Articles

Articles are a collaborative effort to provide a single canonical page on all topics relevant to the practice of radiology. As such, articles are written and edited by countless contributing members over a period of time. A global group of dedicated editors oversee accuracy, consulting with expert advisers, and constantly reviewing additions.

522 results found
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CHALICE rule

The Children’s Head injury ALgorithm for prediction of Clinically Important Events (CHALICE) clinical decision rule was developed to predict clinically important brain injuries in children with head trauma. This rule identifies high-risk criteria and divides them into history, examination and me...
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Chalk stick fracture

Chalk stick, also known as carrot stick fractures, are fractures of the fused spine, classically seen in ankylosing spondylitis. Terminology Some authors define the chalk stick fracture as a fracture through a Pagetoid long bone (see Paget disease) 3. Pathology They usually occur through the...
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Chance fracture

Chance fractures, also referred to as seatbelt fractures, are flexion-distraction type injuries of the spine that extend to involve all three spinal columns. These are unstable injuries and have a high association with intra-abdominal injuries. Pathology Mechanism They tend to occur from a fl...
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Chauffeur fracture

Chauffeur fractures (also known as Hutchinson fractures or backfire fractures) are intra-articular fractures of the radial styloid process. The radial styloid is within the fracture fragment, although the fragment can vary markedly in size. Pathology Mechanism These injuries are sustained eit...
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Chopart fracture-dislocation

Chopart fracture-dislocations occur at the midtarsal (Chopart) joint in the foot, i.e. talonavicular and calcaneocuboid joints which separate the hindfoot from the midfoot. The commonly fractured bones are the calcaneus, cuboid and navicular. The foot is usually dislocated medially and superior...
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Classification of gamekeeper thumb

This classification of gamekeeper's thumb (also known as skier's thumb) was proposed by Hintermann et al. 1 in 1993 and is based on whether a fracture is present and whether the injury is stable: type I fracture present, which is non-displaced and stable in flexion typically treated with a sp...
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Classification of sacral fractures

There are several classification systems for sacral fractures, but the most commonly employed are the Denis classification and subclassification systems, and the Isler classification system. These classification systems are important to understand as proper classification can impact management. ...
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Clavicular fracture

Clavicular fractures are common and account for 2.6-10% of all fractures 2,3. They usually require minimal treatment, which relies on analgesia and a collar-and-cuff. However, in some cases, open reduction and internal fixation are required. Pathology Mechanisms of injury Fractures can occur ...
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Clay-shoveler fracture

Clay-shoveler fractures are fractures of the spinous process of a lower cervical vertebra. Clinical presentation Often these injuries are unrecognised at the time and only found incidentally years later when the cervical spine is imaged for other reasons. Acutely they tend to be associated wi...
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Closed reduction

Closed reduction or manipulation is a common non-invasive method of treating mildly displaced fractures. Usually performed in an emergency department or orthopedic clinic with light sedation and analgesia, the fracture is manipulated back into anatomic alignment and immobilized with a cast, brac...
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Clothing artifact

Clothing artifacts, like jewelry artifacts, are a regular feature on imaging examinations, especially plain radiographs, but in general are recognized for what they are, either at the time the image is taken by the radiographer, or later by the reporting radiologist. The radiographer will often ...
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Coccygeal fracture

Coccygeal fractures are generally low-severity injuries, which nonetheless can be diagnostically challenging.  Diagnosis may be delayed or missed due to coccygeal anatomy and patient/technical factors (e.g. obesity, overlying bowel gas/feces). Given that management of coccygeal fractures is nea...
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Colles fracture

Colles fractures are very common extra-articular fractures of the distal radius that occur as the result of a fall onto an outstretched hand. They consist of a fracture of the distal radial metaphyseal region with dorsal angulation and impaction, but without the involvement of the articular surf...
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Comminuted fracture

Comminuted fractures are fractures where more than 2 bone components are created. The problem with the term is that it includes a very heterogeneous group of fractures from a 3 part humeral head fracture to a multi-part fracture of the femur following a high-energy road traffic accident.
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Complete fracture

Complete fractures are fractures where the parts of the bone that have been fractured are completely separated from each other. There is complete separation of the cortex circumferentially. Complete fractures can be classified as: transverse: straight across the bone oblique: oblique line acr...
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Complex midfacial fracture

