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Salter-Harris type IV fracture

Salter-Harris type IV fractures are relatively uncommon injuries that occur in children. They are intra-articular injuries in which the fracture extends through the epiphysis, across the physis and through the metaphysis. Salter-Harris fractures are a group childhood injuries where a fracture in...

Salter-Harris type V fracture

Salter-Harris type V fractures are very uncommon injuries that occur in children. These fractures involve a crush injury of the physis secondary to compressive forces that involve all or part of the physis 1,2. In general Salter-Harris fractures are childhood injuries where there is a fracture t...

Sanders CT classification of calcaneal fracture

The Sanders classification system is used to assess intraarticular calcaneal fractures, which are those involving the posterior facet of the calcaneus. This classification is based on the number of intraarticular fracture lines and their location on semicoronal CT images. This classification is ...

Sandwich sign (disambiguation)

The sandwich sign is used for two different imaging appearances: sandwich sign (Marchiafava-Bignami disease) sandwich sign (mesentery) Sandwich sign has also been coined for the appearance of: primary pleural lymphoma 1,2 mediastinal lymphoma 3 marrow edema and hemorrhage on MRI of flexion...

Scalp hematoma

A scalp hematoma usually occurs following an injury at delivery although they are commonly seen with head trauma. Classification There are three types of hematoma, which are defined by their location within the scalp, particular their location as related to the galea aponeurosis and skull peri...

Scaphoid fracture

Scaphoid fractures (i.e. fractures through the scaphoid bone) are common, in some instances can be difficult to diagnose, and can result in significant functional impairment. Epidemiology Scaphoid fractures account for 70-80% of all carpal bone fractures 1. Although they occur essentially at a...

Scaphoid fracture (summary)

This is a basic article for medical students and other non-radiologists Scaphoid fractures are the second commonest group of fractures that are seen following a fall onto an outstretched hand and result in wrist pain, specifically tenderness in the anatomical snuffbox. They are particularly imp...

Scaphoid non-union

Scaphoid non-union is one of the complications of scaphoid fracture because of the unique anatomy of the scaphoid and its vascular supply. Epidemiology Scaphoid fractures have one of the highest rates non-union of all fractures at ~10% (range 5-15%) 3,4. Pathology Scaphoid non-union occurs m...

Scapholunate dissociation

Scapholunate dissociation, also known as rotary subluxation of the scaphoid, refers to an abnormal orientation of the scaphoid relative to the lunate, and implies severe injury to the scapholunate interosseous ligament and other stabilizing ligaments. Carpal dissociation implies carpal instabil...

Scapular fracture

Scapula fractures are uncommon injuries, representing ~3% of all shoulder fractures. Pathology 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 of tibial plateau fractures

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...

Schenck classification of knee dislocation

The Schenck classification is categorizing knee dislocation based on the pattern of ligament tears. The four major ligamentous stabilizers are the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL) and the lateral collateral ligament (LCL) compl...

Scrotal hematocele

Scrotal hematoceles are collections of blood within the scrotal sac, but outside of the testis. Pathology A hematocele normally results from trauma to the scrotum, or on occasion following surgery. Some think that a varicocele is a risk factor for developing a hematocele 4. Radiographic featu...

Seatbelt sign (abdomen)

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...

Seatbelt syndrome

The seatbelt syndrome is the constellation of traumatic thoracic, abdominal and/or vertebral column injuries associated with three-point seatbelts 1,2: bowel perforation mesenteric tear sternal fracture lumbar spine fracture female breast trauma

Second-impact syndrome

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. Epidemiology Second-impact syndrome is common in young athletes. Clinical presentation The typical second-impact syndrome scenario occur...

Segmental fracture

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

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...

Seurat spleen

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. Pathology Several mechanisms are thought to to attribute to this appearance which include sinusoidal s...

Seymour fracture

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. Clinical presentation The skeletally-immature patient presents wi...

Shock thyroid

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 ...

Shoulder dislocation

The shoulder dislocation (more accurately termed a glenohumeral joint dislocation) involves 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 the...

