CT hypotension complex refers to the predominantly abdominal imaging features that occur in the context of profound hypotension. Multiple abdominal organs can display atypical appearances not related to the initial trauma but reflect alterations in perfusion secondary to hypovolemia which affect...
Below is an approach used for the "primary survey" of a CT polytrauma/multitrauma (also called trauma CT), often performed at the CT console with the patient still on the CT table. It allows rapid communication of significant findings to the trauma team as well as the decision to perform additi...
CT polytrauma/multitrauma (also called trauma CT) is an increasingly used test in the patient with multiple injuries sustained after significant trauma.
There is some evidence that trauma patients who undergo whole body CT (WBCT) / panscan have better survival than patients who undergo selectiv...
The deep sulcus sign on a supine chest radiograph raises suspicion of a pneumothorax.
On a supine plain chest film (common in intensive care units or as part of a trauma radiograph series), it may be the only suggestion of a pneumothorax because air collects anteriorly and basally, within the n...
Degloving bowel injuries are a rare type of bowel and mesenteric injury only being described a handful of times in the literature 1-5. In these injuries the bowel is stripped of its mesentery and muscle, leaving a "mucosal tube" 2,3. Perforation may or may not be present.
Degloving injuries can refer to a number of conditions:
degloving soft tissue injury
Morel-Lavallee lesion (closed degloving soft tissue injury)
intramuscular degloving injury
degloving bowel injury
Degloving soft tissue injuries can be extensive and quite severe conditions. These may be open or, less commonly, closed injuries, which are known as Morel-Lavallee lesions. This article focuses on open injuries with closed injuries discussed in the Morel-Lavallee lesion article.
Deltoid ligament injuries involve the deltoid ligament that forms the medial part of the ankle joint. It attaches the medial malleolus to multiple tarsal bones.
Mechanism of injury
It occurs due to eversion and/or pronation injury, or can be associated with lateral ankle fractures.
The Denver criteria are a set of screening criteria for blunt cerebrovascular injury (BCVI) in trauma used to reduce the need for CT angiography and its associated radiation exposure.
The screening protocol criteria 1,3 for BCVI are divided into signs and symptoms of BCVI a...
Depressed skull fractures result in the bone of the skull vault being folded (depressed) inward into the cerebral parenchyma. It is usually the result of a high energy impact to the skull.
These mostly (~75%) occur in the frontoparietal region 3.
There are number of as...
Describing a fracture is a basic requirement when making an assessment of a plain radiograph. There are many ways to approach the assessment of the radiograph; this is just one approach.
I: Describe the film
What film (or films) are you looking at? Check the who, what, why, when, and where.
Diaphragmatic rupture often results from blunt abdominal trauma. The mechanism of injury is typically a motor-vehicle collision.
Given that the most common mechanism is motor vehicle collisions, it is perhaps unsurprising that young men are most frequently affected. The estimated ...
A die-punch fracture results from axial loading forces on the distal radius. It is an intra-articular fracture of the lunate fossa of the distal radius1. It is by definition depressed or impacted and is named after the machining technique of shearing a shape, depression or hole in a material wit...
Diffuse axonal injury (DAI), also known as traumatic axonal injury (TAI), is a severe form of traumatic brain injury due to shearing forces. It is a potentially difficult diagnosis to make on imaging alone, especially on CT as the finding can be subtle, however, it has the potential to result in...
Grading of diffuse axonal injury has been described histologically according to the anatomic distribution of injury, which correlated with outcome 1-3. The classification was first proposed by Adams in 1989 4 and divides diffuse axonal injury (DAI) into three grades:
grade I: involves grey-whit...
The term disarticulation refers to the disconnection of all or part of a limb from the body, specifically through a joint. This is in contrast to amputation, which is the disconnection or removal of the structure through a bone.
Distal fibula fractures are the most common type at the ankle and are usually the result of an inversion injury with or without rotation. They are the extension of a lateral collateral ligament injury.
Most ankle injuries occur because of an inversion injury. A pure...
Distal phalanx fractures are the most common fractures in the hand.
They represent >50% of all phalangeal fractures and frequently involve the ungual tuft 1.
They are frequently related to sports, with lesions such as the Mallet finger and the Jersey finger, or can occur after a crush injury,...
