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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 hemolymphatic 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 for students (curriculum)

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...

Nasolacrimal injury

Nasolacrimal injuries are reported to be common and may result in temporary or permanent dysfunction. Epidemiology Fracture of the nasolacrimal apparatus has been reported in ~10% of patients with craniofacial fracture, with ~10% of these reporting symptoms of epiphora or dacryocystitis 1. ...

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 system along with the AO classification of proximal humeral fractures. The terminology and factors which influence the classification are essential for the utility of radiological reports of proximal humer...

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 recovery occurs within a few days to 3 months axono...

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 meters or motor vehicle crash >64 km/hour chest pain intoxication abnormal alertness or mental status ...

Nightstick fracture (ulna)

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 are uncommon injuries usually resulting from high-energy blunt trauma. They are considered a specific type of basilar skull fracture, and importantly can be seen along with craniocervical dissociation. Treatment of isolated injury is generally conservative, unless t...

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 clinical signs of a fracture without one actually being seen. MRI or nuclear medicine studies are som...

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 sixties with a slight male predominance 5. Clinical presentation If a perforation is not detected during the proced...

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 (antonym: closed fracture) 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 o...

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 compartment syndrome

Orbital compartment syndrome is an ophthalmological emergency referring to an increased intraorbital pressure that may lead to permanent visual impairment if left untreated. Clinical presentation Features usually include: acute visual impairment periorbital bruising fixed, dilated pupil in ...

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 (OCD) 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 localized gap in the articular cartilage and subchondral bone 5. It ...

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 ...

Pancreatic trauma injury grading

A number of pancreatic injury grading systems have been proposed. Classifications American Association for the Surgery of Trauma (AAST) grade 1: hematoma with minor contusion/laceration but without duct injury grade 2: major contusion/laceration but without duct injury grade 3: distal lacer...

Paranasal sinus and facial bone radiography

Paranasal sinus and facial bone radiography is the radiological investigation of the facial bones and paranasal sinuses. Plain radiography of the facial bones is still often used in the setting of trauma, postoperative assessments and dental radiography.

Paranasal sinus fractures

Paranasal sinuses are air-filled cavities surrounding the nasal cavity proper which includes maxillary sinus, sphenoid sinus, frontal sinus and ethmoid sinus. Trauma to the superior and middle thirds of the face can often lead to in paranasal sinus fractures involving one or more paranasal sinus...

Patellar fracture

Patella fracture is one of the common knee injuries usually post direct trauma to the patella or sudden forceful contraction of the quadriceps muscles in the context of a sports injury. Epidemiology Fractures of the patella represent ~1% all fractures, and are most common in those aged 20-50 y...

Patellar sleeve fracture

Patellar sleeve fractures (also commonly, patellar sleeve avulsion fracture) represent chondral or osteochondral avulsion injury commonly at the inferior pole of the patella (including cartilage from the articular surface, as well as periosteum and cartilage over the dorsal surface). Very rarel...

Pathological fracture risk (Harrington criteria)

Harrington criteria can be used to predict which long bone skeletal metastases are at high risk of pathological fracture and should undergo prophylactic internal fixation. It preceded the Mirels classification for impending pathological fracture but has not been validated and its use is debated....

Pathological fracture risk (Mirels classification)

Mirels classification is a system used to predict the highest risk of pathological fracture among long bones affected by metastases, and is based on site, location, matrix and/or presence of pain. Classification 1 point upper limb involving <1/3 of bone diameter blastic/sclerotic lesion m...

PECARN traumatic brain injury algorithm

The PECARN (Pediatric Emergency Care Applied Research Network) traumatic brain injury algorithm is a clinical decision rule that aims to identify children at very low risk of clinically important traumatic brain injury (ci-TBI) 1. This validated pediatric algorithm predicts likelihood of the abo...

Pectoralis major tear

Pectoralis major tears, also known as pectoralis major ruptures, are an uncommon traumatic injury of the pectoralis major. Epidemiology mostly young, physically-active males age 20-40 years old, although has also reported in elderly women 1 associated with weight lifting (mostly bench press)...

Pellegrini-Stieda lesion

Pellegrini-Stieda lesions are ossified post-traumatic lesions at (or near) the medial femoral collateral ligament adjacent to the margin of the medial femoral condyle. One presumed mechanism of injury is a Stieda fracture (avulsion injury of the medial collateral ligament at the medial femoral c...

Pelvic bucket handle fracture

Bucket handle fractures of the pelvis are a result of anteroposterior compression energy vectors. It is described as a vertically-oriented fracture through ipsilateral superior and inferior pubic rami with contralateral sacroiliac joint disruption/dislocation 1, 2. See also pelvic fractures b...