Shoulder (modified trauma axial view)

The modified trauma axial view is a supplementary projection that replaces the ‘Y view’ of the two-view shoulder series. It is an orthogonal view of the AP projection of the glenohumeral joint and is often performed in the context of trauma. Indications The modified trauma axial view is used t...

Shoulder series (summary)

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. Reference article This is a summary article. For more information, you can read a more i...

Skull fractures

Skull fractures are common in the setting of both closed traumatic brain injury and penetrating brain injury. Their importance is both as a marker of the severity of trauma and because they are, depending on location, associated with a variety of soft tissue injuries. This article will focus o...

Skull fractures (summary)

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. Reference article This is a summary article; read more in our article on skull fractures. Summary anatomy...

Slipped upper femoral epiphysis (summary)

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 fracture

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...

Solid and hollow abdominal viscera

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 cord transection

Spinal cord transection, as the name implies, refers to a tear within the spinal cord as a result of a significant traumatic injury. It is an important radiological finding that can influence the decision on potential surgery in the setting of spinal trauma. Clinical presentation The presentat...

Spinal fractures

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 dens fracture flexion teardrop...

Spinal hematoma

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

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 stenosis is not to be confused with foraminal stenosis which is the narrowing of the foramina with subsequent compression...

Spiral fracture

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 pseudoaneurysm

Splenic artery pseudoaneurysms are a rare type of pseudoaneurysm arising from any portion of the splenic artery and its branches. Clinical presentation Unlike splenic artery true aneurysms, splenic artery pseudoaneurysms will nearly always present with symptoms 2. While there occurrence may b...

Splenic pseudocyst

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: splen...

Splenic trauma

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. Epidemiology In blunt trauma, the spleen can account for up to 49% of abdominal organ injuries 2. Cli...

Splenomegaly

Splenomegaly refers to enlargement of the spleen. The upper limit of normal adult splenic length is traditionally cited at 12 cm, but lengths upwards of 14 cm can be seen in normal, taller males 7. Massive splenomegaly is variably defined, including when the spleen is 5 standard deviations abov...

Spondylolisthesis grading system

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 wound (overview)

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. Terminology Although commonly caused by a knife as well, slash injuries ...

Starfield pattern (fat embolism)

A starfield pattern has been described as being typical of DWI of patients with cerebral fat embolism 1,2. Although the term is closely linked to the diagnosis of fat embolism, it should be noted that such an appearance is merely the result of very numerous microemboli. As such, a similar patter...

Sternal fracture

Sternal fractures occur in ~5% of blunt chest trauma with the manubrium being the most commonly injured part. Clinical presentation Acute, severe sternal pain that is worse with respiration with localized tenderness. Pathology Mechanism of injury Fractures of the sternum can result from bot...

Sternoclavicular joint dislocation

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. Epidemiology Most cases result from indirect trauma 5, especially high-speed motor vehicle accident...

Stieda fracture

Stieda fractures refer to a bony avulsion injury of the medial collateral ligament (MCL) at the medial femoral condyle. When it fails to unite, it is known as a Pellegrini Stieda lesion. It should not be confused with a Stieda process fracture of the talus.

Stove-in chest

A stove-in chest is a rare and complex type of flail chest injury where the flail segment collapses into the chest. It is usually due to severe blunt trauma to the chest wall and is rarely encountered in imaging or emergency medicine due to the high mortality at the scene. It may evolve over day...

Straight left heart border sign

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. It is different to ...

Stress fracture

Stress fractures refer to fractures occurring in the bone due to a mismatch of bone strength and chronic mechanical stress placed upon the bone. Terminology A pathological fracture, although a type of insufficiency fracture, is a term in general reserved for fractures occurring at the site of ...

Subaxial cervical spine injury classification

The subaxial cervical spine injury classification (SLIC) and severity score is a system for cervical spine trauma that helps guide treatment and predicts prognosis. Classification Three parameters are assessed, two being radiologic determined and the last being a clinical assessment. Injury m...

Subcapital fracture

Subcapital fracture is the most common type of intracapsular neck of femur fracture. The fracture line extends through the junction of the head and neck of femur. Classification Although many classifications are proposed Garden classification and Pauwel classification are generally followed fr...

