Topics covered include: trauma systems and management; surgical procedures; epidemiological studies; The glenohumeral joint has a greater range of motion than any other joint in the body. The PLC is injured with edema of the interspinous ligament and a torn flaval ligament (3 points). 2009 Nov 1;34(23):E841-7. At surgery the rupture of the supraspinous ligament was confirmed (red and black arrows). You have to decide what you think is the main issue: the collapse of the vertebral body or the distraction. It is important to recognise these variants, because they can mimick a SLAP tear. 2016;8(4):367-72. fractures involving a single facial buttress, Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture), Watson-Jones classification (tibial tuberosity avulsion fracture), Nunley-Vertullo classification (Lisfranc injury), pelvis and lower limb fractures by region. On MR an os acromiale is best seen on the superior axial images. Burst is the result of compression with severe axial loading. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Bickle I, Lustosa L, Iqbal S, et al. In Shoulder MR-Part I we will focus on the normal anatomy and the many anatomical variants that may simulate pathology. 4. J Fam Pract. Skinner HB. The Importance of Injury Morphology, the Integrity of the Posterior Ligamentous Complex, and Neurologic Status A recess more than 3-5 mm is always abnormal and should be regarded as a SLAP-tear. So this is a distraction fracture, also known as Chance fracture. Overall, patients are reported to have better satisfaction with surgical management with a sooner return to work/sport 9. Study the inferior labral-ligamentary complex. The Weber ankle fracture classification(or Danis-Weber classification) is a simple system for classification of lateral malleolar fractures, relating to the level of the fracture in relation to the ankle joint, specifically the distal tibiofibular syndesmosis. The Journal The concavity at the posterolateral margin of the humeral head should not be mistaken for a Hill Sachs, because this is the normal contour at this level. The sagittal reformatted image also shows the cortical disruption. The angled buckle fracture in pediatrics: a frequently missed fracture. Emerg Radiol. ORTHOPEDICS August 2010;33(8):562. by Schreinemachers SA, van der Hulst VP, Willems WJ, Bipat S, van der Woude HJ. The main feature is posterior distraction with horizontal fractures of posterior elements (red arrow), Avulsion of a spinous process (yellow arrow), The morphology is of a vertebral fracture with retropulsion of a fragment, i.e. 2009; 38(10):967-975. by Herold T, Bachthaler M, Hamer OW, et al. 2002;33 (6): 503-5. Fractures through the posterior elements (red arrows). They are usually seen in children, frequently involving the distal radial metaphysis. WebIt typically takes from 9 to 12 months for an acetabular fracture to completely heal. As a result, subtle articular-sided partial thickness tears will not lie apposed to the adjacent intact fibers of the remaining rotator cuff Here a fracture that just looks like another compression fracture on the lateral view. In some cases it can be difficult to decide whether there is a translation or distraction injury and we have to assume that the traumtic mechanism is a combination of forces. If there was a lot of fluid in the joint, we should call this indeterminate. The different morphology patterns will be discussed more in detail in the following chapter. The PLC serves as a posterior "tension band" of the spinal column and plays an important role in the stability of the spine (3). There is a spinous process fracture, which is not a key element but a frequently associated injury. 5 (2): 65-73. Case 13: bilateral neonatal clavicle fractures, Case 15: birth trauma - left clavicle fracture, Case 17: fractured clavicle and bent ORIF cannulated screw, Neer classification of clavicle fractures, Allman classification of clavicle fractures, Robinson classification of clavicle fractures, Gustilo Anderson classification (compound fracture), Anderson and Montesano classification of occipital condyle fractures, Traynelis classification of atlanto-occipital dissociation, longitudinal versus transverse petrous temporal bone fracture, naso-orbitoethmoid (NOE) complex fracture, cervical spine fracture classification systems, AO classification of upper cervical injuries, subaxial cervical spine injury classification (SLIC), thoracolumbar spinal fracture classification systems, AO classification of thoracolumbar injuries, thoracolumbar injury classification and severity score (TLICS), Rockwood classification (acromioclavicular joint injury), Neer classification (proximal humeral fracture), AO classification (proximal humeral fracture), AO/OTA classification of distal humeral fractures, Milch classification (lateral humeral condyle fracture), Weiss classification (lateral humeral condyle fracture), Bado classification of Monteggia fracture-dislocations (radius-ulna), Mason classification (radial