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Hanging and strangulation (trauma)

Hanging and strangulation are injuries involving constricting pressure applied to the neck. The vast majority are sustained as a result of attempted suicide. Epidemiology In America, hangings are the second most common form of suicide after firearm use. In other parts of the world due to the r...

Hangman fracture

Hangman fracture, also known as traumatic spondylolisthesis of the axis, is a fracture which involves the pars interarticularis of C2 on both sides, and is a result of hyperextension and distraction. Clinical presentation Post-traumatic neck pain after a high-velocity hyperextension injury is ...

High-velocity penetrating brain injury

High-velocity penetrating brain injuries, in practical terms most often due to cranial gunshot injuries, are a form of penetrating traumatic brain injuries, which are much less common than blunt traumatic brain injuries and distinguished from low-velocity penetrating brain injuries (such as stab...

Hill-Sachs lesion

Hill-Sachs lesions are a posterolateral humeral head compression fracture, typically secondary to recurrent anterior shoulder dislocations, as the humeral head comes to rest against the anteroinferior part of the glenoid. It is often associated with a Bankart lesion of the glenoid. Pathology I...

Hip dislocation

Hip dislocation is a relatively rare entity and may be congenital or acquired. Epidemiology Hip dislocations account for ~5% of all dislocations 3. Pathology There are numerous patterns of dislocation 1: posterior hip dislocation (most common ~85%) anterior hip dislocation (~10%) inferio...

Hook of hamate fracture

Hook of hamate fractures are rare. They occur from the hamate fracturing after blunt trauma, falls, and in sports player (e.g. golf, baseball, racquet sports) from a direct blow while swinging. Stress fractures have also been reported. It may result in Guyon's canal syndrome. Differential dia...

Humeral shaft fracture

Humeral shaft fractures are readily diagnosed and usually, do not require internal fixation. Epidemiology Humeral shaft fractures account for 3-5% of all fractures 1,3. Although they occur in all age groups, a bimodal distribution is noted. The first peak is seen in the third decade in males ...

Humeral shaft fracture (summary)

This is a basic article for medical students and other non-radiologists Humeral shaft fractures are readily diagnosed and do not usually require internal fixation. Reference article This is a summary article. For more information, you can read a more in-depth reference article: humeral shaft...

Imaging of gunshot injuries

Gunshot injuries often require imaging assessment, and this evaluation has both clinical relevance (assessment of organ damage, surgical planning and prognostication), and often also forensic implications. Epidemiology Incidence of gunshot injuries to the head is increasing in some countries, ...

Incidental findings on trauma CT

Incidental findings on trauma CT are defined as findings unrelated to the specific mechanism of injury. Epidemiology They are reported to be present in 55-75% of patients, with most being within the abdomen and pelvis 1. As the use of whole body CT for trauma increases, there is an associated ...

Infantile cervical ligament edema

Infantile cervical ligament edema can typically be seen when infants have suffered accidental or abusive head and neck trauma. The finding is best seen on sagittal STIR images. Terminology The posterior ligamentous complex refers to the ligamentum flavum and interspinous ligaments. The anterio...

Inferior shoulder dislocation

An inferior shoulder dislocation is the least common form of shoulder dislocation. The condition is also called luxatio erecta because the arm appears to be permanently held upward, in fixed abduction. The patient will often present with their hand placed on the head or near it. Pathology It i...

Intermediary injury

Intermediary injuries affect the basal ganglia and/or thalami and are associated with diffuse axonal injury and poor prognosis. Pathology They are a shearing injury of the lenticulostriate arteries and result in hemorrhagic contusions, which are often bilateral. Radiographic features CT hy...

Interphalangeal joint dislocation

Interphalangeal joint dislocations are common upper extremity dislocations. Although considered minor injuries by many, they can result in significant disability. Pathology The typical mechanism is a hyperextension injury. The proximal interphalangeal joints are the most commonly involved and...

Investigating fall onto an outstretched hand (summary)

This is a basic article for medical students and other non-radiologists Fall onto an outstretched hand (FOOSH) is a very common presentation across all ages. It occurs following sporting injuries, or simply after a fall. Summary assessment history bimodal age and sex presentation young pa...

