Scapula lies over the ribs and some of the lung fields in PA
chest x-ray unless the shoulders are rotated

HUMERUS
 Head of the humerus is separated from the greater and lesser
tubercles by the anatomical neck
 Bicipital groove: between the tubercles for the long head of
the biceps
 Surgical neck: narrow shaft just below the tubercles
 Deltoid tuberosity
 On the lateral aspect of the midshaft
 Site of insertion of the deltoid muscle
 Distal end of the humerus: medial and lateral epicondyles
 Capitulum: articular surface or the elbow joint for articulation
with the radial head
 Trochlea: for the olecranon fossa of the ulna

Page 2 of 12
“Vitanda est improba siren desidia”
CD B: RADIO | IMAGING OF THE UPPER AND LOWER EXTREMITIES
MARCH 2018

SHAFT

SURGICAL NECK
RADIUS & ULNA
 RADIUS
 Has a cylindrical head that is separated from the radial
tubercle and the remainder of the shaft by the neck
 Lower end is expanded -- most distal part is radial styloid
 ULNA
 Upper part of the ulna (olecranon) is hookshaped, with the
concavity of the hook (trochlear fossa) anteriorly
 Styloid process at the distal end is narrower and more
proximal than that of the radius

 Proximal humeral fractures are most common in older


populations and especially in those who are osteoporotic

Page 3 of 12
“Vitanda est improba siren desidia”
CD B: RADIO | IMAGING OF THE UPPER AND LOWER EXTREMITIES
MARCH 2018

COLLES’ FRACTURE
 MOI: fall on an outstretched arm
 Fracture of the distal radius and ulna with dorsal angulation

SMITH’S FRACTURE
 MOI: fall on an outstretched arm
 Fracture of the distal radius and ulna with ventral angulation

MONTEGGIA FRACTURE
 Fracture of the proximal third of the ulna with dislocation of the
head of the radius

GALLEAZZI FRACTURE
 Fracture of the radius with distal ulnar dislocation

Page 4 of 12
“Vitanda est improba siren desidia”
CD B: RADIO | IMAGING OF THE UPPER AND LOWER EXTREMITIES
MARCH 2018

CARPAL BONES
 Arranged in two rows of four each
 Form an arch, with its concavity situated anteriorly
 Flexor retinaculum converts the arch of bones into a tunnel --
carpal tunnel
 Conveys the superficial and deep flexor tendons of the
fingers and the thumb (except flexor carpi ulnaris and
palmaris longus tendons) and the median nerve
 Radiography
 Radiographed in the anteroposterior, lateral and oblique
positions
 Supernumerary bones
 Found in the wrist
 Os centrale THUMB (BENNETT’S FRACTURE)
 Found between the scaphoid, trapezoid and capitates  Fracture at the base of the thumb
 Intra-articular fracture/dislocation of base of 1st metacarpal
 May represent the tubercle of the scaphoid that has
 Small fragment of 1st metacarpal continues to articulate with
not fused with its upper pole
 Os radiale externum trapezium
 Lateral retraction of 1st metacarpal shaft by abductor pollicis
 Found on the lateral side of the scaphoid distal to the
longus
radial styloid
 Nutrient arteries of the scaphoid

METACARPALS AND PHALANGES


 Five metacarpals are numbered from the lateral to medial
 Third metacarpal has a styloid process extending from its base
on the dorsal aspect
 Each metacarpal has a rounded head distally, which articulates
with the proximal phalanx
 Phalanges are 14 in number, three for each finger and two for
the thumb
 Each has a head, a shaft and a base ROLANDO’S FRACTURE
 Distal part of the distal phalanx is expanded as the tuft  Comminuted fracture of the base of the thumb
 Intra-articular
 Prognosis: worse than Bennett's fracture (difficult to reduce)

Page 5 of 12
“Vitanda est improba siren desidia”
CD B: RADIO | IMAGING OF THE UPPER AND LOWER EXTREMITIES
MARCH 2018