head fracture), Frykman classification (distal radial fracture), Hintermann classification (gamekeeper's thumb), Eaton classification (volar plate avulsion injury), Keifhaber-Stern classification (volar plate avulsion injury), Judet and Letournel classification (acetabular fracture), Harris classification (acetebular fracture), Young and Burgess classification of pelvic ring fractures, Pipkin classification (femoral head fracture), American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture), Cooke and Newman classification (periprosthetic hip fracture), Johansson classification (periprosthetic hip fracture), Vancouver classification (periprosthetic hip fracture), Winquist classification (femoral shaft fracture), Schatzker classification (tibial plateau fracture), AO classification of distal femur fractures, Lauge-Hansen classification (ankle injury), Danis-Weber classification (ankle fracture), Berndt and Harty classification (osteochondral lesions of the talus), Sanders CT classification (calcaneal fracture), Hawkins classification (talar neck fracture), anterior superior iliac spine (ASIS) avulsion, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, avulsion fracture of the proximal 5th metatarsal, angulation and fracture end displacement (including direction), degree of overlap (measurement is useful), associated findings and relevant negatives. Compression is usually the result of axial force with flexion. Radiology. (2009) ISBN:1416022201. 3. Scroll through the images and notice the unattached labrum at the 12-3 o'clock position at the site of the sublabral foramen. extra-articular fracture; there may be posterior displacement of the distal segment; more: supracondylar fracture; Lateral condyle fracture. MRI (or magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. A torus is the convex portion of the upper part of the base of a Greek column and resembles the appearance of the cortical buckling seen in the "column" of bone which has been fractured in the pattern discussed in this article. The image shows a vertebral fracture with a transverse fracture of the spinous process, but also a fracture of the sternum. Sambandam B, Gupta R, Kumar S, Maini L. Fracture of distal end clavicle: A review. Injury. Study the attachment of the IGHL at the humerus. 8. You can see the edema related to the fracture of the vertebral body and the massive edema in the paraspinous muscles. The supraspinatus tendon is the most important structure of the rotator cuff and subject to tendinopathy and tears. There are 3 types of attachment of the superior labrum at the 12 o'clock position where the biceps tendon inserts. Clavicular fracture. WebGuidelines and Measures provides users a place to find information about AHRQ's legacy guidelines and measures clearinghouses, National Guideline Clearinghouse (NGC) and National Quality Measures Clearinghouse (NQMC) However, the vast majority (~75%; range 69-85%) occur in the midshaft, at or near the junction of the middle and outer third with distal clavicle fractures (15-20%) and medial clavicle fractures (<5%) less common 3,8. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Datir A, Ramsey, MD A, Lustosa L, et al. WebIt typically takes from 9 to 12 months for an acetabular fracture to completely heal. Injury of the posterior ligamentous complex of the thoracolumbar spine: a prospective evaluation of the diagnostic accuracy of magnetic resonance imaging. The interspinous ligaments are weak, thin, membranous structures connecting the adjacent spinous processes. 9. Clin Orthop Surg. For example, in a translation/rotation injury, the PLC is always involved, making a total of 3+3=6 points. by Mihai H. Vioreanu et al Notice the rigid spine and how easily this major injury can be overlooked. Check for errors and try again. 7. 40 (5): 1355-1382. Gardne MJ, Siegel JA. In part III we will focus on impingement and rotator cuff tears. Notice the fibers of the inferior GHL. The small size of the glenoid fossa and the relative laxity of the joint capsule renders the joint relatively unstable and prone to subluxation and dislocation. Radiology 2005;236:601, by Bharti Khurana Mainwaring BL, Daffner RH, Riemer BL. An Sist Sanit Navar. These descriptions may thus be misleading. In the Denis classification this would be a three column fracture -anterior/middle/posterior - indicating a very unstable fracture. Detection of partial-thickness supraspinatus tendon tears: is a single direct MR arthrography series in ABER position as accurate as conventional MR arthrography? Ossification of the spinal ligaments and calcification of the annulus fibrosus alter the biomechanics of the spine, creating long lever arms and limiting the ability to absorb even minor impacts. The Thoraco-Lumbar Injury Classification and Severity score (TLICS) is a classification system for thoracolumbar spine injuries, designed to assist in clinical management. The facet joints are separated on both sides. Unable to process the form. Citations may include links to full text content from PubMed Central and publisher web sites. 