Investigating head injury (summary)

This is a basic article for medical students and other non-radiologists Investigating head injury is frequently required because head injury is common: in the US there are 1.3 million traumatic brain injuries per year 1. Causes include falls (children and the elderly), motor vehicle accidents (...

Investigating shoulder injury (summary)

This is a basic article for medical students and other non-radiologists Shoulder injury is a relatively uncommon, but important cause for presentation to the Emergency Department. Pain may be the result of acute or chronic injury. Summary assessment history history of trauma? previous inj...

Isolated free fluid in trauma

Isolated free fluid in trauma may or may not represent a significant injury, and this creates a diagnostic dilemma in determining appropriate treatment for these patients. Epidemiology The presence of isolated free fluid in trauma occurs in 3-5% of blunt trauma patients 1-4. Pathology The c...

Isolated greater trochanteric fracture

Greater trochanteric fractures generally result from forceful muscle contraction of a fixed limb, which usually occurs in those who are young and physically active. It can also be caused by direct trauma. Epidemiology Generally, isolated trochanteric fractures are seen more so in young, active...

Jefferson fracture

Jefferson fracture is the eponymous name given to a burst fracture of C1. It was originally described as a four-part fracture with double fractures through the anterior and posterior arches, but three-part and two-part fractures have also been described. Pathology Mechanism A typical mechanis...

Jersey finger

Jersey finger (also called Rugby finger or Sweater finger) describes a type of injury where there is avulsion of the flexor digitorum profundus (FDP) at the base of the distal interphalangeal joint (DIP) 1. Most commonly affects the 4th digit as the FDP insertion into the ring finger is anatomi...

Johansson classification

The Johansson classification of periprosthetic hip fractures was the first classification system proposed and is the simplest. It is based on the level of the fracture in relation to the prosthesis. type I: fracture proximal to the tip of the prosthesis with the stem still in contact with the m...

Joint effusion

A joint effusion is defined as an increased amount of fluid within the synovial compartment of a joint. There is normally only a small amount of physiological intra-articular fluid. Abnormal fluid accumulation can result from inflammation, infection (i.e. pus) or trauma and may be an exudate, t...

Judet and Letournel classification for acetabular fractures

The Judet and Letournel classification is the most widely used classification system for acetabular fractures. It is based on three radiographic views (anteroposterior view, obturator oblique view and iliac oblique view) and classifies acetabular fractures into ten major fracture patterns, wh...

Keifhaber-Stern classification of volar plate avulsion injuries of hand

The Keifhaber-Stern classification was proposed originally by Hastings and later modified by Keifhaber and Stern in 1998. This classification, along with the Eaton classification, is the most widely accepted classification at the time of writing (August 2016) for the management of volar plate av...

Knee dislocation

Knee dislocations are rare, but a significant number have serious associated vascular injury. They account for <0.5% of all joint dislocations. This article discussed tibiofemoral joint dislocation. Please see separate articles for discussion of medial and lateral patellar dislocation. Patho...

Labelled imaging anatomy cases

This article lists a series of labelled imaging anatomy cases by system and modality. Brain CT head: non-contrast axial CT head: non-contrast coronal CT head: non-contrast sagittal CT head: angiogram axial CT head: angiogram coronal CT head: angiogram sagittal MR head: T2 axial MR head:...

Large joint dislocation

Large joint dislocation is a not uncommon presentation to emergency rooms. Described in order of comonality: shoulder dislocation elbow dislocation posterior dislocation of the hip knee dislocation

Laryngeal trauma

Laryngeal trauma is uncommon in the setting of external blunt or penetrating trauma. The larynx may also be injured internally, for example during endotracheal intubation. Clinical presentation Symptoms include hoarseness, laryngeal pain, dyspnea, and/or dysphagia. Also, stridor, hemoptysis, s...

Lateral humeral condyle fracture

Lateral humeral condyle fractures also referred to simply as lateral condyle fractures (in the appropriate context), are relatively common elbow fractures that predominantly occur in children. They may be subtle but are hugely important to diagnose in a timely manner because if they are missed, ...

Lateral patellar dislocation

Lateral patellar dislocation refers to lateral displacement followed by dislocation of patella due to disruptive changes to the medial patellar retinaculum. Epidemiology Patellar dislocation accounts for ~3% of all knee injuries and is commonly seen in those individuals who participate in spor...

