Scapula fractures are uncommon injuries, representing ~3% of all shoulder fractures.
Mechanisms of injury
requires high energy trauma (e.g. motor vehicle accidents account for 50% of scapular fractures)
direct trauma to the shoulder region
indirect trauma through falling on outstr...
Schatzker classification system is one method of classifying tibial plateau fractures.
Increase in type number denotes increasing severity, reflecting an increase in energy imparted to the bone at the time of injury and also an increasingly worse prognosis 1. The most common fracture of the tib...
Scrotal haematocoeles are collections of blood within the scrotal sac, but outside of the testis.
A haematocele normally results from trauma to the scrotum, or on occasion following surgery. Some think that a varicocele is a risk factor for developing a haematocele 4.
The seatbelt sign is both a clinical and radiological sign. It is simply the presence of bruising/abrasions in the distribution of a seatbelt (i.e. horizontal and/or diagonal) across the abdomen, chest and sometimes neck.
A positive seatbelt sign, in combination with abdominal pain or tenderne...
The seatbelt syndrome is the constellation of traumatic injuries associated with three-point seatbelts:
lumbar spine fracture
Second-impact syndrome is a rare traumatic brain injury occurs in athletes receiving a second head injury while still symptomatic from a prior head injury.
Second-impact syndrome is common in young athletes.
The typical second-impact syndrome scenario occur...
Segmental fracture is a fracture composed of at least two fracture lines that together isolate a segment of bone, usually a portion of the diaphysis of a long bone. This fracture pattern is frequently associated with high energy mechanism and devascularisation of the segmental fracture fragment(...
Segond fracture is an avulsion fracture of the knee that involves the lateral aspect of the tibial plateau and is very frequently (~75% of cases) associated with disruption of the anterior cruciate ligament (ACL). On the frontal knee radiograph, it may be referred to as the lateral capsular sign...
Semimembranosus tendon avulsion is a specific type of avulsion injury that can occur in the knee.
Mechanism of injury
External rotation and abduction of the flexed knee or valgus force applied to the tibia. Associated injuries include anterior cruciate ligament (ACL) rupture and po...
Seurat spleen is an angiographic appearance seen following blunt trauma to the spleen. Multiple small punctate regions of intraparenchymal contrast extravasation lead to a spotted appearance.
History and etymology
The term refers to a likeness between the angiographic appearance and the artwor...
The Seymour fracture is a clinically important subtype of mallet finger type injury. The Seymour fracture is comprised of a distal phalanx physeal fracture that has an associated nail bed injury commonly with ungual subluxation.
The skeletally-immature patient presents wi...
Shock thyroid is an uncommon part of the hypovolemic shock complex.
It was initially described in 2016 as heterogenous thyroid contrast enhancement and fluid surrounding the thyroid in trauma CT of shocked patients without evidence for direct thyroid injury 2. Only 7 cases have been described ...
In a shoulder dislocation (more accurately termed a glenohumeral joint dislocation) there is separation of the humerus from the glenoid of the scapula at the glenohumeral joint.
This article contains a general discussion on shoulder dislocation. For specific dislocation types please refer to th...
The modified trauma axial view is a supplementary projection that replaces the ‘Y view’ of the two-view shoulder series often performed in the context of trauma.
It is an orthogonal view of the AP projection of the glenohumeral joint, with a higher diagnostic yield than the lateral scapular sho...
This is a basic article for medical students and other non-radiologists
A shoulder series (or shoulder x-ray) is most frequently performed following trauma looking for evidence of fracture or dislocation.
This is a summary article. For more information, you can read a more i...
This is a basic article for medical students and other non-radiologists
Skull fractures usually occur following significant head injury and may herald underlying neurological pathology.
This is a summary article; read more in our article on skull fractures.
This is a basic article for medical students and other non-radiologists
Slipped upper femoral epiphysis (SUFE), also known as a slipped capital femoral epiphysis (SCFE), is a relatively common condition affecting the physis of the proximal femur in adolescents. It is one of commonest hip abnor...
Smith fractures, also known as Goyrand fractures in the French literature 3, are fractures of the distal radius with associated volar angulation of the distal fracture fragment(s). Classically, these fractures are extra-articular transverse fractures and can be thought of as a reverse Colles fra...
The solid abdominal viscera (singular: viscus) is a collective term for those internal organs of the upper abdomen that are primarily solid in nature, namely the liver, pancreas, spleen, adrenals, and kidneys. It is used in contradistinction to the hollow abdominal viscera, which includes, the s...