Subcapsular perirenal hematoma

A subcapsular perirenal hematoma is a form of perirenal hematoma where blood accumulates beneath the renal capsular margin. Pathology 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

Subcutaneous emphysema (also known commonly, although less correctly, as 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 ...

Subdural hemorrhage

Subdural hemorrhage (SDH) (also commonly called a subdural hematoma) 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 ...

Subdural hygroma

Subdural hygromas (alternative plural: hygromata 9) 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. Epidemiology Subdural hygromas are encountered in all age-groups but ar...

Subgaleal hematoma

Subgaleal hematoma describes scalp bleeding in the potential space between the periosteum and the galea aponeurosis. It is a rare but possibly lethal emergency. Epidemiology 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

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 dislocation

Subtalar dislocations is the simultaneous dislocation of the talonavicular and talocalcaneal joints, without tibiotalar or talar neck fractures 1. Epidemiology Subtalar dislocations comprise 1-2% of all dislocations. Pathology Mechanism Subtalar dislocations are often associated with high e...

Superior labral anterior posterior tear

Superior labral anterior posterior (SLAP) tears are injuries of the glenoid labrum, and can often be confused with a sublabral sulcus on MRI. Pathology SLAP tears involve the superior glenoid labrum, where the long head of biceps tendon inserts. They can extend into the tendon, involve the gl...

Superior orbital fissure syndrome

Superior orbital fissure syndrome (SOFS) (also known as 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 ner...

Supermicrosurgery

Supermicrosurgery is the specialized surgical technique employed to anastomose blood vessels and nerves measuring 0.3 to 0.8 mm in caliber (so-called microneurovascular anastomosis) 1. The instruments developed for these demanding procedures are very fine microsurgical devices. Microsurgery as a...

Supracondylar humeral fracture

Supracondylar humeral fractures, often simply referred to as supracondylar fractures, are a classic pediatric injury which requires vigilance as imaging findings can be subtle. Epidemiology Simple supracondylar fractures are typically seen in younger children, and are uncommon in adults; 90% a...

Systemic hypotension

Systemic hypotension - or often just - hypotension - is the presence of an abnormally low blood pressure. This may be relative, so that a poorly-controlled hypertensive patient who runs a normal blood pressure at 160/100, may be severely hypotensive at 80/60. Hypotension is usually defined with...

Tadpole sign

The tadpole sign, also known as the lollipop sign, refers to a characteristic morphology of post-traumatic bridging vein thrombosis with a rounded "head" and a tapering "tail". The finding demonstrates a high specificity for abusive head trauma, a sub-type of non-accidental injury, and should wa...

Talar body fractures

Talar body fractures are a subtype of talar fracture, subdivided into: talar dome osteochondral fracture posterior talar process fracture lateral talar process fracture

Talar dislocation

There are many types of talar dislocation given its multiple articulations: tibiotalar dislocation subtalar dislocation total talar dislocation talonavicular dislocation Chopart fracture-dislocation

Talar fractures

Talar fractures are an uncommon injury, accounting for <5% of all foot fractures. Recognition of the unique talar anatomy is important for correct diagnosis. Pathology Location talar head fractures talar neck fractures talar body fractures talar dome osteochondral fracture posterior talar...

Talar head fracture

Talar head fractures most commonly result from a compressive force with a plantar flexed foot. Pathology 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 dislocation

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). See also ta...

Tarsal fracture

Tarsal fractures are fractures of the tarsal bones of the foot, which are further divided by anatomic site: calcaneal fracture (most common) calcaneal tuberosity avulsion fracture lover's fracture talar fractures talar head fracture talar neck fracture aviator fracture lateral talar (sno...

Temporal bone fracture

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...

Temporal bone fracture complications (mnemonic)

A helpful mnemonic for remembering the complications of temporal bone fractures that may require early intervention is: CLONE Mnemonic C: carotid artery injury L: leakage of CSF O: other intracranial complications, e.g. hematoma N: nerve injury leading to complete facial paralysis E: ext...