2011;45 (5): 454-8. LWW. The integrity of the posterior ligamentous complex plays an important role in the TLICS. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Weerakkody Y, Niknejad M, Bell D, et al. 7. WebAbout Our Coalition. by Clare J. Groves et al. The right facet joint looks a bit widened on the CT and there is some fluid in the joint on the MRI. Hoogervorst P, van Schie P, van den Bekerom M. Midshaft Clavicle Fractures: Current Concepts. Gustilo Anderson classification (compound fracture), Anderson and Montesano classification of occipital condyle fractures, Traynelis classification of atlanto-occipital dissociation, longitudinal versus transverse petrous temporal bone fracture, naso-orbitoethmoid (NOE) complex fracture, cervical spine fracture classification systems, AO classification of upper cervical injuries, subaxial cervical spine injury classification (SLIC), thoracolumbar spinal fracture classification systems, AO classification of thoracolumbar injuries, thoracolumbar injury classification and severity score (TLICS), Rockwood classification (acromioclavicular joint injury), Neer classification (proximal humeral fracture), AO classification (proximal humeral fracture), AO/OTA classification of distal humeral fractures, Milch classification (lateral humeral condyle fracture), Weiss classification (lateral humeral condyle fracture), Bado classification of Monteggia fracture-dislocations (radius-ulna), Mason classification (radial head fracture), Frykman classification (distal radial fracture), Hintermann classification (gamekeeper's thumb), Eaton classification (volar plate avulsion injury), Keifhaber-Stern classification (volar plate avulsion injury), Judet and Letournel classification (acetabular fracture), Harris classification (acetebular fracture), Young and Burgess classification of pelvic ring fractures, Pipkin classification (femoral head fracture), American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture), Cooke and Newman classification (periprosthetic hip fracture), Johansson classification (periprosthetic hip fracture), Vancouver classification (periprosthetic hip fracture), Winquist classification (femoral shaft fracture), Schatzker classification (tibial plateau fracture), AO classification of distal femur fractures, Lauge-Hansen classification (ankle injury), Danis-Weber classification (ankle fracture), Berndt and Harty classification (osteochondral lesions of the talus), Sanders CT classification (calcaneal fracture), Hawkins classification (talar neck fracture), anterior superior iliac spine (ASIS) avulsion, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, avulsion fracture of the proximal 5th metatarsal, Danis-Weber ankle fracture classification, below the level of the syndesmosis (infrasyndesmotic), usually stable if medial malleolus intact, distal extent at the level of the syndesmosis (trans-syndesmotic); may extend some distance proximally, tibiofibular syndesmosis usually intact, but widening of the distal tibiofibular joint (especially on stressed views)indicates syndesmotic injury, deltoid ligament may be torn, indicated by widening of the space between the medial malleolus and talar dome, variable stability, dependent on the status of medial structures (malleolus/, Weber B fractures could be further subclassified as, above the level of the syndesmosis (suprasyndesmotic), tibiofibular syndesmosis disruption with widening of the distal tibiofibular articulation, fracture may arise as proximally as the level of fibular neck and not visualized on ankle films, requiring knee or full-length tibia-fibula radiographs (, Weber C fractures can be further subclassified as, a fracture above the syndesmosis results from external rotation or abduction forces that also disrupt the joint, usually associated with an injury to the medial side. (2018) Orthopedic Traumatology. In severe pelvic fracture patients, 60.6% received transfusion, with a mean of more than 3.5 L. When severe pelvic injury was the only significant injury, more than 50% received transfusion, with a mean of 2.7 L. Overall, 16.6% of pelvic fracture patients required more than 2 L of blood in transfusion. First look at the first CT-images and decide what is going on. There is severe narrowing of the spinal canal. Indian J Orthop. Retropulsion of posterosuperior vertebral body fragment. Levine AM, Jupiter JB et-al. 7. It is present in 5% of the population. They all attach to the greater tuberosity. It is important to note that occult fractures may be present in the apparently normal radiograph; this is relatively common in children and also occasionally seen in adults 2. The primary feature is pulling apart. Sometimes a cast may be applied, but often a splint is all that is required with a period of rest and immobilization. Dr. Thomas L. Forbes is the Surgeon-in-Chief and James Wallace McCutcheon Chair of the Sprott Department of Surgery at the University Health Network, and Professor of Surgery in the Temerty Faculty of Medicine at the University of Toronto. In the absence of a neurologic deficit, PLC integrity should be confirmed at MR imaging, especially if conservative management of a burst fracture is planned (3). 