Distal radial fractures are a heterogeneous group of fractures that occur at the distal radius and are the dominant fracture type at the wrist. These common fractures usually occur when significant force is applied to the distal radial metaphysis.
Distal radial fractures can be s...
Distal radial fractures are a relatively common group of injuries that usually occur following a fall. The commonest of these fractures is a transverse extra-articular fracture and where there is associated dorsal angulation, this is termed a Colles fracture.
This is a summar...
Isolated distal radioulnar joint (DRUJ) dislocations are rare and are more commonly part of complex forearm fracture-dislocations.
Wrist pain, swelling and deformity following FOOSH or direct trauma. The patient will be unable to supinate/pronate the forearm 1,2.
Distal ulnar fractures are common, and usually occur with a concurrent distal radius fracture.
Isolated fractures occurs as a result of direct force to the ulna. Fractures associated with radius fractures usually occur as the result of a fall on an outstretched arm.
Distal ulnar fra...
Dolan's lines are the collective name given to three lines described by Dolan and Jacoby 1 that aid in evaluating for maxillofacial fractures on an occipitomental skull radiograph. They are usually used as an adjunct to McGrigor-Campbell lines.
orbital line traces the inner margins of the later...
Dorsal intercalated segment instability (DISI) is one of the types of instability involving the wrist. It occurs because of a disruption of the dorsal intercarpal ligament. It is more often encountered than volar intercalated segment instability (VISI).
wrist trauma, with ...
The double delta sign is a feature that has been described in a bucket handle meniscal tear when the inner meniscal fragment flipped anteriorly adjacent to the anterior horn of the donor site and is referred to as a displaced bucket handle tear. The original location of the posterior horn remain...
Duodenal haematoma results in haematoma formation in the duodenal wall. It may occur as a result of blunt abdominal trauma, non-accidental injury to children and spontaneously in anti-coagulated patients.
Distinction must be made from duodenal perforation since the latter will require immediate...
This classification was proposed by Eaton and Malerich in 1980, and presently (time of writing, August 2016) along with Keifhaber-Stern classification, is the most widely accepted classification of volar plate avulsion injuries 1.
Knowledge of the orthopaedic Eaton classification is practical ...
Elbow dislocation is the second most common large joint dislocation in the adult population.
A dislocation with no fracture is simple whereas an accompanying fracture makes the dislocation complex. The most common fracture is a radial head fracture, although coronoid process fracture is also c...
The elbow extension test is a clinical decision rule aimed at reducing the number of unnecessary elbow radiographs in patients aged ≥3 years.
The test has a specific examination whereby the seated patient, with the arm in supination and 90º shoulder flexion, is asked to fully extend the elbow ...
An elbow series is the standard series of radiographs that are performed when looking for evidence of fracture, dislocation or elbow joint effusion following trauma.
This is a summary article. For more information, you can read a more in-depth reference article: elbow series....
Epibasal fractures of the thumb (also called pseudo-Bennett fracture) are two-piece fractures of the proximal first metacarpal bone. They are usually stable, depending on the degree of displacement, and often do not require surgery. It is important to distinguish them from intra-articular fractu...
Epicondyle fractures are common injuries in children. They represent 10% of all elbow fractures in children and usually occur in boys after a fall on an outstretched arm.
Medial epicondyle fractures comprise most of these injuries. They can usually be treated with splinting and early physiother...
There are numerous eponymous fractures which are named after the people who first described their existence 1:
Bankart fracture: glenoid
Barton fracture: wrist
Bennett fracture: thumb
Bosworth fracture: ankle
Chance fracture: vertebral
Charcot joint: foot
Chopart fracture: foot
Essex-Lopresti fracture-dislocations comprise of a comminuted fracture of the radial head accompanied by dislocation of the distal radioulnar joint (DRUJ). The force of trauma is transmitted down the forearm through the interosseous membrane causing disruption. The DRUJ injury may be missed lead...
Extracranial brain herniation refers to herniation of brain tissue external to the calvaria through a skull bone defect, which may be post-traumatic or post-surgical. Unlike encephaloceles, brain herniation is surrounded by the meninges.
The herniated brain tissue requires surgical reduction a...
Differentiating extradural (EDH) from subdural (SDH) haemorrhage in the head is usually straightforward, but occasionally it can be challenging. SDHs are more common and there are a few distinguishing features which are usually reliable.