PHALANGES (SPRAINS & DISLOCATIONS)

BOXER’S FRACTURE
 Fracture of the 2nd to 5th metacarpals
 The end of the 5th metacarpal takes the force of impact and
breaks at its neck and angulates towards the palm creating a SHOULDER (GLENOHUMERAL JOINT)
dorsal bump
 A ball-and-socket synovial joint
 Articular surfaces
 Head of the humerus
 Glenoid cavity of the scapula
 Synovium
 Ligaments

PHALANGES (FRACTURES)

Page 6 of 12
“Vitanda est improba siren desidia”
CD B: RADIO | IMAGING OF THE UPPER AND LOWER EXTREMITIES
MARCH 2018

SHOULDER DISLOCATION ELBOW JOINT


 Anterior
 A synovial hinge joint
 Most common
 Incorporates the humeroulnar, the humeroradial and
 When arm is forcibly externally rotated and abducted
superior radioulnar joints as one cavity
 AP film – humeral head lie inferiorly and medially to the
 Articular surfaces
glenoid
 Trochlea and capitulum of the humerus
 Hill Sachs deformity
 Head and ulnar notch of the radius and the trochlear fossa,
 Indentation on the posterosuperior portion of the
 Radial notch of the ulna
head
 Plain radiographs
 Indicates repetitive shoulder dislocation
 Capsule of the elbow joint is lax anteriorly and posteriorly
 Bankart deformity
 Effusion within the joint causes distension of the capsule
 Bony irregularity or fragment off the inferior glenoid
anteriorly and posteriorly
fossa
 Fat pads anterior and posterior to the joint are displaced
away from the joint by an effusion and become visible as
linear lucencies that are separated by soft-tissue densities
from the bones on a lateral radiograph
 Anterior fat pad may be normally seen
 A posterior fat pad, when seen, is pathological

 Posterior
 Difficult to diagnose
 AP film – normally, humeral head slightly overlaps the
glenoid, forming the crescent sign  in posterior
dislocation, this crescent appearance is lost

 Acromio-clavicular (AC) dislocation


 Widening of the joint space of > 3 mm secondary to
disruption of the AC ligament
 MOI: fall on shoulder

Page 7 of 12
“Vitanda est improba siren desidia”
CD B: RADIO | IMAGING OF THE UPPER AND LOWER EXTREMITIES
MARCH 2018

Supracondylar BONY PELVIS AND HIP JOINT


 The bony pelvis consists of a ring formed by:
 Paired innominate bones - composed of three parts:
 Ilium, ischium, and pubis
 Sacrum
 Coccyx
 Paired sacroiliac joints - posteriorly
 Pubic symphysis – anteriorly
 Sacroiliac joints
 Symphysis pubis
 Hip joint
 Note: the fovea capitis, where the ligament of the head
(ligamentum teres) is attached, is not covered in cartilage
 Plain radiography
 Relies mainly on the anteroposterior (AP) view and several
landmarks should be identified.
 Shenton’s line: is a smooth curve running from the medial
aspect of the femoral neck to the superior border of the
obturator foramen.
 The iliopectineal line and ilio-ischial lines should also be
smooth symmetrical arcs.
 The posterior and anterior rims of the acetabulum and the
acetabular “teardrop”.
 Kohler’s “teardrop distance” should be less than 11 mm,
and there should not be a difference of more than 2 mm
Posterior fat pad sign between the two sides

LOWER EXTREMITIES Discontinuity of Shenton’s line

Page 8 of 12
“Vitanda est improba siren desidia”
CD B: RADIO | IMAGING OF THE UPPER AND LOWER EXTREMITIES
MARCH 2018