3. Always go for the highest possible score in TLICS. In both cases the patient is a surgical candidate. Important aspects of evaluation include: occipital condyle integrity. of the biceps in the bicipital groove. This type of fracture includes all fractures that are the result of displacement in the horizontal plane: side-to-side motion, either left-to-right or anterior-to-posterior or side-to-side rotary motion of one vertebral body with respect to another. How would you describe the morphology and the PLC? Analogous to the 3-column classification of Denis, some investigators consider the sternum as the fourth column in upper thoracic spinal fractures and recognize it as an independent variable in the assessment and treatment of these patients (5). Fractures can occur at any part of the clavicle. The teaching point is: pay careful attention to little pieces of bone. Since the integrity of the PLC depends mostly on ligamentous structures, MR is sometimes needed to adequately diagnose pathology of the PLC, especially when there is no dislocation or disruption on CT. MRI has a tendency to overdiagnose PLC injury (4). 2006; 240(1):152-160. Pathology. The level with the highest TLICS score will determine the type of treatment. subchondral cysts and osteophytes (arrow). The American Journal of Medicine - "The Green Journal" - publishes original clinical research of interest to physicians in internal medicine, both in academia and community-based practice.AJM is the official journal of the Alliance for Academic Internal Medicine, a prestigious group comprising internal medicine department chairs at more Look for tears of the infraspinatus tendon. It is seen in 11% of individuals. It is very common to see more fractures on imaging with CT and MRI than on the radiographs. The os acromiale may cause impingement because if it is unstable, it may be pulled inferiorly during abduction by the deltoid, which attaches here. In this case the CT shows 2 fractures and the MRI shows 3 fractures. comminuted fracture: suggests impaction. The abduction external rotation (ABER) view is excellent for assessing the anteroinferior labrum at the 3-6 o'clock position, Large tears of the rotator cuff may allow the humeral head to migrate upwards resulting in a high riding humeral head. Some of the injuries thought to be due to extension mechanisms, however, turn out to be due to flexion and vice versa. Absolute indications for surgery include open fractures, patients with skin compromise or tenting, associated neurovascular injury or scapular neck fractures 9. Strictly speaking, a torus fracture refers to a circumferential buckle fracture 7. The fractures involve the medial malleolus, the posterior aspect of the tibial plafond (referred to as the posterior malleolus) and the lateral malleolus. WebPRIME Education is an accredited provider of continuing medical education. Sternum fracture That is until we zoom in and look at the distance between the spinous processes. Prop 30 is supported by a coalition including CalFire Firefighters, the American Lung Association, environmental organizations, electrical workers and businesses that want to improve Californias air quality by fighting and preventing wildfires and reducing air pollution from vehicles. A distraction injury is separation or pulling apart of two adjacent vertebrae. The affected femoral head will appear larger if the dislocation is anterior, and smaller if posterior. They usually require minimal treatment, which relies on analgesia and a collar-and-cuff. What are the findings? Indirect MR arthrography of the shoulder: use of abduction and external rotation to detect full- and partial-thickness tears of the supraspinatus tendon. Study the cartilage. Appendicitis - Pitfalls in US and CT diagnosis, Acute Abdomen in Gynaecology - Ultrasound, Transvaginal Ultrasound for Non-Gynaecological Conditions, Bi-RADS for Mammography and Ultrasound 2013, Coronary Artery Disease-Reporting and Data System, Contrast-enhanced MRA of peripheral vessels, Vascular Anomalies of Aorta, Pulmonary and Systemic vessels, Esophagus I: anatomy, rings, inflammation, Esophagus II: Strictures, Acute syndromes, Neoplasms and Vascular impressions, TI-RADS - Thyroid Imaging Reporting and Data System, The Abduction External Rotation (ABER) View for MRI of the Shoulder. Closed / Simple: A fracture is considered to be clinically healed based upon the combination of physical findings and symptoms over time. Indian J Orthop. On these axial images a Buford complex can be identified. It aims to reduce deaths and long-term health problems by The rotator cuff is made of the tendons of subscapularis, supraspinatus, infraspinatus and teres minor muscle. A problem with classifications such as the AO-classification is that they are usually complex, leading to high inter-reader variability. Trimalleolar fractures refer to a three-part fracture of the ankle. This is the severe variant of a compression fracture with higher risk of neurologic deficits. Reconstruction plate versus minimal invasive retrograde titanium elastic nail fixation for displaced midclavicular fractures. Commonly missed subtle skeletal injuries in children: a pictorial review. Minimally Invasive Orthopaedic Trauma. 