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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-dislocations

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. ...

Three column concept of spinal fractures

The three column concept of thoracolumbar spinal fractures was initially devised by Francis Denis. 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 the general...

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. Most injuries are compound. Pathology Mechanism of injury Total talar dislocation is a rare injury caused by the combination of tibiotal...

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 ...

Trampoline fracture

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 fracture

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 fracture

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. Pathology Transverse process fracture most commonly occur in the u...

Transverse temporal bone fractures

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...

Trapdoor fracture

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 fracture

Trapezium fractures are uncommon carpal bone injuries. They can either occur in isolation or combination with another carpal bony injury. Epidemiology Isolated fractures of the trapezium are only thought to account for 3-5% of all carpal fractures 1-2. Pathology They can be broadly classifie...

Trauma films (summary approach)

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 in pregnancy

Trauma is a leading cause of mortality in pregnancy. Pregnancy increases the incidence and severity of abdominal trauma in females. Epidemiology Trauma affects up to 7% of pregnancies, and the incidence of pregnancy in level 1 trauma patients is estimated to be ~2% 1. Pathology Etiology 9...

Traumatic abdominal wall hernia

Traumatic abdominal wall hernia describes traumatic disruption of musculature and fascia of anterior abdominal wall without skin penetration. Clinical presentation Abdominal skin ecchymosis or abrasions may be seen. Pathology Traumatic abdominal wall hernia is caused by blunt trauma to the a...

Traumatic brain injury

Traumatic brain injuries (TBI) are common and come with a large cost to both society and the individual. The diagnosis of traumatic brain injury is a clinical decision, however, imaging, particularly CT, plays a key role in diagnostic work-up, classification, prognostication and follow-up. The...

Traumatic spinal cord 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

Traumatic subarachnoid hemorrhage (tSAH) is a common injury, and trauma is the most common cause of subarachnoid hemorrhage (SAH). Epidemiology Traumatic subarachnoid hemorrhage occurs in ~35% (range 11-60%) of traumatic brain injuries 1. Pathology Traumatic subarachnoid hemorrhage is more...

Trimalleolar fracture

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 fracture

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 fracture

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...

Trochanteric fracture

A trochanteric fracture is a fracture involving the greater and/or lesser trochanters of the femur. Classification Fractures in these regions can be classified as: intertrochanteric pertrochanteric: intertrochanteric, involving both trochanters subtrochanteric greater trochanteric avulsio...

Ulnar styloid fracture

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. Pathology 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

Uncal herniation is a subtype of transtentorial downward brain herniation, usually related to cerebral mass effect increasing the intracranial pressure. Clinical presentation pupils and globe clinical features 3 initially, an ipsilateral dilated pupil that is unresponsive to light, signifying...

Unilateral facet dislocation

Unilateral facet dislocation is a relatively stable type of facet dislocation. Pathology Mechanism 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

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

Ureteric injury is a relatively uncommon, but severe event, which may result in serious complications as a diagnosis is often delayed. Clinical presentation 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 injury

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. Clinical presentation In the setting of trauma, the classic triad of blood of the external urethral...

Urinary bladder rupture

Urinary bladder rupture is usually seen in the context of significant trauma. Pathology Etiology Bladder rupture can be categorized into five types depending on the location and extent of the rupture: Bladder contusion This is commonly seen but sometimes not classed as true rupture, since i...

Urinothorax

Urinothorax (plural: urinothoraces), also known as urothorax, is a rare cause of pleural effusion due to the accumulation of urine within the pleural space. Clinical presentation Patients present with varying degrees of respiratory distress depending on the amount of fluid that has accumulated...

Vacuum assisted therapy

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. Components foam dressing applied on the wound suction drains covering transparent adhesive membrane vacuum source: VAC ...

Vancouver classification of periprosthetic hip fractures

The Vancouver classification of periprosthetic hip fractures proposed by Duncan and Masri is the most widely used classification system. It takes into account the fracture site, the status of the femoral implant, and the quality of surrounding femoral bone stock. type A: fractures involve the t...

Vitreous hemorrhage

Vitreous hemorrhage refers to bleeding into the vitreous chamber. Epidemiology Vitreous hemorrhage has an incidence of approximately 7 in 100000 1,2. Clinical presentation The most common clinical presentation is with sudden, painless visual loss to varying degrees of severity 2. Associate...

Volar intercalated segmental instability

Volar intercalated segmental instability (VISI) is a type of instability involving the wrist. It is less often encountered than dorsal intercalated segmental instability (DISI). Clinical presentation It presents in most cases with nonspecific wrist pain and a "clunking" on the ulnar deviation ...

Volar plate avulsion injury

Volar plate avulsion injuries are a type of avulsion injury. The volar plate of the proximal interphalangeal (PIP) joint is vulnerable to hyperextension injury, in the form of either a ligament tear or an intra-articular fracture. Gross anatomy The volar plate forms the floor of the PIP joint ...

Weber classification of ankle fractures

The Weber ankle fracture classification (or Danis-Weber classification) is a simple system for classification of lateral malleolar fractures, relating to the level of the fracture in relation to the ankle joint. It has a role in determining treatment. Classification type A below the level of...

Wedge fracture

Wedge fractures are hyperflexion injuries to the vertebral body resulting from axial loading. Most commonly affecting the anterior aspect, wedge fractures are considered a single-column (i.e. stable) fracture. Less commonly wedge fractures refer to a subtype of tibial plateau fractures. This a...

Whiplash syndrome

Whiplash syndrome, also known as whiplash-associated disorders (WAD), are the various symptoms caused by rapid acceleration and/or deceleration injuries, which result in cervical sprain or strain. Epidemiology Whiplash is a common injury, usually associated with motor vehicle collisions 1-5. T...

Winquist classification of femoral shaft fractures

The Winquist classification of femoral shaft fractures is based on fracture comminution and was proposed by Winquist in 1980. This classification is used with regards to management decision making, in determining whether a fracture requires an intramedullary nail or open reduction. Type 0: no ...

Young and Burgess classification of pelvic ring fractures

The Young and Burgess classification is a modification of the Tile classification 1. It is the recommended 5 and most widely used classification system for pelvic ring fractures. It takes into account force type, severity, and direction, as well as injury instability. Three basic mechanistic ...

Yo-yo on a string sign (Stener lesion)

The yo-yo on a string sign denotes the characteristic appearance of the torn, proximally retracted and superficially displaced ulnar collateral ligament (UCL) due to a Stener lesion. Mechanism The sign occurs as a consequence of the tear of the ulnar collateral ligament of the thumb (gamekeepe...

Zygomaticomaxillary complex fracture

Zygomaticomaxillary complex (ZMC) fractures, also known as tripod, tetrapod, quadripod, malar or trimalar fractures, are seen in the setting of traumatic injury to the face. They comprise fractures of the: zygomatic arch inferior orbital rim, and anterior and posterior maxillary sinus walls l...

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