IMAGING OF THE PELVIS AND HIPS  Ultrasound


 Able to detect small amounts of fluid within the joint;
 General Radiography
 A lateral film is often required to rule out subtle fractures the anterior surface of the femoral neck within the joint
of the femoral neck. capsule is accessible to high resolution scanning.
 CT
 A “frog” lateral is sometimes obtained using an AP
 Particularly useful in the evaluation of complex bony
radiograph with the hip abducted and externally rotated so
injuries of the pelvis, sacro-iliac joints and for identifying
that the knee is lying nearly on the table top.
bony fragments in the acetabulum.
 The frog lateral is particularly useful in assessing the
 MRI
femoral capital epiphyses in children and comparing one
 Increasingly being used to make the early diagnosis of
side with the other.
avascular necrosis of the hip, a condition for which MR has
 Other views occasionally used include oblique (Judet’s)
a high sensitivity and specificity. It is also able to
views of the acetabulum and pelvic inlet and outlet views
characterize the soft tissues, ligaments, and the acetabular
in cases of pelvic trauma.
labrum.

THIGH
 Femur
 The femur consists of a shaft, a neck, and a head, which
articulates with the acetabulum.
 The patella is a flattened sesamoid bone within the
quadriceps tendon.

Posterior Dislocation

Anterior Dislocation

FEMORAL NECK FRACTURES


 Common in elderly
 Resulting from simple fall
 Subcapital and intertrochanteric fractures – most common

Page 9 of 12
“Vitanda est improba siren desidia”
CD B: RADIO | IMAGING OF THE UPPER AND LOWER EXTREMITIES
MARCH 2018

Shaft (middle third) IMAGING OF THE KNEE


 Plain radiography
 Able to demonstrate the bony contours of the joint space.
 If an abnormality of the patella is suspected, it should be
imaged by the “skyline” view, a tangential view taken with
the knee flexed.
 MRI
 Most useful imaging technique.
 It demonstrates the joint cavity, meniscus, ligaments, and
articular cartilage very well.

Supracondylar Fracture

 Dynamic scanning of the knee is also possible with modern


scanners, which allow assessment of patellar tracking.
 Ultrasound scanning
 May be used to assess the patellar tendon, the collateral
ligaments and meniscal and popliteal cysts.

KNEE JOINT
 Modified hinge joint
 This synovial joint is the largest in the body
 Comprises two condylar joints between the femoral and
corresponding tibial condyles and a saddle joint between the
patella and the femur.
 The tibiofemoral compartments are each divided by a
fibrocartilaginous meniscus.
 Medial meniscus is larger and more semicircular
 Lateral is smaller, thicker and forms a nearly complete ring.
 Meniscal tear
 Menisci elongated triangles in profile
 Uniformly black or of low signal intensity signal extending
to and through surface of the meniscus
 Bucket-handle tear medial meniscus - most common KNEE FRACTURES
 Lies beneath and parallel to the posterior cruciate ligament
(PCL), double PCL'' sign of buckethandle meniscus tears
 Flipped meniscus ''sign ,torn posterior horn of the meniscus
flipped or inverted anteriorly

Page 10 of 12
“Vitanda est improba siren desidia”
CD B: RADIO | IMAGING OF THE UPPER AND LOWER EXTREMITIES
MARCH 2018

PATELLAR DISPLACED FRACTURE

TIBIAL AND FIBULAR FRACTURE

PATELLAR DISLOCATION

ANKLE JOINT

LOWER LEG
 The tibia and fibula
 These are joined by a tough fibrous interosseous
membrane.
 They give rise to the attachments of many of the muscles
of the lower leg.
 The tibiofibular joints
 Superior tibiofibular.
 Inferior tibiofibular joint

Page 11 of 12
“Vitanda est improba siren desidia”
CD B: RADIO | IMAGING OF THE UPPER AND LOWER EXTREMITIES
MARCH 2018

ANKLE FRACTURE

FOOT

 Lisfranc’s fracture
 Serious fracture in the foot
 Fracture-dislocations of the tarsometatarsal joints

Page 12 of 12
“Vitanda est improba siren desidia”

Você também pode gostar