Spinal fractures are usually the result of significant trauma to a normally formed skeleton, or the result of trauma to a weakened spinal column. Examples include:
Jefferson fracture: ring fracture of C1
hangman fracture: bilateral pedicle or pars fracture of C2
Spinal hematomas are a rare clinical entity and are often idiopathic. Prompt diagnosis and treatment are crucial, lest they cause permanent neurological damage.
Identifying the location of the hematoma is important for treatment, as is distinguishing it, to the extent possible, from other entit...
Spinal stenosis is a condition in which a portion of the spinal canal narrows to the point at which it can exert pressure on the nerves that travel through the spine (spinal cord or cauda equina).
Spinal stenosis is not to be confused with foraminal stenosis which is the narrowing of the forami...
Spiral fractures are complete fractures of long bones that result from a rotational force applied to the bone. Spiral fractures are usually the result of high energy trauma and are likely to be associated with displacement.
Splenic artery pseudoaneurysms are a rare type of pseudoaneurysm arising from any portion of the splenic artery and its branches.
Unlike splenic artery true aneurysms, splenic artery pseudoaneurysms will nearly always present with symptoms 2. While there occurrence may b...
Splenic pseudocysts, also referred as secondary splenic cysts, are acquired cystic lesions not delineated by a true epithelial wall. They represent the majority of the splenic cystic lesions, corresponding to approximately 80% of them (c.f. splenic epithelial cysts). The main causes are:
Splenic trauma can occur after blunt or penetrating trauma or secondary to medical intervention (i.e. iatrogenic). The spleen is the most frequently injured internal organ after blunt trauma.
In blunt trauma, the spleen can account for up to 49% of abdominal organ injuries 2.
Splenomegaly is a term which refers to enlargement of the spleen. The normal adult splenic length upper limit is usually around 12-15 cm. It can also be helpful to know how to calculate splenic index, volume and mass by CT and MR techniques. Massive splenomegaly is a term used when the spleen we...
A commonly adopted method of grading the severity of spondylolisthesis is the Meyerding classification. It divides the superior endplate of the vertebra below into 4 quarters. The grade depends on the location of the posteroinferior corner of the vertebra above.
This classification was original...
Stab wounds are a form of penetrating trauma that may be self-inflicted or inflicted by another person either accidentally or intentionally. They may be caused from a variety of objects and may occur anywhere in the body.
Although commonly caused by a knife as well, slash injuries ...
Sternal fractures occur in ~5% of blunt chest trauma with the manubrium being the most commonly injured part.
Acute, severe sternal pain that is worse with respiration with localised tenderness.
Mechanism of injury
Fractures of the sternum can result from bot...
Sternoclavicular joint (SCJ) dislocation is rare, accounting for only ~2% of joint dislocations and especially when compared to other traumatic upper limb injuries such as clavicular fractures.
Most cases result from indirect trauma 5, especially high-speed motor vehicle...
Stieda fractures refer to a bony avulsion injury of the medial collateral ligament (MCL) at the medial femoral condyle.
Pellegrini Stieda lesion
Stieda process fracture
Straight left heart border sign is a recently described finding on chest radiograph. It is a fairly specific (84%) sign of hemopericardium after a penetrating chest trauma, although sensitivity at 40% is relatively poor. Positive predictive value (PPV) was found to be 89% 1.
Stress fractures refer to fractures occurring in bone due to a mismatch of bone strength and chronic mechanical stress placed upon the bone. Fractures can either be:
fatigue fracture: abnormal stresses on normal bone
insufficiency fracture: normal stresses on abnormal bone
Radiographs have li...
Subcapital fracture is the commonest type of intracapsular fracture of the proximal femur. The fracture line extends through the junction of the head and neck of femur.
Although many classifications are proposed Garden classification and Pauwel classification are generally follo...
A subcapsular perirenal hematoma is a form of perirenal hematoma where blood accumulates beneath the renal capsular margin.
It can arise from a number of causes
trauma, important in assessing renal trauma grading
post procedural, e.g. extracorporeal shock-wave lithotripsy (ESWL) 5-...
Subcutaneous emphysema (or less correctly surgical emphysema), strictly speaking, refers to gas in the subcutaneous tissues. But the term is generally used to describe any soft tissue emphysema of the body wall or limbs since the gas often dissects into the deeper soft tissues and musculature al...