Complex midfacial fractures consist of multiple facial fractures that cannot be classified as any of the defined complex facial fracture (e.g. Le Fort fracture, zygomaticomaxillary complex fracture, naso-orbital-ethmoid fracture).
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Complications of petrous temporal bone fracture (mnemonic)

A handy mnemonic to recall the complications of transverse and longitudinal petrous temporal bone fractures is: Listen Carefully To Something Funny Mnemonic listen carefully = longitudinal / conductive hearing loss to something funny = transverse / sensorineural hearing loss and facial nerve...
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Condylar process fractures

Condylar process fractures are fractures of the condylar process of the mandible. The condylar process of the mandible is involved in around 30% of all mandibular fractures. Condylar fractures are classified according to the location of the fracture and the direction displacement of the condyle...
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Condyle-C1 interval (CCI)

The condyle-C1 interval (CCI) is the measurement of the interval between condyle and C1 at four equidistant points on the joint surface in sagittal and coronal reconstructions of computed tomography. The CCI is reported to have a high lateral symmetry in children 1. Used with a cut-off of 4 mm,...
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Congenital insensitivity to pain

Congenital insensitivity to pain (CIP) refers to a group of rare hereditary sensory and autonomic neuropathies (HSANs) characterized by an inability to feel pain 1. Terminology Although not clearly defined in the literature, congenital insensitivity to pain is not one specific diagnosis, but d...
Article

Cooke and Newman classification

The Cooke and Newman classification of periprosthetic hip fractures is a modification of the Bethea classification proposed several years earlier. type I explosion type fracture, comminuted around the stem of the implant the prosthesis is always loose and the fracture is inherently unstable ...
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Coracoclavicular ligament injury

Coracoclavicular (CC) ligament injury is common with shoulder trauma. It is considered part of the spectrum of acromioclavicular joint injuries 2 and is not often an isolated injury. It is also often injured with clavicular fractures.  This injury is easy to miss, especially with the presence o...
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Coracoid process fracture

Coracoid process fractures are an uncommon type of scapular fracture. They do not often occur in isolation and are often associated with acromial, clavicular, or scapular fracture, as well as humeral head dislocation. In general, the coracoid process tends to fracture at its base and be minimal...
Article

Coronoid process fracture

Fractures of the coronoid process of the ulna are uncommon and often occur in association with elbow dislocation.  Pathology Mechanism Fracture of the coronoid process is thought to result from elbow hyperextension with either avulsion of the brachialis tendon insertion or shearing off by the...
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Costal cartilage fracture

Costal cartilage fractures are fractures of the cartilage connecting the ribs anteriorly to the sternum. Epidemiology There is little published data on costal cartilage fractures. Most reported cases are in males and resulted from blunt trauma or a fall 1,2. Clinical presentation In young ch...
Article

Costal hook sign (flail chest)

The costal hook sign is a chest x-ray feature seen in some cases of flail chest. It represents the rotation of a fractured rib along its long axis, something that is only possible if a second fracture is present along its length, even if the second fracture is not visible 1. 
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Coup-contrecoup injury (brain)

A coup-contrecoup injury is a term applied to head injuries and most often cerebral contusions and traumatic subarachnoid hemorrhage. It refers to the common pattern of injury whereby damage is located both at the site of impact (often less marked) and on the opposite side of the head to the poi...
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Cranioplasty

Cranioplasty is the surgical intervention to repair cranial defects, and is mostly performed after traumatic injuries. The procedure is performed using different materials and techniques, with no consensus about the best option. Methyl methacrylate is the prosthetic material most extensively use...
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CT abdomen (summary)

This is a basic article for medical students and other non-radiologists CT abdomen is an increasingly common investigation that is used to help make diagnoses of a broad range of pathologies. A CT abdomen in its simplest form is a CT from diaphragm to symphysis pubis performed 60 seconds after ...
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CT comma sign (head)

The CT comma sign is a characteristic sign seen in head trauma. It is the presence of concurrent epidural and subdural hematomas, which gives the characteristic appearance of this sign as a "comma" shape.
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CT cystography

CT cystography is a variation of the traditional fluoroscopic cystogram. Instead of anterograde opacification of the urinary collecting system (as with CT urography), contrast is instilled retrograde into the patient's bladder, and then the pelvis is imaged with CT. Indications suspected bladd...
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CT hypoperfusion complex