2005;22 (3): 232-3. 5. 2015;111 (21): 377-88. fractures involving a single facial buttress, Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture), Watson-Jones classification (tibial tuberosity avulsion fracture), Nunley-Vertullo classification (Lisfranc injury), pelvis and lower limb fractures by region. Radiology. Notice MGHL, which has an oblique course through the joint and study the relation to the subscapularis tendon. Now in this case there are lots of other things going on, but sometimes these little pieces of bone are all you get. Wolters Kluwer 2014. J Orthop Traumatol. The fact that these little pieces of bone have been so severely displaced means there has to be a major injury. Radiologic history exhibit. Vertebral bodies show marrow edema as a result of a fracture. Unable to process the form. The small size of the glenoid fossa and the relative laxity of the joint capsule renders the joint relatively unstable and prone to subluxation and dislocation. TLICS: distraction injury + PLC disruption. Edema without clear rupture; high signal intensity of the interspinous ligaments or along the facet joints on T2 SPIR or STIR. Missed clavicular fracture; inadequate radiograph or occult fracture? elderly)3-5. However labral tears may originate at the 3-6 o'clock position and subsequently extend superiorly. A burst fracture gets 2 points for morphology in the TLICS. This is an interesting case since non-surgical management was initially attempted in this patient. The outcomes of treatment will vary from patient to patient, depending on the following: Pattern and severity of the fracture; Other injuries associated with the trauma Patient's age and bone quality; Patient's general health, including smoking status. Musculoskeletal Imaging,The Requisites (Expert Consult - Online and Print), 4th ed (2013). Radiology report. TLICS score based on imaging is 7 points: In this case there is severe compression of the vertebral body. hook of hamate fracture; Clinical presentation. It has a role in determining treatment. where most labral tears are located. Labral tears This guideline covers assessing and managing pelvic fractures, open fractures and severe ankle fractures (known as pilon fractures and intra-articular distal tibia fractures) in pre-hospital settings (including ambulance services), emergency departments and major trauma centres. Dtsch Arztebl Int. In these cases the PLC is always involved, resulting in a total of 7 points for the TLICS-score. ISBN: 9781451114744. Loss of normal low signal intensity of the ligamenta flava or supraspinous ligaments on T1 and T2. Pitfalls in diagnosing a compression fracture are: The images show two cases of osteochondrosis. A New Type of Occult Wrist Fracture? Gardne MJ, Siegel JA. Epidemiology. Retropulsion of a body fragment and the percentage of narrowing of the spinal canal. Dtsch Arztebl Int. The key point in this case is that you should not describe this morphology as burst - 2 points. There is major disruption of the PLC of both the ligamenta flava and the interspinous ligament. Notice the rotator cuff interval with coracohumeral ligament. fracture may arise as proximally as the level of fibular neck and not visualized on ankle films, requiring knee or full-length tibia-fibula radiographs (Maisonneuve fracture) unstable: usually requires ORIF; Weber C fractures can be further subclassified as 6. Traditionally midshaft fractures of the clavicle have been treated with immobilization and a sling or figure-of-8 dressing, and in most cases, results are said to be excellent with low non-union rates and minimal functional impairment 3. Look for supraspinatus-impingement by AC-joint spurs or a thickened coracoacromial ligament. The undersurface of the supraspinatus tendon should be smooth. Skeletal Trauma. Check for errors and try again. Weber C Fractures. 4. 4+3 points. A total of more than 4 points indicates surgical treatment. Pylon fractures of the ankle: a distinct clinical and radiologic entity. Skeletal Trauma. This most commonly occurs at the distal radius or tibia following a fall on an outstretched arm;the force is transmitted from carpusto the distal radiusand the point of least resistance fractures,usually the dorsal cortex of the distal radius. 