Lateral talar process fracture

Lateral talar process fractures or snowboarder fractures are talus fractures that can mimic a lateral ankle sprain. It may be an isolated fracture or occur as a component of more complex ankle fractures. Mechanism The fracture occurs when the foot is dorsiflexed and inverted, as can happen wit...

Lauge-Hansen classification of ankle injury

The Lauge-Hansen classification system is used for the classification of the ankle injuries based on injury mechanisms which have predictable patterns and imaging findings. Along with the Weber classification, these systems are useful tools for describing and classifying ankle injuries. Classif...

Le Fort fracture classification

Le Fort fractures are fractures of the midface, which collectively involve separation of all or a portion of the midface from the skull base. In order to be separated from the skull base, the pterygoid plates of the sphenoid bone need to be involved as these connect the midface to the sphenoid b...

Levine and Edwards classification

Levine and Edwards classification is used to classify hangman fractures of C2 (also known as traumatic spondylolisthesis of axis). Classification type I: fracture with <3 mm antero-posterior deviation no angular deviation type II: fracture with >3 mm antero-posterior deviation significant a...

Lightbulb sign (shoulder dislocation)

The lightbulb sign refers to the abnormal AP radiograph appearance of the humeral head in posterior shoulder dislocation. When the humerus dislocates it also internally rotates such that the head contour projects like a lightbulb when viewed from the front 1. See also light bulb sign (hepatic...

Lipohemarthrosis

Lipohemarthrosis results from an intra-articular fracture with escape of fat and blood from the bone marrow into the joint, and is most frequently seen in the knee, associated with a tibial plateau fracture or distal femoral fracture; rarely a patellar fracture. They have also been described in ...

Lisfranc injury

Lisfranc injuries, also called Lisfranc fracture-dislocations, are the most common type of dislocation involving the foot and correspond to the dislocation of the articulation of the tarsus with the metatarsal bases. Pathology Anatomy The Lisfranc joint is the articulation of the tarsus with ...

Liver trauma

The liver is one of the most frequently damaged organs in blunt trauma, and liver trauma is associated with a significant mortality rate. Epidemiology In blunt abdominal trauma, the liver is injured ~5% (range 1-10%) of the time 1,3. Clinical presentation Patients can present with right uppe...

Locked facet joint

Locked facet joint is a type of facet joint dislocation that results from jumping of the inferior articular process over the superior articular process of the vertebra below and becomes locked in the position. It can be unilateral or bilateral. Radiographic features Plain radiograph The tip ...

Longitudinal temporal bone fractures

Longitudinal temporal bone fractures are petrous temporal bone fractures that occur parallel to the long axis of the petrous temporal bone. Although more current classifications of the extent of temporal bone fractures focus on the integrity of the otic capsule rather than the fracture orientati...

Longitudinal versus transverse petrous temporal bone fracture

Petrous temporal bone fractures are classically divided into longitudinal, transverse or mixed fracture patterns depending on the direction of fracture plane with respect to the long axis of the petrous temporal bone. Some features may aid in distinguishing them. Longitudinal pe...

Lover's fracture

Lover's fracture, also known as Don Juan fracture, is a type of calcaneal fracture. They are fractures of the calcaneal body and may be intra- or extra-articular. History and etymology The name "lover's fracture" is derived from the fact that a suitor may jump from great heights while trying t...

Lunate dislocation

Lunate dislocations are an uncommon traumatic wrist injury that require prompt management and surgical repair. The lunate is displaced and rotated volarly. The rest of the carpal bones are in a normal anatomic position in relation to the radius. These should not be confused with perilunate disl...

Lung point sign

The lung point sign is a highly specific ultrasound sign of pneumothorax. It involves visualizing the point where the visceral pleura (lung) begins to separate from the parietal pleural (chest wall) at the margin of a pneumothorax. In the absence of pneumothorax, the two pleural layers slide a...

Macklin effect (pulmonary interstitial emphysema and pneumomediastinum)

The Macklin effect describes one of the pathophysiological processes of pneumomediastinum in blunt chest trauma. The Macklin effect accounts for ~40% of severe blunt traumatic pneumomediastinum. Exclusion of tracheobronchial and esophageal causes of pneumomediastinum is mandatory to exclude conc...

