1. MSK Trauma
.Prof.Dr.Hesham Kotb
.Professor of Radiodiagnosis, Alex. University

2. Osseous Trauma
1) Acute Osseous Trauma:
1- Complete Fractures.
2- Incomplete Fractures
3- Radiologically Occult Fractures:
a) Bone contusions
b) Avulsion Fractures.
2) Chronic Osseous Trauma:
a) Insufficiency Fractures.
b) Fatigue Fractures.

3. Radiologically Occult Fractures
Imaging Modalities:
1)
2)
3)
•
•
Conventional Radiography: Mostly negative in many acute
and chronic osseous injuries ( Occult injuries)‫ز‬
Radioisotope Scanning :
It has Limitations
- Can be falsely negative foe 24-72 hours after injury.
- Positive scan is non-specific.
- Examination requires 4-6 hours , so delay diagnosis.
MRI: is highly sensitive. A normal MRI excludes the presence
of an osseous injury.
Linear low signal T1 with low signal edema.
High signal (edema) T2 with linear low signal (fracture line)

4. Acute Osseous Trauma
A) Impaction Injuries:
1- Contusion: bone contusion or bruises.
STIR or fat Sat T2 == focal areas of
increased signal- easily missed on non-fat
Sat spin echo T2 as edema and
surrounding fat display similar intensities.
• Sites: ACL tear –Patellar Dislocation

5. Acute Osseous Trauma
• 2- Avulsion Injuries: Occur when excessive
tensile forces result in a piece of bone or cartilage being
pulled away from the host bone by ligament , tendon or
capsular structures.
• Common sites:
• Knee , femur , humerus , elbow ,Ankle & Foot.

6. :Chronic Osseous Trauma
• Fatigue fractures –abnormal stress
across normal bone.
• Insufficiency fractures—normal stress
across abnormal bone.
- Femoral neck
- Sacrum
- Supraacetabular
- Pubic bones, superior and inferior
pubic rami

10. Recognizing Fractures
((And describing them
 A disruption in all
or part of the
cortex of a bone.
• All = Complete.
• Part =
Incomplete.

11. Incomplete Fractures
 GreenstickFacture through one
cortex
 Buckled – Fracture
with buckling of the
cortex.

12. Description of Fractures






By direction of fractures line.
By the relationship of the fragments.
By the number of the fragments.
By communication with the atmosphere.
Age of fracture (recent-healing- healed (
Type of union ( normally alignedmalaligned(.

13. Description of Fractures
 By direction of fractures line.
= Transverse.
= Oblique.
= Longitudinal.
= Spiral

17. Description of Fractures
 By the relationship of the fragments.
- Displacement.
- Shortening.
- Angulation.
- Rotation.
 Most fractures display more than one of
these abnormalities of position.

20. Description of Fractures
 Number of fragments:
1- Simple: Two fragments.
2- Comminuted : More than two
fragments.

23. Description of Fractures
 Open Or closed
fracture.
 Gas lucency at the
soft tissue.

25. ??Diagnosis Please

26. Common Fracture Eponyms
-Colle's Fracture.
-Smith's Fracture.
-Jones Fracture.
-Boxer's Fracture.

27. Common Fracture Eponyms
• Colle's Fracture.
Fracture of the
distal radius with a
dorsal angulation

28. Common Fracture Eponyms
• Smith's Fracture.
- Fracture of the
distal radius with a
palmar angulation.
- Fall on a flexed
hand.

29. Common Fracture Eponyms
• Jones Fracture.
Fracture base of the
fifth metatarsal

30. Common Fracture Eponyms
 Boxer's Fracture.
Fracture head of the
fifth metacarpal with
palmar angulation.

31. Fracture Healing
1. Indistinctness of Fracture line.
2. Bony callus formation.
3. Bridging of fracture and obliteration of
fracture line.
4. Remodeling of bone.

32. Fracture Healing