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Why is it important to know skeletal trauma and surgical radiography terms?
- Allows technologist to understand:
- which type of injury or fracture is suspected
- which projection to make
- how to avoid positioning that could cause pain or injury
Dislocation / luxation
- Bone is displaced from a joint
- Movement of these parts could be painful and must be avoided
- Get two projections, 90 degrees apart to show degree of separation
If dislocated joint has relocated, are x-rays still necessary?
- Damage could have still occurred
- Get two projections, 90 degrees apart
Nursemaid's Elbow / Jerked Elbow
- Partial dislocation of radial head of child's elbow, due to hand / wrist being sharply jerked by an adult.
- Frequently reduced when forearm is supinated for AP elbow projection.
Forced wrenching or twisting of a joint that results in a partial rupture or tearing of supporting ligaments, without dislocation.
Possible damage caused by sprain
- May result in severe damage to associated:
- blood vessels
Bruise type of injury with possible avulsion fracture.
A break in the bone.
Positioning of possible fractures
- Use caution when moving possible fractures parts
- Never force a potentially fractured limb or body part into position
- Adapt positioning as needed
Describes the manner in which the fragmented ends of the bone make contact with each other.
Ends of the broken fragments make end-to-end contact.
Lack of apposition
Ends of fragments are aligned but pulled apart and are not making contact with each other.
- Fragments overlap and the shafts make contact, but not at the fracture ends.
- (Bont. 573)
- Loss of alignment of the fracture.
- Long bone fragments at angles to each other.
Kind of like, if a straight bone is broken into a kind of sideways V shape. If the point of the V points toward the midline of the body or away from midline of body.
Break opens away from midline of the body, apex of the now broken bone points away from midline of the body.
Break opens toward midline of body, apex of now broken bone points towards midline of body.
Simple / closed fracture
Bone does not break through the skin.
Compound / open fracture
Portion of broken bone protrudes through the skin.
Bone is not broken all the way through / not broken all the way across.
- Incomplete fracture.
- Buckle of cortex ( outer portion of the bone ) with possibly little or not displacement.
- No complete break in cortex.
- Fracture is on one side of bone only.
- Coretex on only one side of bone is broken, other side is bent.
- Happens most often to young children whose bones are still rubbery.
Break is complete across entire bone.
Fracture is transverse across bone, at near right angles to long axis of the bone.
Fracture passes through bone at oblique angle.
Bone has been twisted apart and the fracture spirals around the long axis.
- Bone is splintered or crushed at site of impact.
- Results in two or more fragments.
Bone is broken at two places, creating three bone segments from an original one.
- Two fragments oneacy side of a main, wedge-shaped, separate fragment.
- Kind of a Y-shaped break transverse across a long bone.
Bone is splintered into thin, sharp fragments.
- One fragment is firmly driven into the other.
- I.E. shaft of a long bone being driven into the head of that bone.
- Common at distal or proximal ends of femur, humerus, radius.
Intra-articular fracture of posterior lip of distal radius.
Baseball / mallet fx
Fracture of distal phalanx caused by ball striking the end of an extended finger (ouch).
- Longitudinal fracture of the base of the first metacarpal, with fracture line entering the carpometacarpal joint.
- Usually includes posterior dislocation of subluxation.
- Thumb is forced backwards during partial flexion.
- Usually involves distal fifth mecatarpal
- Apex posterior angulation
- Best demonstrated on lateral view
- Usually happens from punching someone or something.
- Distal radius is fractures with the distal fragment displaced posteriorly.
- May result from forward foll on an outstretched arm.
- "Dinner fork" deformity?
Smith's fx / reverse Colles' fx
- Distal fragment of radius displaced anteriorly.
- Commonly results from backward fall on outstretched hand.
- Complete fracture of the distal fibula with major injury to the ankle joint.
- Includes ligament damage.
- Frequently includes fracture of distal tibia or medial malleolus.
- Fragment of bone is separated or pulled away by the attached tendon or ligament.
- Results from severe stress to a tendon or ligament in a joint region.
Blowout and / or tripod fx
- Fracture of the orbital floorand lateral orbital margins.
- Result from direct blow to the orbit and / or maxilla and zygoma.
- Involves isolated bone fragment.
- Not the result of ligament stress.
- Vertebral body collapses or is compressed.
- Caused by compression type injury.
- Appears on radiograph as decreased vertical dimension of the anterior vertebral body.
Depressed fx / ping pong fx
- Depressed fragment of skull.
- Resembles a dented ping pong ball?
- Fracture through the epiphyseal plate.
- One of the most easily fractures sites in long bones of children.
- Radiologists may use Salter-Harris classification (scale of 1 - 5) to to describe severity and reasonable indication of prognosis.
Fracture due to a disease process within the bone ( osteoporosis, neoplasia ).
- Fracture lines radiate from a central point of injury, with a starlike pattern.
- Most commonly happens on patellas.
- Often caused by knees hitting dash board during a car accident.
Stress or fatique fx / march fx
- Nontraumatic fracture due to repeated stress on a bone such as running or marching.
- If running - fracture at distal shaft of tibia.
- If marching - mid-shafts of metatarsals.
Fracture of medial malleolus, lateral malleolus, and posterior lip of distal tibia.
Tuft fx / burst fx
- Comminuted fx of distal phalanx.
- May be caused by crushing blow to distal finger or thumb.
- Hitting finger or thumb with hammer.
- Fracture fragments are realigned by manipulation ( ouch ) and ar immobilized by a cast or splint.
- Nonsurgical procedure.
- Surgical procedure.
- For severe fractures with significant displacement or fragmentation.
Small to medium plaster cast
Increase exposure by...
+5 to +7 kV
Large plaster cast
Increase exposure by...
+8 to +10 kV
Increase exposure by...
+3 to +4 kV
Fracture occurring in abnormal bone which is weakened by disease.
Avulsion fracture of a small fragment of bone from the corner of a bone.
Growth Plate Fracture
- Break in growth plate cartilage. May not be apparent unless there is separation of growth plate from adjacent bone.
- Growth plate fractures may result in altered length of affected bone.
Slipped Capital Femoral Epiphysiss
- Growth plate injury
- Femoral head slips posteriorly and inferiorly from neck of femur at growth plate of young femur.
Fracture of proximal third of ulnar shaft with anterior dislocation of radial head.
Fracture of proximal radius with dislocation of distal radial-ulnar joint.
Disruption of snydesmosis between distal tibia and fibula with fracture of proximal third of fibula.
- Compression fracture of the humeral head
- Occurs on the superior and posterior head of humerus after anterior dislocation with scapula.
- If not detected and repaired, could lead to increased incidence of future dislocations.