Self-assessment in axial skeleton musculoskeletal trauma X-rays
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Lipohemarthrosis is strongly associated with intra-articular fracture. It may occur also in a marked bony contusion or ligamentary lesion. In lipohemarthrosis, fat and blood are released into the joint from the bone marrow, creating a fat-blood level. The lateral image shows lipohemarthrosis and a lateral tibial plateau fracture.
A tibial plateau fracture is a common knee fracture. Subtle fractures may be missed in a knee X-ray.
Synonyms and antonyms of axial skeleton in the English dictionary of synonyms
When in doubt, a CT scan should be made e. Be aware that there is a reasonable chance that tibial plateau fractures will be underestimated on conventional images. CT scans are required for more reliable Schatzker classifications fig. However, CT scan also reveals a fracture of the medial tibial plateau. Therefore, this is actually a type V Schatzker tibial plateau fracture. Lateral image with horizontal beam. Transversal patellar fracture with significant dislocation. Also note the lipohemarthrosis in the suprapatellar recess.
When a patellar fracture is suspected, an axial sunrise image should always be made. Be aware of bipartite patella as a normal variation. A fracture has an irregular cortex interruption vs. AP image, lateral image mediolateral projection and axial image. The vertical fracture is clearly visible on the axial image and subtly identifiable on the AP image.
The anterior cruciate ligament inserts on the medial tubercle medial tibial spine of the intercondylar eminence. The intercondylar eminence has not yet fully ossified in children. Following excessive stress, an avulsion fracture may develop on the anterior cruciate ligament fig.
Think of e. An intercondylar eminence fracture may occur in the elderly also, particularly in the presence of osteoporosis. Concomitant meniscus and ligamentary damage may be present. However, this occurs more frequently in adults after high-energy trauma.
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AP image and lateral image mediolateral projection of an intercondylar eminence fracture. A segond fracture is an avulsion fracture on the outer side of the lateral tibial plateau and may develop following internal rotation in combination with varus stress fig. Debate continues on which structures are exactly involved in this type of avulsion fracture. It was originally held that an avulsion of the middle third part of the lateral joint capsule occurs. Others now believe it is a more complex avulsion that may also involve the iliotibial ligament and a portion of the lateral collateral ligament.
A Segond fracture is highly associated with rupture of the anterior cruciate ligament. Repetitive microtrauma and traction of the patellar tendon at the level of the tibial tubercle may lead to Osgood-Schlatter disease. The clinical rationale and local pain symptoms are usually sufficient for diagnosis. A knee X-ray may appear entirely normal. The classical radiologic picture of Osgood-Schlatter disease is fragmentation of the tibial tubercle and local soft tissue swelling fig.
There may also be obliteration of the caudal portion of Hoffa's fat pad secondary to infrapatellar bursitis. Lateral image mediolateral projection of the right knee. The lead marking indicates patient's local pain symptoms. Fragmentation of the tibial tubercle and local soft tissue swelling consistent with Osgood-Schlatter disease. A number of predisposing factors to patellofemoral instability:. Patient with habitual patella luxations. The axial image shows a subluxated position towards lateral. Markedly superficial trochlea, consistent with trochlear dysplasia. Chronic instability of the patellofemoral joint may lead to progressive cartilage damage and eventually severe osteoarthritis.
The exact etiology has not been elucidated. It is likely a multifactorial process consisting of genetic factors, growth abnormalities and chronic subchondral stress.
Self-assessment in Axial Skeleton Musculoskeletal Trauma X-rays
The cartilage is still intact stable in A. Instability may lead to a free body corpus liberum D. The literature describes various laparoscopic and non-laparoscopic classifications not addressed here. Intact cartilage suggests stability; a cartilage defect suggests instability.
An OCD may develop in various joints including ankle and elbow but is most common in the knee joint. The next chapter looks at reviewing trauma cervical spine radiographs. Then is presented a series of trauma cases of the axial skeleton, on which you are asked to write reports, plus sometimes answer a few questions, the answers are over the page. This section is divided into six chapters; trauma cases of the pelvis; of the hip and femur; the cervical spine; dorsal and lumber spine; the skull, facial bones and mandible 15 cases in each chapter ; the last chapter being 25 mixed cases.
Although it is preferably to work your way through the book from start to finish; if you feel you need revision on say cervical spine radiographs, then you can flick to the chapter on reviewing the cervical spine and next to the cases on cervical spine. Each case has appropriate clinical history although this may not be the original history in order to anonymous the case.
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All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without either the prior permission of the publishers or a licence permitting restricted copying in the United Kingdom issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London, W1T 4LP. Any person who does any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages.
Clinical practice and medical knowledge constantly evolve. Standard safety precautions must be followed, but, as knowledge is broadened by research, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers must check the most current product information provided by the manufacturer of each drug to be administered and verify the dosages and correct administration, as well as contraindications.
It is the responsibility of the practitioner, utilising the experience and knowledge of the patient, to determine dosages and the best treatment for each individual patient. Any brands mentioned in this book are as examples only and are not endorsed by the Publisher. To the Radiology departments of Leeds General Infirmary, and Wharfedale General Hospital, for their continued support and the use of radiographs in this book. In memory of my beloved mother, Marjorie Wainford, who has not long left this world.
Her courage and strength of mind through difficulties will always be an inspiration to me. Many radiographer practitioners are now continuing to expand their reporting skills from the appendicular skeleton to include the axial skeleton in trauma.
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Other allied professions may also be reviewing axial skeleton trauma radiographs, for instance nurse practitioners particularly in cases of hip trauma, in our trust , physiotherapists, etc. Many radiographers initially fear reviewing axial skeleton radiographs, understandably, as missing an injury may have dire consequences.
http://erstwhile.jeamland.net/sitemap8.xml But with training, audit and care this fear can be overcome; and one can look forward to the challenge of axial radiograph reporting. It can be a revision book, or help in preparation for an assessment. However you use it, I hope it will encourage you to read more and research more into musculoskeletal trauma. As axial trauma radiographs can be difficult to review, the book starts with several chapters, to introduce or revise specific axial trauma.
The first chapter discusses mechanisms of injury of major trauma and is written by Katy Johnson, a Radiographer Practitioner working at Leeds General Infirmary. This is followed by a chapter on pelvic trauma. Would you like to change to the United States site? Andrew K. Brown , David G.
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