Magerl classification of thoracolumbar spinal fractures

The Magerl classification of thoracolumbar spinal fractures is based on the three column concept by Denis, and the McAfee classification. It relies exclusively on CT findings. Classification A: compression injuries A1: impaction fractures A1.1: endplate impaction A1.2: wedge impaction A1.3...

Maisonneuve fracture

Maisonneuve fracture refers to a combination of a fracture of the proximal fibula together with an unstable ankle injury (widening of the ankle mortise on x-ray), often comprising ligamentous injury (distal tibiofibular syndesmosis, deltoid ligament) and/or fracture of the medial malleolus. It i...

Mallet finger

Mallet finger refers to injuries of the extensor mechanism of the finger at the level of the distal interphalangeal joint (DIP). They are the most prevalent finger tendon injury in sport. They may represent an isolated tendinous injury or occur in combination with an avulsion fracture of the bas...

Mandibular fracture

Mandibular fractures are relatively common especially among young men. Although traditionally the mandible and base of skull are thought to form a complete bony ring, interrupted only by the TMJs. This should mean that the mandible should fracture in two places (akin to the bony pelvis) making s...

Marshall classification of traumatic brain injury

The Marshall classification of traumatic brain injury is a CT scan derived metric using only a few features and has been shown to predict outcome in patients with traumatic brain injury. This system was first published in 1992 1 building on findings from a large cohort of head injury cases des...

Mayfield classification of carpal instability (perilunate instability)

Mayfield classification of carpal instability, also known as perilunate instability classification (carpal dislocations), describes carpal ligament injuries. Instability has been divided into four stages 1-2: stage I: scapholunate dissociation (rotatory subluxation of the scaphoid) disruptio...

Mayo classification of scaphoid fractures

Mayo classification of scaphoid fractures divides them into three types according to the anatomic location of the fracture line: middle (70%) distal (20%) proximal (10%) Fractures of the distal third are further divided into distal articular surface and distal tubercle fractures: distal tub...

McAfee classification of thoracolumbar spinal fractures

McAfee classification of acute traumatic spinal injuries is based on the three column concept of the spine. CT is needed for accurate assessment. Classification wedge compression: isolated anterior column compression stable burst: anterior and middle column compression but posterior column i...

McGrigor-Campbell lines

McGrigor-Campbell lines are imaginary lines traced across the face on an occipitomental (Waters) view skull radiograph to assess for fractures: first line is traced from one zygomaticofrontal suture to another, across the superior edge of the orbits second line traces the zygomatic arch, cross...

Mellado-Bencardino classification of Morel-Lavallée lesions

The Mellado-Bencardino classification of Morel-Lavallée lesions is based on shape, signal and enhancement characteristics, and the presence or absence of a capsule 1: type I: laminar shaped and seroma-like with increased T2 signal type II: oval-shape that resembles a subacute hematoma with in...

Meniscal root tear

Meniscal root tears are a type of meniscal tear in the knee where the tear extends to either the anterior or posterior meniscal root attachment to the central tibial plateau. They often tend to be radial tears extending into the root. Epidemiology According to one source, they are thought to ...

Metacarpal fracture

Metacarpal fractures are common. Fractures of the metacarpal bones account for 10% of all fractures and 40% of all hand fractures. The lifetime incidence of a metacarpal fracture is 2.5%. Terminology Specific names are given to fractures of the base of the first metacarpal (see: fractures of t...

Metaphyseal fracture

Metaphyseal fractures are fractures that involve the metaphysis of tubular bones. They may occur in pediatric or adult patients. Examples of metaphyseal fractures: adults surgical neck of humerus fracture distal radial fracture transtrochanteric fracture children distal radial buckle frac...

Midcarpal dislocation

Midcarpal (central carpal) dislocation describes an injury where there is dislocation of the capitate from the lunate, and subluxation of the lunate from the radius. This term is somewhat confusing because some authors use "midcarpal dislocation" to refer generally to perilunate and lunate dislo...

Middle phalanx fracture

Middle phalanx fractures are the least common of the phalanx fractures. Radiographic features These fractures are generally well visualized on plain radiographs. Ultrasonography can be used in unclear cases. Treatment and prognosis Non-displaced fractures can be treated conservatively with a...