CT hypoperfusion complex refers to the predominantly abdominal imaging features that occur in the context of profound hypotension. Multiple abdominal organs can display atypical appearances not related to the initial trauma but reflect alterations in perfusion secondary to hypovolemia which affe...
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CT polytrauma (approach)

Below is an approach used for the "primary survey" of a CT polytrauma/multitrauma (also called trauma CT or whole body CT), often performed at the CT console with the patient still on the CT table. It allows rapid communication of significant findings to the trauma team as well as the decision ...
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CT polytrauma (technique)

CT polytrauma/multitrauma, also called trauma CT, whole body CT (WBCT) or panscan, is an increasingly used investigation in patients with multiple injuries sustained after significant trauma. Clinical assessment and mechanism of injury may underestimate injury severity by 30% 8. There is some e...
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Deep sulcus sign (chest)

The deep sulcus sign on a supine chest radiograph raises suspicion of a pneumothorax. On a supine plain chest film (common in intensive care units or as part of a trauma radiograph series), it may be the only suggestion of a pneumothorax because air collects anteriorly and basally, within the n...
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Deep sulcus sign (disambiguation)

The deep sulcus sign can refer to two different radiographic signs but is best known in the chest: deep sulcus sign (chest): of pneumothorax on supine CXR: deep sulcus sign (knee): better known as the lateral femoral notch sign of ACL injury
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Degloving bowel injury

Degloving bowel injuries are a rare type of bowel and mesenteric injury only being described a handful of times in the literature 1-5. In these injuries the bowel is stripped of its mesentery and muscle, leaving a "mucosal tube" 2,3. Perforation may or may not be present.  See also degloving i...
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Degloving injury

Degloving injuries can refer to a number of conditions: degloving soft tissue injury Morel-Lavallée lesion (closed degloving soft tissue injury) intramuscular degloving injury degloving bowel injury
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Degloving soft tissue injury

Degloving soft tissue injuries can be extensive and quite severe conditions. These may be open or, less commonly, closed injuries, which are known as Morel-Lavallée lesions. This article focuses on open injuries, with closed injuries discussed in the Morel-Lavallée article.  Terminology "Deglo...
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Delbet classification

The Delbet classification helps predict the risk of avascular necrosis of the femoral head in neck of femur fractures, as well as determine operative vs non-operative management.  Classification type I: trans-epiphyseal separation fracture through proximal femoral physis, and represents Salte...
Article

Deltoid ligament injury

Deltoid ligament injuries involve the deltoid ligament that forms the medial part of the ankle joint. It attaches the medial malleolus to multiple tarsal bones. Pathology Mechanism of injury It occurs due to eversion and/or pronation injury, or can be associated with lateral ankle fractures. ...
Article

Dental fracture

Dental fractures are often clinically apparent but can be overlooked in the cases of associated facial fractures, especially as root fractures may be clinically occult.  Terminology When both a tooth and alveolar process are fractured, the term dentoalveolar fracture can be used 1.  Pathology...
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Dental luxation

Dental luxation is a common manifestation of dental trauma and may be associated with socket fractures.   Pathology Dental luxation is a general term encompassing 1: concussion: tender tooth, no loosening/displacement subluxation: tender tooth, loosening without displacement extrusive luxat...
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Dental trauma

Dental trauma is common, affecting up to one-third of the population. While often clinically apparent, they may be overlooked in the setting of severe trauma.  Pathology The maxillary incisors are the most commonly injured tooth. Dental trauma can be classified as 1,2: luxation (loosening): m...
Article

Denver criteria for blunt cerebrovascular injury

The Denver criteria are a set of screening criteria for blunt cerebrovascular injury (BCVI) in trauma used to reduce the need for CT angiography and its associated radiation exposure.  Screening criteria The screening protocol criteria 1,3 for blunt cerebrovascular injury are divided into sign...
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Depressed skull fracture

Depressed skull fractures result in the bone of the skull vault being folded (depressed) inward into the cerebral parenchyma. It is usually the result of a high energy impact to the skull. Pathology These mostly (~75%) occur in the frontoparietal region 3. Associations There are a number of ...
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Describing a fracture (an approach)