Subdural hemorrhage (SDH) is a collection of blood accumulating in the subdural space, the potential space between the dura and arachnoid mater of the meninges around the brain. SDH can happen in any age group, is mainly due to head trauma and CT scans are usually sufficient to make the diagnosi...
Subdural hygromas refer to the accumulation of fluid in the subdural space. In many cases, it is considered an epiphenomenon of head injury when it is called a traumatic subdural hygroma.
Subdural hygromas are encountered in all age-groups but are overall most common in the elder...
Subgaleal hematoma describes scalp bleeding in the potential space between the periosteum and the galea aponeurosis. It is a rare but possibly lethal emergency.
Moderate to severe presentations occur in 1.5 of 10 000 live births. It most commonly occurs after vacuum-assisted and f...
Subluxed facet joint is the mildest form of facet dislocation in which the ligamentous injury leads to partial uncovering of facet joint (c.f. complete uncovering in perched facet). This results in mild anterior displacement of one vertebral body on another (anterolisthesis).
Subtalar dislocations is the simultaneous dislocation of the talonavicular and talocalcaneal joints, without tibiotalar or talar neck fractures 1, and comprises 1-2% of all dislocations,
Subtalar dislocations are often associated with high energy trauma, usually, motor veh...
Superior labral anterior posterior (SLAP) tears are injuries of the glenoid labrum, and can often be confused with a sublabral sulcus on MRI.
SLAP tears involve the superior glenoid labrum, where the long head of biceps tendon inserts. Unlike Bankart lesions and ALPSA lesions, they ...
Superior orbital fissure syndrome (SOFS) or Rochon–Duvigneaud syndrome is a rare complication of craniofacial trauma with an orbital fracture that extends to the superior orbital fissure that results in injury to the cranial nerves III, IV, V (ophthalmic branch of the trigeminal nerve) and VI as...
Supracondylar humeral fractures, often simply referred to as supracondylar fractures, are a classic pediatric injury which require vigilance as imaging findings can be subtle.
Simple supracondylar fractures are typically seen in younger children, and are uncommon in adults; 90% ar...
There are many types of talar dislocation given its multiple articulations:
total talar dislocation
Talar fractures are an uncommon injury, accounting for <5% of all foot fractures. Recognition of the unique talar anatomy is important for correct diagnosis.
talar head fractures
talar neck fractures
talar body fractures
talar dome osteochondral fracture
Talar head fractures most commonly result from a compressive force with a plantar flexed foot.
Talar head fractures almost always involve the talonavicular joint, and associated dislocation/subluxation is common.
Two types of talar fractures are described 3:
compression fracture, o...
Talonavicular dislocations are a rare injury, and is caused by forced extreme abduction or adduction of the forefoot. They are often associated with calcaneocuboid dislocation (often transient) and calcaneal fractures (and are then called transcalcaneal talonavicular dislocations).
Temporal bone fracture is usually a sequela of significant blunt head injury. In addition to potentially damage to hearing and the facial nerve, associated intracranial injuries, such as extra-axial hemorrhage, diffuse axonal injury and cerebral contusions are common. Early identification of tem...
A helpful mnemonic for remembering the complications of temporal bone fractures that may require early intervention is:
C: carotid artery injury
L: leakage of CSF
O: other intracranial complications, e.g. hematoma
N: nerve injury leading to complete facial paralysis
The temporomandibular joint (TMJ) can be affected by trauma in a number of ways:
condylar process fractures
temporomandibular joint dislocation
fracture of the mandibular fossa
A number of processes can cause tendon pathology and there is a discrepancy in terminology reflecting the unclear pathophysiology.
tendinopathy: general umbrella term for pain and swelling of a tendon 2,3
previously popular term largely replaced by tendinopathy 3
Tension gastrothorax describes a rare life-threatening condition caused by mediastinal shift due to a distended stomach herniating into the thorax through a diaphragmatic defect.
Presentation is generally with acute and severe respiratory failure, with clinical features ...
A tension hemothorax refers to hemothorax that exert considerable mass effect. It often results from massive intrathoracic hemorrhage and often causing ipsilateral lung compression and mediastinal displacement.
Tension pneumothoraces occur when intrapleural air accumulates progressively in such a way as to exert positive pressure on mediastinal and intrathoracic structures. It is a life-threatening occurrence requiring both rapid recognition and prompt treatment to avoid a cardiorespiratory arrest.