Temporomandibular joint trauma

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

Tendon pathology

A number of processes can cause tendon pathology and there is a discrepancy in terminology reflecting the unclear pathophysiology. Terminology tendinopathy: general umbrella term for pain and swelling of a tendon 2,3 tendinitis previously popular term largely replaced by tendinopathy 3 now...

Tension gastrothorax

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. Clinical presentation Presentation is generally with acute and severe respiratory failure, with clinical features ...

Tension hemothorax

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 pneumothorax

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. A ...

Terry-Thomas sign

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

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. Epidemiology The condition mainly occurs in younger men with a mean age of 25 years 2. Clinical presentat...

Testicular fracture

Testicular fracture refers to a break in the parenchyma of the testicle as a result of blunt trauma. Radiographic features Ultrasound 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

Thoracic aortic injury is the most common type of traumatic aortic injury and is a critical life-threatening, and often life-ending event. Clinical presentation Approximately 80% of patients with thoracic aortic injury die at the scene of the trauma. In those who make it to hospital, clinical...

Thoracic spine fracture-dislocation

Thoracic spine fracture-dislocations are severe forms of spinal column injuries that occur secondary to high-energy trauma, in which there is vertebral fracture concomitant with dislocation of facet joints and/or the intervertebral disc space. They are mechanically unstable and are associated wi...

Thoracolumbar injury classification and severity score (TLICS)

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...

Thoracolumbar spinal fracture classification systems

Thoracolumbar spinal fracture classification systems are numerous and represent attempts by various authors to create systems that allow uniform and reproducible classification and description of thoracolumbar fractures which in turn can help with treatment decision making and prognostication. ...

Thoracolumbar spine fracture

Thoracolumbar spine fractures are often the result of significant blunt trauma such as motor vehicle accidents or falling from a height. Fractures in this region range from non-complex to highly complex and will vary in prognosis. Epidemiology Males are affected more commonly than females wit...

Three column concept of spinal fractures

The three-column concept of thoracolumbar spinal fractures (of Denis) forms the basis of a number of widely used thoracolumbar spinal fracture classification systems. Usage While the three-column concept was initially developed for classification of thoracolumbar spinal fractures, it can also ...

Tile classification of pelvic fractures

The Tile classification of pelvic fractures is the precursor of the more contemporary Young and Burgess classification of pelvic ring fractures. It takes into account stability, force direction, and pathoanatomy. The integrity of the posterior arch determines the grade, with the posterior arch ...

Tillaux fracture

Tillaux fractures are Salter-Harris III fractures through the anterolateral aspect of the distal tibial epiphysis, with variable amounts of displacement. Epidemiology It occurs in older children and adolescents when the medial aspect of the distal tibial growth plate has started to fuse. Path...

Toddler fracture

A toddler fracture is a minimally or undisplaced spiral fracture, 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. Terminology The term has sometimes also been used t...

Tooth-knuckle injury

Tooth-knuckle injuries are sustained when the clenched fist of a patient strikes the teeth of an opponent. Terminology Tooth-knuckle injuries are also referred to as clenched fist injuries, closed fist injuries and fight bite injuries. Epidemiology These injuries are most commonly found in y...

Torus fracture

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 due to an axial loading force along the long axis of the bone. They are usually seen in children, frequent...

Total talar dislocation

Total talar dislocation, also known as extrusion of the talus, is a tri-articular dislocation of talus at the tibiotalar, talonavicular and subtalar joints. Pan-talar dislocation and luxatio tali totalis are also used for such traumatic insult.7 Most injuries are compound. Pathology Mechanism...

Tourniquet

Tourniquets are external devices used to temporarily stop active arterial bleeding on the extremities, which are not controllable by dressing or packing. The tourniquet is placed proximally to the site of injury, at the most distal aspect of the undamaged, healthy tissue. Note that devices widel...

Tracheobronchial injury

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 ...

Traction splint

Traction splints are external devices primarily used in the pre-hospital acute management for the reduction and immobilization of femoral shaft fractures. Their main aim is to limit movement of fracture fragments, thus reducing the risk of vessel injury, pain, and nerve damage 1. Radiographic ...

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