Describing a fracture is a basic requirement when making an assessment of a plain radiograph. There are many ways to approach the assessment of the radiograph; this is just one approach. I: Describe the radiograph What radiograph (or radiographs) are you looking at? Check the who, what, why, w...
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Diaphragmatic rupture

Diaphragmatic rupture often results from blunt abdominal trauma. The mechanism of injury is typically a motor-vehicle collision. Epidemiology Given that the most common mechanism is motor vehicle collisions, it is perhaps unsurprising that young men are most frequently affected. The estimated ...
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Die-punch fracture

Die-punch fractures result from an axial loading force on the distal radius. It is an intra-articular fracture of the lunate fossa of the distal radius 1. It is by definition depressed or impacted and is named after the machining technique of shearing a shape, depression or hole in a material wi...
Article

Diffuse axonal injury

Diffuse axonal injury (DAI), also known as traumatic axonal injury (TAI), is a severe form of traumatic brain injury due to shearing forces. It is a potentially difficult diagnosis to make on imaging alone, especially on CT as the finding can be subtle, however, it has the potential to result in...
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Diffuse axonal injury (grading)

Grading of diffuse axonal injury has been described histologically according to the anatomic distribution of injury, which correlated with outcome 1-3. The classification was first proposed by Adams in 1989 4 and divides diffuse axonal injury (DAI) into three grades: grade I: involves grey-whit...
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Disarticulation

The term disarticulation refers to the disconnection of all or part of a limb from the body, specifically through a joint. This is in contrast to amputation, which is the disconnection or removal of the structure through a bone.
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Distal fibula fracture (basic)

This is a basic article for medical students and other non-radiologists Distal fibula fractures are the most common type at the ankle and are usually the result of an inversion injury with or without rotation. They are the extension of a lateral collateral ligament injury. Background Pathophy...
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Distal phalanx fracture

Distal phalanx fractures are among the most common fractures in the hand.  They represent > 50% of all phalangeal fractures and frequently involve the ungual tuft 1. They are frequently related to sports, with lesions such as the mallet finger and the Jersey finger. When associated with a crus...
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Distal radial fracture

Distal radial fractures are a heterogeneous group of fractures that occur at the distal radius and are the dominant fracture type at the wrist. These common fractures usually occur when significant force is applied to the distal radial metaphysis.  Epidemiology Distal radial fractures can be s...
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Distal radial fracture (summary)

This is a basic article for medical students and other non-radiologists Distal radial fractures are a relatively common group of injuries that usually occur following a fall. The commonest of these fractures is a transverse extra-articular fracture and where there is associated dorsal angulatio...
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Distal radioulnar joint dislocation

Isolated distal radioulnar joint (DRUJ) dislocations are rare and are more commonly part of complex forearm fracture-dislocations.  Clinical presentation Wrist pain, swelling and deformity following FOOSH or direct trauma. The patient will be unable to supinate/pronate the forearm 1,2.  Patho...
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Distal ulnar fractures

Distal ulnar fractures are common, and usually occur with a concurrent distal radius fracture. Pathology Isolated fractures occurs as a result of direct force to the ulna. Fractures associated with radius fractures usually occur as the result of a fall on an outstretched arm. Distal ulnar fra...
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Dolan's lines

Dolan's lines are the collective name given to three lines described by Dolan and Jacoby 1 that aid in evaluating for maxillofacial fractures on an occipitomental skull radiograph. They are usually used as an adjunct to McGrigor-Campbell lines. orbital line traces the inner margins of the later...
Article

Dorsal intercalated segment instability

Dorsal intercalated segment instability (DISI) is a form of instability involving the wrist. It occurs mainly after the disruption of the scapholunate ligament and is more often encountered than volar intercalated segment instability (VISI). Clinical presentation radial or dorsal wrist pain, m...
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Double delta sign (meniscal tear)

The double delta sign is a feature that has been described in a bucket handle meniscal tear when the inner meniscal fragment flipped anteriorly adjacent to the anterior horn of the donor site and is referred to as a displaced bucket handle tear. The original location of the posterior horn remain...
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Duodenal hematoma

Duodenal hematoma results in hematoma formation in the duodenal wall. It may occur as a result of blunt abdominal trauma, non-accidental injury to children and spontaneously in anti-coagulated patients. Distinction must be made from duodenal perforation since the latter will require immediate s...
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Eaton classification of volar plate avulsion injury