20 (3): 819-36. So be sure not to underestimate the injury by only looking at the compression fracture and overlooking the distraction injury. The Weber ankle fracture classification(or Danis-Weber classification) is a simple system for classification of lateral malleolar fractures, relating to the level of the fracture in relation to the ankle joint, specifically the distal tibiofibular syndesmosis. The level with the highest TLICS score usually will be decisive for the therapy of choice. Study the labrum in the 3-6 o'clock position. Macheras G, Kateros KT, Savvidou OD, Sofianos J, Fawzy EA, Papagelopoulos PJ. (2018) Pediatric Radiology. MR is the best imaging modality to examen patients with shoulder pain and instability. Jadhav SP, Swischuk LE. The PLC is composed of the supraspinous ligaments, interspinous ligaments, articular facet capsules, and ligamenta flava (figure). Only the level with the highest score counts. Both of these commonly used systems fail to systematically take into account the neurological status of the patient and the indication for MRI to determine the integrity of the posterior ligamentous complex. Cervical spine fractures can occur secondary to exaggerated flexion or extension, or because of direct trauma or axial loading.. Check for errors and try again. When there is a distraction on the posterior side, the PLC is always involved, making a total of 4+3=7 points. The TLICS describes injury morphology as a pattern; it is not a mechanism of injury. At first glance this looks just like another burst fracture. At this level study the middle GHL and the anterior labrum. B. J. Manaster, David A. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. In cases where there is significant displacement, angulation, shortening (>2 cm or >10%)9 or comminution, internal fixation either with plate-and-screw fixation or with a medullary device (e.g. In that position the 3-6 o'clock region is imaged perpendicular. 3. Rotator cuff tears J Am Acad Orthop Surg. Look for excessive fluid in the subacromial bursa and for tears of the supraspinatus tendon. The posterior vertebral cortex is intact. Clavicular fractures are most common in young adults and elderly women 8. Then scroll to the next images. Classification. 2011;45 (5): 454-8. Fractures are best visualized on coronal and sagittal reformatted images. Assuming the neurological exam was normal, this patient would still get 7 points. Here a typical case of translation. However, the terms are often used interchangeably. MR is the best imaging modality to examen patients with shoulder pain and instability. The thickened middle GHL should not be confused with a displaced labrum. Skeletal Radiol. Dislocation of the long head of the biceps will inevitably result in rupture of part of the subscapularis tendon. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. A distraction injury on the posterior side can lead to a compression fracture on the anterior side. unstable or oblique fractures; Union rates of surgical management approach. You have to look at the thin slices to detect such a subtle fracture. 1. Due to the tension by the anterior band of the inferior GHL labral teras will be easier to detect. Internal fixation is thus probably advisable in such cases and in patients who are at risk of non-union (e.g. Usually the morphology matches the injury mechanism, but sometimes it does not. Musculoskeletal eponyms: who are those guys? The axial MR-images show an os acromiale with degenerative changes, i.e. Acute midshaft clavicular fracture. Goost H, Wimmer MD, Barg A et-al. Radiographics. An os acromiale must be mentioned in the report, because in patients who are considered for subacromial decompression, 6. www.wheelessonline.com. If compression is the main feature, then the morphology is burst, i.e. McGraw-Hill Medical. These are typical findings in translation-rotation fractures. This is all based on the premise that a fracture caused by forward flexion should be treated by undoing the flexion by positioning the patient in an extension brace, or by surgical intervention correcting the spinal column in extension. So we should call this a translation fracture with anterior displacement. The midshaft fracture dominance is due to two factors: firstly this is the thinnest part of the bone, and secondly, it is the only part of the bone not reinforced by attached musculature and ligaments 3. 28 (7): 693-6. Typical mechanism: punching (most common) fall 2018;3(6):374-80. Benjamin W. Iles, Julie B. Samora, Satbir Singh, Lynne Ruess. fractures involving a single facial buttress, Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture), Watson-Jones classification (tibial tuberosity avulsion fracture), Nunley-Vertullo classification (Lisfranc injury), pelvis and lower limb fractures by region. Distraction is the result of displacement in the vertical plane. However in this case the compression is the most prominent finding. You could call these compression fractures. EFORT Open Rev. After a fall on his back no fracture was seen on the x-rays. Gustilo Anderson classification (compound fracture), Anderson and Montesano classification of occipital condyle fractures, Traynelis classification of atlanto-occipital dissociation, longitudinal versus