Pelvic fractures

Pelvic fractures can be simple or complex and can involve any part of the bony pelvis. Pelvic fractures can be fatal, and an unstable pelvis requires immediate management. Epidemiology Pelvic fractures can be seen in any group of patients. Like much trauma, there is a bimodal distribution with...

Pelvic fractures (summary)

This is a basic article for medical students and other non-radiologists Pelvic fractures are a heterogeneous group of injuries that can occur secondary to a variety of mechanisms that range from an innocuous simple fall to severe high-energy trauma in a road traffic collision. Reference articl...

Penetrating thoracic trauma

Penetrating thoracic trauma, namely gunshot and stab injuries, vary widely in incidence globally but nevertheless result in high mortality and serious morbidity. CT is the modality of choice in imaging these patients and can reduce the need for surgical exploration. Pathology Penetrating thor...

Penetrating traumatic neck injury

Penetrating traumatic neck injury can be a potentially devastating injury due to the high density of crucial anatomical structures within the neck. Epidemiology Young males are highly represented in patients with a traumatic neck injury. In one study, 11:1 ratio of males to females were ident...

Penile fracture

Penile fracture (or rupture) is a rare event, however requires emergency diagnosis and intervention. It is a rupture of penile tunica albuginea of the corpora cavernosa or spongiosum caused by trauma to an erect penis, most commonly during sexual intercourse. What a urologist needs to know in s...

Perched facet joint

Perched facet joint is a vertebral facet joint whose inferior articular process appears to sit 'perched' on the ipsilateral superior articular process of the vertebra below. Any further anterior subluxation will result in dislocation, with one facet "jumping" over the other and becoming locked ...

Pericardial fat tag sign (pneumothorax)

The pericardial fat tag sign is a sign of pneumothorax on supine CXR where the cardiac border has a lumpy contour. When gas is located in the pleural space between the lung and mediastinum, the pericardial fat is no longer compressed against the mediastinum and therefore can hang or dangle late...

Perilunate dislocation

Perilunate dislocations and perilunate fracture-dislocations are potentially devastating closed wrist injuries that are often missed on initial imaging. These injuries involve dislocation of the carpus relative to the lunate which remains in normal alignment with the distal radius. They should...

Periprosthetic fracture

Periprosthetic fracture is a term used to describe any fracture that occurs around an implanted orthopedic prosthesis, most commonly knee or hip arthroplasties. Epidemiology Periprosthetic fractures complicate, ~1% of total hip arthroplasties and ~1.5% of total knee arthroplasties 1,2. Radiog...

Periprosthetic hip fracture classification systems

Several classification systems have been proposed for periprosthetic fractures of the hip: American Academy of Orthopedic Surgeons (AAOS) classification Cooke and Newman (modified Bethea) classification Johansson classification Vancouver classification: most widely used

Peritalar dislocation

Peritalar dislocation, also referred to as subtalar dislocation, involves the combined dislocation of the talocalcaneal/subtalar and talonavicular joints without the involvement of the tibiotalar and calcaneonavicular joints. It is generally associated with high-energy trauma and accounts for a ...

Perthes lesion

Perthes lesion of the shoulder is one of the types of the anterior glenohumeral injury in which the anterior inferior labrum is torn and lifted from the edge of the glenoid 1 but still attached to the intact lifted periosteum from the anterior aspect of the glenoid. Although the labrum may be no...

Phalanx fracture

Phalanx fractures are common injuries, although less common than metacarpal fractures. They have different prognosis and treatment depending on the location of the fracture. Pathology Phalanx fractures can be intra or extra-articular and can occur at the base, neck, shaft or head of the phalan...

Phthisis bulbi

Phthisis bulbi, also known as end-stage eye, is an atrophic scarred and disorganized globe that may result from a variety of severe ocular insults. Epidemiology In general, phthisis bulbi involves elderly patients, usually 65-85 years of age 7. Children and adolescents are only rarely affecte...

Physiological pelvic intraperitoneal fluid

Physiological pelvic intraperitoneal fluid refers to the presence of a small volume of free fluid in the pelvis, particularly the pouch of Douglas. It occurs in young females of reproductive age and can be a mimic of traumatic free fluid in abdominal trauma. Unfortunately, pelvic free fluid may...

Piedmont fracture

Piedmont fractures have been variably defined in the literature. Many suggest that Piedmont fractures are synonymous with Galeazzi fractures. That is a fracture of the radius at the middle and distal third with associated disruption of the distal radioulnar joint. The initial report about the s...

Pilon fracture

A pilon fracture is a type of fracture involving the distal tibia. These are considered to represent 1-10% of all lower limb fractures 6. Mechanism Typically occurs as a result of an axial loading injury which drives the talus into the tibial plafond. Classification Several classification s...