The Eaton classification was proposed by Eaton and Malerich in 1980, and presently (time of writing, August 2016) along with Keifhaber-Stern classification, is the most widely accepted classification of volar plate avulsion injuries 1.  Knowledge of the orthopedic Eaton classification is practi...
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Elbow dislocation

Elbow dislocation is the second most common large joint dislocation in adults and the most common in children.  Epidemiology Elbow dislocations are common and account for 10-25% of all elbow injuries in the adult population 1. They are the most common dislocation in children 4. Associations ...
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Elbow extension test

The elbow extension test is a clinical decision rule aimed at reducing the number of unnecessary elbow radiographs in patients aged ≥3 years.  The test has a specific examination whereby the seated patient, with the arm in supination and 90º shoulder flexion, is asked to fully extend the elbow ...
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Elbow series (summary)

This is a basic article for medical students and other non-radiologists An elbow series is the standard series of radiographs that are performed when looking for evidence of fracture, dislocation or elbow joint effusion following trauma. Reference article This is a summary article. For more i...
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Epibasal fracture of the thumb

Epibasal fractures of the thumb (also called pseudo-Bennett fracture) are two-piece fractures of the proximal first metacarpal bone. They are usually stable, depending on the degree of displacement, and often do not require surgery. It is important to distinguish them from intra-articular fractu...
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Epicondyle fracture (elbow)

Epicondyle fractures are common injuries in children. They represent 10% of all elbow fractures in children and usually occur in boys after a fall on an outstretched arm. Medial epicondyle fractures comprise most of these injuries. They can usually be treated with splinting and early physiother...
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Eponymous fractures

There are numerous eponymous fractures which are named after the people who first described their existence (but see Stigler's law of eponymy) 1: Bankart fracture: glenoid Barton fracture: wrist Bennett fracture: thumb Bosworth fracture: ankle Chance fracture: vertebral Charcot joint: foot...
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Essex-Lopresti fracture-dislocation

Essex-Lopresti fracture-dislocation is characterized by a fracture of the radial head, dislocation of the distal radioulnar joint and rupture of the antebrachial interosseous membrane 3. Epidemiology As little as 20% of Essex-Lopresti fracture-dislocations are recognized at the time of initial...
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Extension teardrop fracture

Extension teardrop fracture typically occurs due to forced extension of the neck with resulting avulsion of the anteroinferior corner of the vertebral body. Extension teardrop fractures are stable in flexion and unstable in extension as the anterior longitudinal ligament is disrupted. Extension ...
Article

Extracranial brain herniation

Extracranial brain herniation refers to herniation of brain tissue external to the calvaria through a skull bone defect, which may be post-traumatic or post-surgical. Unlike encephaloceles, brain herniation is not surrounded by the meninges.  Craniectomy may be performed to decompress intracran...
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Extradural hematoma vs subdural hematoma

Differentiating extradural (EDH) from subdural (SDH) hemorrhage in the head is usually straightforward, but occasionally it can be challenging. SDHs are more common and there are a few distinguishing features which are usually reliable. Pathology History and mechanism of injury Extradural hem...
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Extradural hemorrhage

Extradural hematoma (EDH), also known as an epidural hematoma, is a collection of blood that forms between the inner surface of the skull and outer layer of the dura, which is called the endosteal layer. They are usually associated with a history of head trauma and frequently associated skull fr...
Article

Extrapleural hematoma

Extrapleural hematomas are uncommon and usually seen in the context of rib fracture, subclavian venous catheter traumatic insertion, and blunt chest injury. Pathology Extrapleural hematomas result from the accumulation of blood in the extrapleural space where the overlying extrapleural fat is ...
Article

Facet dislocation

Facet dislocation refers to anterior displacement of one vertebral body on another. Without a fracture, the only way anterior displacement can occur is by dislocation of the facets.  Facet dislocation can occur to varying degrees: subluxed facets perched facets locked facets The injury usua...
Article

Facial fractures

Facial fractures are commonly caused by blunt or penetrating trauma at moderate or high levels of force. Such injuries may be sustained during a fall, physical assault, motor vehicle collision, or gunshot wound. The facial bones are thin and relatively fragile making them susceptible to injury. ...
Article