transverse petrous temporal bone fracture, naso-orbitoethmoid (NOE) complex fracture, cervical spine fracture classification systems, AO classification of upper cervical injuries, subaxial cervical spine injury classification (SLIC), thoracolumbar spinal fracture classification systems, AO classification of thoracolumbar injuries, thoracolumbar injury classification and severity score (TLICS), Rockwood classification (acromioclavicular joint injury), Neer classification (proximal humeral fracture), AO classification (proximal humeral fracture), AO/OTA classification of distal humeral fractures, Milch classification (lateral humeral condyle fracture), Weiss classification (lateral humeral condyle fracture), Bado classification of Monteggia fracture-dislocations (radius-ulna), Mason classification (radial head fracture), Frykman classification (distal radial fracture), Hintermann classification (gamekeeper's thumb), Eaton classification (volar plate avulsion injury), Keifhaber-Stern classification (volar plate avulsion injury), Judet and Letournel classification (acetabular fracture), Harris classification (acetebular fracture), Young and Burgess classification of pelvic ring fractures, Pipkin classification (femoral head fracture), American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture), Cooke and Newman classification (periprosthetic hip fracture), Johansson classification (periprosthetic hip fracture), Vancouver classification (periprosthetic hip fracture), Winquist classification (femoral shaft fracture), Schatzker classification (tibial plateau fracture), AO classification of distal femur fractures, Lauge-Hansen classification (ankle injury), Danis-Weber classification (ankle fracture), Berndt and Harty classification (osteochondral lesions of the talus), Sanders CT classification (calcaneal fracture), Hawkins classification (talar neck fracture), anterior superior iliac spine (ASIS) avulsion, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, avulsion fracture of the proximal 5th metatarsal, Danis-Weber ankle fracture classification, below the level of the syndesmosis (infrasyndesmotic), usually stable if medial malleolus intact, distal extent at the level of the syndesmosis (trans-syndesmotic); may extend some distance proximally, tibiofibular syndesmosis usually intact, but widening of the distal tibiofibular joint (especially on stressed views)indicates syndesmotic injury, deltoid ligament may be torn, indicated by widening of the space between the medial malleolus and talar dome, variable stability, dependent on the status of medial structures (malleolus/, Weber B fractures could be further subclassified as, above the level of the syndesmosis (suprasyndesmotic), tibiofibular syndesmosis disruption with widening of the distal tibiofibular articulation, fracture may arise as proximally as the level of fibular neck and not visualized on ankle films, requiring knee or full-length tibia-fibula radiographs (, Weber C fractures can be further subclassified as, a fracture above the syndesmosis results from external rotation or abduction forces that also disrupt the joint, usually associated with an injury to the medial side. Additionally, cosmetic concerns may be an indication for internal fixation to avoid unsightly deformity. Sagittal 2 points for morphology. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Two-thirds of patients with persistent complaints opt for further surgical intervention9. All we see is a cortical disruption in the upper anterior wall of the vertebral body and slight loss of height ventrally. A sagittal fracture of the vertebral body and a sagittal posterior element fracture is seen in respectively 90% and 85% of cases of burst fracture cases. 6. www.wheelessonline.com. fracture of vertebral body and The facet joints act against rotational forces. On the right with kyphosis. However the most important findings are the horizontal fractures of the posterior elements. This patient is at high risk of developing a spinal cord injury. Bipolar clavicular fractures occur when there are both distal and medial clavicular injuries, most commonly a distal clavicle fracture in combination with an anterior sternoclavicular joint dislocation 8. Emerg Radiol. The posterior cortex may bulge slightly posteriorly in a simple compression fracture. It has a role in determining treatment. This classification was first described by the Belgian general surgeon,Robert Danis (1880-1962), in 1949. Philadelphia : Lippincott Williams Wilkins, c2007. Browner BD. The fractures involve the medial malleolus, the posterior aspect of the tibial plafond (referred to as the posterior malleolus) and the lateral malleolus. This classification was first described by the Belgian general surgeon,Robert Danis (1880-1962), in 1949. 2. When you plan the coronal oblique series, it is best to focus on the axis of the supraspinatus tendon. Here is a patient with distraction on the anterior side. CJEM. The TLICS-score is high, because there is distraction and injury to the PLC. Treatment and prognosis. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-27657. There is widening between the spinous processes. Images in the ABER position are obtained in an axial way 45 degrees off the coronal plane (figure). The MRI demonstrates rupture of the flava ligaments, interspinous and supraspinous ligaments as well as fracture of the posterior elements and compression of the vertebral body. 5. In most trauma situations, orthogonal views of the affected bone or joint are obtained. Mohammed R, Syed S, Metikala S et-al. Scroll through the images. Radiographics. 6. Usually it is an incidental finding and regarded as a normal variant. In many cases the axis of the supraspinatus tendon (arrowheads) is rotated more anteriorly compared to the axis of the muscle (yellow arrow). Widening of the interpedicular distance, often a result of the sagittal fracture, is seen in 80% of burst fractures. 2. McGraw-Hill Medical. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 2011;12 (4): 185-92. Notice rotator cuff muscles and look for atrophy. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Bennett DL, Mencio GA, Hernanz-schulman M et-al. The MRI also shows disruption of the ligamentum flavum and a partial disruption of the interspinous ligament. intramedullary titanium elastic nail) has shown to result in a better cosmetic outcome and higher rates of union. 2005;199(1):27-9. fractures involving a single facial buttress, Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture), Watson-Jones classification (tibial tuberosity avulsion fracture), Nunley-Vertullo classification (Lisfranc injury), pelvis and lower limb fractures by region. Skeletal trauma, basic science, management, and reconstruction. In addition to reporting the presence of the fracture a number of features should be sought and in many instances commented upon as relevant negatives: 4 points. Furthermore, the word stability itself is ambiguous and may refer to direct osseous stability; it may refer to neurological stability and finally, to long-term (ligamentous) stability. 1. Differential diagnosis 2019;42(1):69-73. On the AP-view notice the subtle widening of the interpedicular distance compared to the levels above and below. In the Denis classification a burst fracture is classified as a two-column injury, calling it unstable and requiring surgical stabilization. posterior element. Should we just splint and go? Notice that the supraspinatus tendon is parallel to the axis of the muscle. The role of the radiologist is to report the following: One of the key points here is that an incomplete cord lesion will likely benefit more from surgery than a complete lesion; therefore a complete cord injury is scored as only 2 points, while an incomplete cord injury gets 3 points. Notice that the biceps tendon is attached at the 12 o'clock position. Avulsion fractures or transverse fractures of spinous processes or articular facets. The supraspinous ligament is a strong, cordlike ligament which connects the tips of the spinous processes from C7 to the sacrum. It is common for clavicle fractures to be displaced due to a combination of the weight of the upper limb pulling the distal fragment down and the sternocleidomastoid pulling the medial fragment upwards. A sublabral recess however is located at the site of the attachment of the biceps tendon at 12 o'clock and does not extend to the 1-3 o'clock position. Look for rim-rent tears of the supraspinatus tendon at the insertion of the anterior fibers. Skinner HB. 1. 1. Ankle joint dislocation treating dislocated trimalleolar fractures accompanied with the complex posterior malleolus fracture without separation of the tibiofibular syndesmosis. In either case the TLICS-score is high and this patient is a surgical candidate. W B Saunders Co. (2003) ISBN:0721691757. (2007) ISBN:0781766206. Posterolateral corner injury is thought to account for approximately 16% of acute injuries of the knee 4,5.It is often seen in sports-related injuries and mostly related to direct anteromedial tibial impact trauma, but is also caused by hyperextension and external rotation injuries, non-contact varus stress injuries, and 5. Based on imaging alone, the TLICS score is 5 points and this patient is a surgical candidate. 3. Browner BD. Dr. Tom Forbes Editor-in-Chief. So here is a typical case of distraction. They result from trabecular compression due to an axial loading force along the long axis of the bone. the removal of the acromion distal to the synchondrosis may further destabilize the synchondrosis and allow for Relative indications include the age of the patient and their activity level, their hand dominance and occupation (e.g. But there are also little pieces ofbone, that have avulsed at least 10mm away. 2007;15 (4): 239-48. While it is not unusual for only a single AP film to be obtained, ideally, as with any trauma situation, two views are better than one. 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