Minimal aortic injury

Minimal aortic injuries are traumatic aortic lesions that usually involve the intima and are recognised more frequently due to the use of high-resolution imaging. Epidemiology Minimal aortic injuries account for 10-28% of all blunt traumatic aortic injuries 1,6,7. The proportion of this type o...

Mixed temporal bone fractures

Mixed temporal bone fractures are a combination of longitudinal and transverse fracture types, and are probably the most common type. They frequently involve the otic capsule, and are associated with both conductive and sensorineural hearing loss.

Modified Memphis criteria for blunt cerebrovascular injury

The modified Memphis criteria are a set of screening criteria for blunt cerebrovascular injury (BCVI) in trauma. The presence of one or more of these criteria makes necessary a complementary CTA or DSA study to exclude a BCVI. The screening protocol criteria for BCVI are: base of skull fractur...

Monteggia fracture-dislocation

Monteggia fracture-dislocations consist of a fracture of the ulnar shaft with concomitant dislocation of the radial head. The ulnar fracture is usually obvious, whereas the radial head dislocation can be overlooked, with potentially serious functional and medico-legal ramifications. Mechanism ...

Morel-Lavallée lesion

Morel-Lavallée lesions are closed degloving injuries associated with severe trauma which then present as haemolymphatic masses. MRI and ultrasound are useful modalities for evaluation. Terminology The lesions classically occur over the greater trochanter of the femur 1. Morel-Lavallée lesions,...

Musculoskeletal radiology curriculum (student)

This is a basic article for medical students and other non-radiologists The medical student musculoskeletal radiology curriculum represents a core set of common pathologies and presentations that are key to understand during any orthopedic attachment in medical school.

Named fractures

Named fractures are usually eponymous or occupational. The simplest way of spiting them up is by body area: spinal fractures facial fractures upper extremity fractures pelvic fractures lower extremity fractures

Nasal bone fracture

Nasal bone fractures are the most common type of facial fractures, accounting for ~45% of facial fractures, and are often missed when significant facial swelling is present. Clinical presentation Unsurprisingly, nasal bone fractures occur when the nose impacts against a solid object (e.g. fis...

Nasal septal hematoma

Nasal septal hematomas arise from ruptures in the small blood vessels in the nasal septum and are largely secondary to trauma. The nasal septum has a rich vascular supply which sources from both the internal and external carotid arteries. Radiographic features CT Septal hematomas appear as i...

Naso-orbitoethmoid (NOE) complex fracture

Naso-orbitoethmoid (NOE) fractures (also known as orbitoethmoid or nasoethmoidal complex fractures) are fractures which involve the central upper midface. Pathology Naso-orbitoethmoid fractures are caused by a high-impact force applied anteriorly to the nose and transmitted posteriorly through...

Navicular fracture

Navicular fractures along with cuboid fractures form the most common isolated mid-foot fractures. Clinical presentation May present with pain, swelling or hematoma directly over the mid-foot. Stress fractures in athletes and construction workers may present with vague pain and swelling over t...

Neer classification of proximal humeral fractures

The Neer classification of proximal humeral fractures is probably the most frequently used along with the AO classification of proximal humeral fractures. Even if an exact knowledge of this classification system is beyond the everyday use of many radiologists, the terminology and factors which i...

Nerve injury classification

Nerve injury classification describes the various features of nerve injury on MRI with respect to pathological events. Classification neuropraxia grade I: there is increased T2/STIR signal in the nerve, however the muscle appears normal axonotmesis grade II: increased T2/STIR signal in ne...

NEXUS Chest

NEXUS Chest is a clinical decision rule that supports the appropriate use of thoracic imaging in trauma. There are seven criteria 1,2: >60 years old rapid deceleration defined as fall > 6 metres or motor vehicle crash >64 km/hour chest pain intoxication abnormal alertness or mental status ...

Nightstick fracture

Nightstick fractures are isolated fractures of the ulna, typically transverse and located in the mid-diaphysis and usually resulting from a direct blow. It is a characteristic defensive fracture when the patient tries to ward off an overhead blow from an assailant (or local law enforcement offic...

Oblique fracture

Oblique fractures are complete fractures that occur at a plane oblique to the long axis of the bone. Like transverse fractures, the term is predominantly used in the context of describing a fracture in a long bone. Oblique fractures are particularly prone to angulation in the plane of the fract...