Ping pong skull fracture

Ping pong skull fracture or pond skull fracture refers to a depressed skull fracture of the infant skull caused by inner buckling of the calvarium. It is seen in newborns because of the soft and resilient nature of their bones (like greenstick fractures of long bones) and the fracture line is no...

Pipkin femoral head fracture classification

Pipkin classification is the most commonly used classification for femoral head fractures, which are uncommon but are associated with hip dislocations. Classification type I: fracture inferior to the fovea capitis, a small fracture not involving the weightbearing surface type II: fracture ext...

Pisiform fracture

Pisiform fractures are an uncommon type of fracture involving the carpal bones. Epidemiology They are only thought to account for ~0.2% of all carpal fractures. Approximately 50% occur in association with other carpal fractures. Very rarely the pisiform may be dislocated without fracture and ...

Pivot shift test

The pivot shift test forms part of the orthopedic examination of a post-traumatic knee. A positive test shows high specificity for injury of the anterior cruciate ligament. Procedure The pivot shift test is performed on a supine patient. At the start the subject's knee is permitted to droop ...

Plaster of Paris

Plaster of Paris (POP) casts are the most commonly used material for immobilizing injured limbs. History Various materials have been used to immobilize limbs since antiquity. Splints have been found by Egyptian archaeologists dating from 2500 BCE. Various mixtures of waxes, resins, gums and f...

Pneumocephalus

Pneumocephalus (plural: pneumocephali), also known as pneumocranium, pneumocrania, pneumatocephalus and intracranial pneumatocele, refers to the presence of intracranial gas, and in the vast majority of cases the gas is air. The term encompasses gas in any of the intracranial compartments, and i...

Pneumolipohaemarthrosis

Pneumolipohaemarthrosis is the presence of intra-articular gas in a lipohemarthrosis. It indicates an open intra-articular fracture.

Pneumomediastinum

Pneumomediastinum is the presence of extraluminal gas within the mediastinum. Gas may originate from the lungs, trachea, central bronchi, esophagus, and peritoneal cavity and track from the mediastinum to the neck or abdomen. Terminology In the setting of trauma, if pneumomediastinum is visibl...

Pneumopericardium

Pneumopericardium represents gas (usually air) within the pericardium, thus surrounding the heart. Pathology Etiology Underlying causes include: positive pressure ventilation thoracic surgery/pericardial fluid drainage penetrating trauma blunt trauma (rare) infectious pericarditis with ...

Pneumorrhachis

Pneumorrhachis refers to the presence of gas within the spinal canal (either intra- or extradural). It is rare. Clinical presentation Patients can often be asymptomatic 3. Pathology Etiology Pneumorrhachis can result from a number of causes: trauma (traumatic pneumorrhachis): can occur in ...

Pneumothorax

Pneumothorax (PTX) (plural: pneumothoraces) refers to the presence of gas (air) in the pleural space. When this collection of gas is constantly enlarging with resulting compression of mediastinal structures, it can be life-threatening and is known as a tension pneumothorax (if no tension is pres...

Pneumothorax in supine projection

A pneumothorax does not display classical signs when a patient is positioned supine for a chest radiograph. Instead, the pneumothorax may be demonstrated by looking for the following signs: relative lucency of the involved hemithorax deep, sometimes tongue-like, costophrenic sulcus: deep sulcu...

Point-of-care ultrasound (curriculum)

The point-of-care ultrasound (PoCUS) curriculum is one of our curriculum articles and aims to be a collection of articles that represent the core applications of ultrasonography in a point-of-care setting. Point-of-care ultrasound refers to ultrasonography which may be simultaneously performed,...

Posterior cruciate ligament avulsion fracture

Posterior cruciate ligament (PCL) avulsion fractures are a type of avulsion fracture of the knee that represent the most common isolated PCL lesion. This typically involves separation of the posterior tibial insertion of the PCL to variable degrees. Pathology These injuries are commonly seen i...

Posterior dislocation of the hip

Posterior dislocations of the hip, although uncommon, are the most common direction of dislocation for this joint, outnumbering anterior dislocations 9:1. Pathology It most frequently occurs in the setting of significant trauma, given a large amount of force required. The most common scenario ...

Posterior fat pad sign (elbow)

The posterior fat pad sign is the visualization of a lucent crescent of fat located in the olecranon fossa on a true lateral view of an elbow joint with the elbow flexed at a right angle indicating an elbow joint effusion. Normally, the posterior fat pad will not be seen on this view. In the s...

Posterior shoulder dislocation

Posterior shoulder dislocations are far less common than anterior shoulder dislocations and can be difficult to identify if only AP projections are obtained. A high index of suspicion is helpful. Epidemiology Posterior shoulder dislocations account for only 2-4% of all shoulder dislocations (t...