The Terry Thomas sign refers to an increase in the scapholunate space on an AP radiograph of the wrist (or coronal CT). The increased distance indicates scapholunate dissociation (often with rotary subluxation of the scaphoid) due to ligamentous injury. There is no consensus as to what measureme...
Testicular dislocation is a rare condition in which a testicle is dislocated from its normal position within the scrotum to another location, most commonly the superficial inguinal pouch.
The condition mainly occurs in younger men with a mean age of 25 years 2.
Testicular fracture refers to a break in the parenchyma of the testicle as a result of blunt trauma.
A fracture line can be seen as a hypoechoic and avascular area within the testis but is only seen in 17% of cases 1. A tunica albuginea rupture may also be pr...
Thoracic aortic injury is the most common type of traumatic aortic injury and is a critical life-threatening, and often life ending event.
Approximately 80% of patients with thoracic aortic injury die at the scene of the trauma. In those who make it to hospital, clinical...
The thoracolumbar injury classification and severity score (TLICS), also sometimes known as the thoracolumbar injury severity score (TISS), was developed by the Spine Trauma Group in 2005 to overcome some of the perceived difficulties regarding the use of other thoracolumbar spinal fracture clas...
The two most commonly currently used thoracolumbar spinal fracture classification systems are the AO classification and the TLICS although a number of other classification systems have been proposed over the years 1. Each has benefits and drawbacks and each incorporates various features in an at...
The three column concept of thoracolumbar spinal fractures was initially devised by Francis Denis and presently CT is mandatory for an accurate classification.
While initially developed for classification of thoracolumbar spinal fractures, it can also be applied to the lower cervical spine 3 as...
Tillaux fractures are Salter-Harris III fractures through the anterolateral aspect of the distal tibial epiphysis, with variable amounts of displacement.
It occurs in older children and adolescents when the medial aspect of the distal tibial growth plate has started to fuse.
Toddler fractures are minimally or undisplaced spiral fractures usually of the tibia, typically encountered in toddlers. It is a potentially difficult diagnosis to establish on account of both the symptoms and imaging findings being subtle.
The term has sometimes also been used to ...
Tooth-knuckle injuries are sustained when the clenched fist of a patient strikes the teeth of an opponent.
Tooth-knuckle injuries are also referred to as clenched fist injuries, closed fist injuries and fight bite injuries.
These injuries are most commonly found in y...
Torus fractures, also known as buckle fractures, are incomplete fractures of the shaft of a long bone that is characterized by bulging of the cortex. They result from trabecular compression from an axial loading force along the long axis of the bone. They are usually seen in children, frequently...
Total talar dislocation, also known as extrusion of the talus, is a tri-articular dislocation of talus at the tibiotalar, talonavicular and subtalar joints. Most injuries are compound.
Mechanism of injury
Total talar dislocation is a rare injury caused by the combination of tibiotal...
Tracheobronchial injury is a serious but uncommon manifestation of chest trauma. It is usually a fatal injury with only a small percentage of patients making it to hospital. Given the magnitude of force required to injure the major airways, there are often multiple chest injuries and other body ...
Trampoline fractures are transverse fractures of the proximal tibial metaphysis that occur in children while jumping on a trampoline (or inflatable castle).
The fracture is thought to occur when a second, usually heavier individual causes the jumping surface to recoil upwards as the unsuspectin...
Transverse fractures are complete fractures that traverse the bone perpendicular to the axis of the bone. The fracture involves the cortex circumferentially and there may be displacement.
The term is predominantly used in the context of fractures of long bones although other types of bones may ...
Transverse process fractures are a common sequelae of trauma, although they are considered a minor and stable lumbar spine fracture. There is strong association between transverse process fractures and other traumatic injuries.
Transverse process fracture most commonly occur in the u...
Transverse temporal bone fractures are oriented perpendicular to the long axis of the petrous temporal bone, with the line of force running roughly anterior to posterior. Although more current classifications of the extent of temporal bone fractures focus on the integrity of the otic capsule rat...
A trapdoor fracture is a fracture of the orbital floor where the inferiorly displaced blowout fracture recoils back to its original position and potentially entraps contents of the orbit. It is seen in children and young adults due to the elasticity of the orbital floor. These fractures may be s...
Trapezium fractures are uncommon carpal bone injuries. They can either occur in isolation or combination with another carpal bony injury.
Isolated fractures of the trapezium are only thought to account for 3-5% of all carpal fractures 1-2.