Occipital condyle fracture

Occipital condylar fractures result from high-energy blunt trauma and is a specific and localized type of basilar skull fracture. Epidemiology The exact incidence of these fractures is unknown but are reported to occur in 3-4% patients with moderate-severe traumatic brain injuries 3. Clinical...

Occult fracture

Occult fractures are those that are not visible on imaging, most commonly plain radiographs and sometimes CT, either due to lack of displacement or limitations of the imaging study. There may be signs of a fracture without one actually being seen. MRI or nuclear medicine studies are sometimes re...

O'Donoghue unhappy triad

O'Donoghue unhappy triad or terrible triad often occurs in contact sports, such as basketball, football, or rugby, when there is a lateral force applied to the knee while the foot is fixated on the ground. This produces the "pivot shift" mechanism. The O'Donoghue unhappy triad comprises three t...

Odontoid fracture

Odontoid process fracture, also known as the peg or dens fracture, occurs where there is a fracture through the odontoid process of C2. Pathology The mechanism of injury is variable, and can occur both during flexion or extension with or without compression 5. Classification There are two cl...

Esophageal perforation

Esophageal perforation is a rare but serious medical emergency with a very high mortality rate, especially if the diagnosis is delayed. Epidemiology Most patients are in their 60s with a slight male predominance 5. Clinical presentation If a perforation is not detected during the procedure ...

Off-ended

The term off-ended is used by some orthopedic surgeons and radiologists to describe a long bone fracture that is displaced by more than the width of the bone. An off-ended fracture is often shortened due to muscle contraction.

Olecranon fracture

Olecranon fractures are clinically and radiographically obvious, and usually require open reduction and internal fixation. Mechanism Olecranon fractures occur as the result of one of four mechanisms 2: direct blow (or fall directly on the elbow) fall on outstretched hand with elbow flexed a...

Open book pelvic injury

Open book pelvic injuries are most often the result of high-energy trauma and are associated with significant morbidity and mortality due to associated vascular injuries. Pathology Open book pelvic injuries result from an anteroposterior compression injury to the pelvis and result in a combin...

Open fracture

An open or compound fracture or dislocation refers to a fracture or dislocation associated with soft tissue injury where the fractured bone or dislocated joint is in direct communication with the outside environment. It is of surgical importance due to the high risk of microbial contamination a...

Orbital blow-in fractures

Orbital blow-in fractures occur when there is displacement of bone fragments towards the orbits. Pathology blow-in fracture effectively reduces the volume of the orbit associated intraorbital injuries include extraocular muscle entrapment and optic nerve injury as an isolated (pure) orbital ...

Orbital blowout fracture

Orbital blowout fractures occur when there is a fracture of one of the walls of orbit but the orbital rim remains intact. This is typically caused by a direct blow to the central orbit from a fist or ball. Epidemiology The blowout fracture is the most common type of orbital fracture and is usu...

Orbital emphysema

Orbital emphysema is the presence of gas within the orbital soft tissues. It is usually due to orbital fractures communicating with the paranasal sinuses but can be caused by penetrating trauma and infection. It is a common finding also after orbital or ocular surgery. Location preseptal pos...

Ossicular chain disruption

Ossicular chain disruption (or ossicular discontinuity) is loss of normal alignment between the three middle ear ossicles. The condition is a cause of conductive hearing loss. Epidemiology Exact incidence and prevalence are not known. Hearing loss associated with temporal bone fractures in chi...

Osteochondral defect

Osteochondral defects are focal areas of articular damage with cartilage damage and injury of the adjacent subchondral bone. Terminology Osteochondral defect is a broad term that describes the morphological change of a localised gap in the articular cartilage and subchondral bone 5. It is oft...

Osteochondral fracture

Osteochondral fractures involve are an articular surface injury involving the articular cartilage and the subchondral bone plate. Radiographic features Osteochondral fractures appear as a combination of 1-2: fracture line extending to the joint surface depression of the subchondral bone pla...

Pancreatic trauma

The pancreas is uncommonly injured in blunt trauma. However, pancreatic trauma has a high morbidity and mortality. Imaging features range from subtle to obvious. Epidemiology The pancreas is injured in ~7.5% (range 2-13%) of blunt trauma cases 1,3. Motor vehicle accidents account for the vast ...

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