Fallen lung sign

The fallen lung sign (also known as CT fallen lung sign) describes the appearance of collapsed lung away from the mediastinum encountered with tracheobronchial injury (in particular those >2 cm away from the carina). It is helpful to look for this rare but specific sign, in cases of unexplained ...
Article

Fall onto an outstretched hand

Fall onto an outstretched hand (FOOSH) is a common mechanism for wrist-forearm fractures, in certain cases with involvement of elbow structures, particularly in children. Some injuries that result from such a fall include: Colles fracture Scaphoid fracture Monteggia fracture-dislocation Gal...
Article

Fatigue fracture

Fatigue fractures (also known as overuse fractures) are a type of stress fracture due to abnormal stresses on normal bone. They should not be confused with an insufficiency fracture, which occurs due to normal stresses on abnormal bone. Plain radiographs typically demonstrate a linear sclerotic ...
Article

Femoral artery pseudoaneurysm

Femoral artery pseudoaneurysms are usually iatrogenic, as the femoral artery is the vessel of choice for most endovascular arterial interventions. Pathology Etiology iatrogenic anticoagulation therapy inadequate compression following femoral arterial puncture for endovascular intervention ...
Article

Finger pulley injury

Finger pulley injuries can occur at any one of the five flexor tendon pulleys of the fingers, but most commonly affects the A2 pulley.  Clinical presentation These are overwhelmingly the result of a discrete trauma occurring with the hand in a finger grip position. They are most frequently see...
Article

Flail chest

Flail chest or flail thoracic segment occurs when three or more contiguous ribs are fractured in two or more places. Clinically, a segment of only one or two ribs can act as a flail segment, hence there is some controversy between the clinical and radiological definitions. Clinical presentation...
Article

Fleck sign (disambiguation)

The radiographic fleck sign refers to an avulsion fracture in the lower limb at either of two sites: fleck sign (ankle) due to superior peroneal retinaculum injury fleck sign (foot) due to Lisfranc injury
Article

Flexion supracondylar fracture

Flexion supracondylar humeral fractures account for only 2-4% of all supracondylar fractures 1. Unlike the much more common extension supracondylar fracture which are seen in children, flexion fractures are seen in older patients. They are usually the result of a fall directly onto a flexed elbo...
Article

Flexion teardrop fracture

Flexion teardrop fractures represent a fracture pattern occurring in severe axial/flexion injury of the cervical spine. They are important to recognize because they indicate extensive underlying ligamentous injury and spinal instability. Associated spinal cord injury is common, especially anteri...
Article

Focused Assessment with Sonography for Trauma (FAST) scan

Focused Assessment with Sonography for Trauma (FAST) scan is a point-of-care ultrasound examination performed at the time of presentation of a trauma patient.  It is invariably performed by a clinician, who should be formally trained, and is considered as an 'extension' of the trauma clinical a...
Article

Forearm fracture

Forearm fractures are a group of fractures that occur in the forearm following trauma. The radius and ulna are bound together at the proximal and distal radioulnar joints and act as a ring. Like elsewhere in the body, it is difficult to only fracture one bone if there is a bony ring. If the radi...
Article

Forearm fracture (summary)

This is a basic article for medical students and other non-radiologists Forearm fractures are a group of fractures that occur in the forearm following trauma. The radius and ulna are bound together at the proximal and distal radioulnar joints and act as a ring. Like elsewhere in the body, it is...
Article

Fracture-a-la-signature (skull fracture)

Fracture-a-la-signature (or signature fracture) is another term used to described a depressed skull fracture.  Fracture-a-la-signature derives its name from forensic medicine because the size and shape of a depressed skull fracture may give information on the type of weapon used. It can be a si...
Article

Fracture complications (summary)

This is a basic article for medical students and other non-radiologists Assessment of fracture complications is key to accurate assessment of a fracture. It is vital to assess for these when describing a fracture. Reference article This is a summary article. There is no accompanying reference...
Article

Fracture description (summary approach)

This is a basic article for medical students and other non-radiologists Fracture description allows an individual to accurately determine fracture type and communicate important information to colleagues without the use of the radiograph. Practicing fracture description is important and using a...
Article

Fracture-dislocations of the radius and ulna

Fracture-dislocations of the radius and ulna illustrate the importance of including the joint above and below the site of injury on radiographic assessment. Most forearm fractures (60%) include fracture of the distal radius as well as an ulnar fracture. In some cases, there is associated disloc...

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