They can be broadly classifie...
This is a basic article for medical students and other non-radiologists
Trauma films are ubiquitous in an orthopedic attachment and also in the Emergency Department.
In most cases, a trauma film will come with two views. It is important that you review both films because in some cases a fractu...
Trauma is a leading cause of mortality in pregnancy. Pregnancy increases the incidence and severity of abdominal trauma in females.
Trauma affects up to 7% of pregnancies, and the incidence of pregnancy in level 1 trauma patients is estimated to be ~2% 1.
Traumatic abdominal wall hernia describes traumatic disruption of musculature and fascia of anterior abdominal wall without skin penetration.
Abdominal skin ecchymosis or abrasions may be seen.
Traumatic abdominal wall hernia is caused by blunt trauma to the a...
Traumatic brain injuries (TBI) are common and come with a large cost to both society and the individual. Imaging, particularly CT, plays a key role in accurate diagnosis, classification and follow-up.
They can be broadly divided into closed and penetrating head injuries 4:
closed head injury
Traumatic spinal cord injury can manifest as a wide variety of clinical syndromes resulting from damage to the spinal cord or its surrounding structures. It can result from minor injury if the spine is weakened from disease such as ankylosing spondylitis or if there is pre-existing spinal stenos...
Traumatic subarachnoid hemorrhage (tSAH) is a common injury, and trauma is the most common cause of subarachnoid hemorrhage (SAH).
Traumatic subarachnoid hemorrhage occurs in ~35% (range 11-60%) of traumatic brain injuries 1.
Traumatic subarachnoid hemorrhage is most...
Trimalleolar fractures refer to a three-part fracture of the ankle. The fractures involve the medial malleolus, the posterior aspect of the tibial plafond (referred to as the posterior malleolus) and the lateral malleolus. Having three parts, this is a more unstable fracture and may be associate...
Triplane or triplanar fractures are of the distal tibia only occurring in adolescents. As the physiological closure of the physeal plate begins medially, the lateral (open) physis is prone to this type of fracture. The name is due to the fact of the fracture expanding both in frontal and lateral...
Triquetral fractures are carpal bone fractures generally occuring on the dorsal surface of the triquetrum. The triquetral may be fractured by means of impingement from the ulnar styloid, shear forces, or avulsion from strong ligamentous attachments. They are the second commonest carpal bone frac...
A trochanteric fracture is a fracture involving the greater and/or lesser trochanters of the femur.
Fractures in these regions can be classified as:
pertrochanteric: intertrochanteric, involving both trochanters
greater trochanteric avulsio...
Ulnar styloid fractures occur in association with ~60% of distal radius fractures. Most of these are small avulsion fractures involving the tip of the ulnar styloid.
Usually, this kind of fracture occurs as the result of a fall on an outstretched arm and is often associated with a di...
Uncal herniation is a subtype of transtentorial downward brain herniation, usually related to cerebral mass effect increasing the intracranial pressure.
pupils and globe clinical features 3
initially, an ipsilateral dilated pupil that is unresponsive to light, signifying...
Unilateral facet dislocation is a relatively stable type of facet dislocation.
Flexion/distraction associated with rotation. The inferior articular facet of vertebral above moves over the superior facet of the vertebral below and becomes locked. It usually affects C4-C5 or...
Upper extremity dislocations are relatively common on account of the great range of motion the upper limb is capable of (a general principle is that the greater the range of motion of a joint, the more prone it is to dislocation). In many instances dislocations are associated with fractures eith...
Ureteric injury is a relatively uncommon, but severe event, which may result in serious complications as a diagnosis is often delayed.
Ureteric injuries unreliably demonstrate macro- or micro-scopic hematuria as it may be absent in up to 25% of patients 5, 6. Classic cli...
Urethral injuries can result in long-term morbidity and most commonly result from trauma. The male urethra is much more commonly injured than the female urethra and is the focus of this article.
In the setting of trauma, the classic triad of blood of the external urethral...
Urinary bladder rupture is usually seen in the context of significant trauma.
Bladder rupture can be categorized into five types depending on the location and extent of the rupture:
This is commonly seen but sometimes not classed as true rupture, since i...
Vacuum-assisted therapy, also known vacuum-assisted closure (VAC) or negative pressure wound therapy, refers to a device used in the treatment of acute or chronic wounds.
foam dressing applied on the wound
covering transparent adhesive membrane
vacuum source: VAC ...