Posterior talar process fracture

Posterior talar process fractures may involve medial or lateral tubercle of the posterior process of talus. The posterior talofibular ligament attaches on the lateral tubercle and flexor hallucis longus runs between these tubercles. Unfused ossification center of the lateral tubercle forms the o...

Posterolateral corner injury of the knee

Posterolateral corner injury of the knee can occur in isolation or with other internal derangements of the knee, particularly cruciate ligament injuries. The importance of injuries to the posterolateral ligamentous complex lies in the possible long-term joint instability and cruciate graft failu...

Posteromedial corner injury of the knee

Posteromedial corner injury of the knee is a readily identifiable but frequently underappreciated injury on imaging. Importantly, it can result in increased stress on the cruciate ligaments and can result in anteromedial rotatory instability (AMRI) of the knee. Clinical presentation These inju...

Postmortem and forensic curriculum

The postmortem and forensic curriculum is one of our curriculum articles and aims to be a collection of topics that represent core knowledge pertaining to forensic and postmortem radiology. Definitions Postmortem radiology: the radiographic examination of the body after death. Forensic radi...

Priapism

Priapism (rarely penile priapism, to differentiate from the very rare clitoral priapism) is a prolonged erection, after or not related to sexual stimulation, lasting >4 hours. The role of imaging in priapism is to distinguish between ischemic low-flow priapism (95%) and non-ischemic high-flow pr...

Pronator quadratus sign

The pronator quadratus sign can be an indirect sign of distal forearm trauma. It relies on displacement of the fat pad that lies superficial to the pronator quadratus muscle. Pathology Displacement, anterior bowing, or obliteration of the fat plane in the setting of trauma may indicate a dista...

Proximal femoral fractures

Proximal femoral fractures are a subset of fractures that occur in the hip region. They tend to occur in older patients, and in those who have osteoporosis. In this group of patients, fracture is usually the result of low-impact trauma although, in younger patients they are usually victims of hi...

Proximal femoral fractures (summary)

This is a basic article for medical students and other non-radiologists Proximal femoral fractures are a heterogeneous group of fractures that occur in and around the hip. The commonest type of fracture in this region is the femoral neck fracture. They can occur anywhere between the joint surf...

Proximal humeral fracture

Proximal humeral fractures are common upper extremity fractures, particularly in older patients, and can result in significant disability. Epidemiology Proximal humeral fractures represent around 5% of all fractures ?. They are most common in older populations and especially in those who are ...

Proximal humeral fracture (summary)

This is a basic article for medical students and other non-radiologists Proximal humeral fractures are a heterogeneous group of fractures that include everything from relatively simple transverse fractures of the surgical neck of humerus, to complex, displaced, multi-part fractures of the proxi...

Proximal phalanx fracture

Proximal phalanx fractures can be epiphyseal or shaft fractures and can be intra-articular or extra-articular. They are most often the result of forced rotation, hyperextension or direct trauma 2. Epidemiology Proximal phalanx fractures are the most common pediatric hand fracture 1. Radiogra...

Proximal radial fracture (summary)

This is a basic article for medical students and other non-radiologists Proximal radial fractures are the commonest elbow injury in adult patients and the injury most likely to cause an elbow joint effusion. Radial head and neck fractures are often subtle and may be occult on initial imaging. ...

Pseudopancreatitis

Pseudopancreatitis refers to the presence of fluid in or around the pancreas in the setting of trauma but in the absence of direct signs of traumatic pancreatic injury. Most patients will have a normal serum lipase level, but amylase has a limited sensitivity and specificity for pancreatic traum...

Pseudosubluxation of the cervical spine

Pseudosubluxation of the cervical spine is the physiological anterior displacement of C2 on C3 in children. It is common in children <7 years, and less often present in older children. Less often it is seen at C3 on C4. It is more pronounced in flexion and is of clinical significance as it can b...

Psoas sign (abdominal x-ray)

The psoas sign is a classic non-specific finding on the abdominal radiograph, potentially representing retroperitoneal pathology. Normally on an abdominal radiograph, the lateral margins of both the psoas muscles are clearly visible due to adjacent fat. When the lateral edge of one, or both, ps...

Pulled elbow syndrome

Pulled elbow (also known as nursemaid's elbow) is a subluxation of the radial head into the annular ligament, which usually spontaneously or easily reduces and rarely demonstrates abnormal radiographic features. It should be distinguished from dislocation of the radial head. Epidemiology Pull...

Pulmonary contusion

A pulmonary contusion refers to an interstitial and/or alveolar lung injury without any frank laceration. It usually occurs secondary to non-penetrating trauma. Epidemiology While contusion can affect anyone, children are considered more susceptible due to greater pliability of the chest wall...

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