History and mechanism of injury
Extradural haematoma (EDH), also known as an epidural haematoma, is a collection of blood that forms between the inner surface of the skull and outer layer of the dura, which is called the endosteal layer. They are usually associated with a history of head trauma and frequently associated skull ...
Extrapleural haematomas are uncommon and usually seen in the context of rib fracture, subclavian venous catheter traumatic insertion, and blunt chest injury.
Extrapleural haematomas result from the accumulation of blood in the extrapleural space where the overlying extrapleural fat i...
Facet dislocation refers to anterior displacement of one vertebral body on another. Without a fracture, the only way anterior displacement can occur is by dislocation of the facets.
Facet dislocation can occur to varying degrees:
The injury usua...
Facial fractures are commonly caused by blunt or penetrating trauma sustained during motor vehicle accidents, assaults, and falls. The facial bones are thin and relatively fragile making them susceptible to injury.
Males are affected more commonly than females and facial fractures...
The fallen lung sign (also known as CT fallen lung sign) describes the appearance of collapsed lung away from the mediastinum encountered with tracheobronchial injury (in particular those >2 cm away from the carina). It is helpful to look for this rare but specific sign, in cases of unexplained ...
Fall onto an outstretched hand (FOOSH) is a common mechanism for wrist-forearm fractures, in certain cases with involvement of elbow structures, particularly in children.
Some injuries that result from such a fall include:
Fatigue fractures are a type of stress fracture due to abnormal stresses on normal bone. They should not be confused with an insufficiency fracture, which occurs due to normal stresses on abnormal bone. Plain films typically demonstrate a linear sclerotic region. MRI is the most sensitive and sp...
Flail chest or flail thoracic segment occurs when three or more contiguous ribs are fractured in two or more places. Clinically, a segment of only one or two ribs can act as a flail segment, hence there is some controversy between the clinical and radiological definitions.
Flexion supracondylar humeral fractures account for only 2-4% of all supracondylar fractures 1. Unlike the much more common extension supracondylar fracture which are seen in children, flexion fractures are seen in older patients. They are usually the result of a fall directly onto a flexed elbo...
Focussed Assessment with Sonography for Trauma (FAST) scan is a point-of-care ultrasound examination performed at the time of presentation of a trauma patient.
It is invariably performed by a clinician, who should be formally trained, and is considered as an 'extension' of the trauma clinical ...
Forearm fractures are a group of fractures that occur in the forearm following trauma. The radius and ulna are bound together at the proximal and distal radioulnar joints and act as a ring. Like elsewhere in the body, it is difficult only to fracture one bone if there is a bony ring. If the radi...
Forearm fractures are a group of fractures that occur in the forearm following trauma. The radius and ulna are bound together at the proximal and distal radioulnar joints and act as a ring. Like elsewhere in the body, it is difficult to only fracture one bone if there is a bony ring. If the radi...
Fracture-a-la-signature (or signature fracture) is another term used to described a depressed skull fracture.
Fracture-a-la-signature derives its name from forensic medicine because the size and shape of a depressed skull fracture may give information on the type of weapon used. It can be a si...
Assessment of fracture complications is key to accurate assessment of a fracture. It is vital to assess for these when describing a fracture.
This is a summary article. There is no accompanying reference article.
When describing a fracture, it is important to keep a...
Fracture description allows an individual to accurately determine fracture type and communicate important information to colleagues without the use of the radiograph. Practicing fracture description is important and using a systematic approach may make this process less stressful.
Fracture-dislocations of the radius and ulna illustrate the importance of including the joint above and below the site of injury on radiographic assessment.
Most forearm fractures (60%) include fracture of the distal radius as well as an ulnar fracture. In some cases, there is associated disloc...
Describing fracture displacement is really important when assessing a fracture. The type and degree of displacement will have a significant effect on the management plan and prognosis.
This is a summary article. For more information, you can read a more in-depth reference art...
Determining fracture location is important when describing a fracture and determining plans for management.
This is a summary article. For more information, you can read a more in-depth reference articles: bone macroscopic structure.
When describing a fracture, loca...
The proximal 5th metatarsal is the site of a number of fractures and variants which mimic fractures. These include:
stress fracture of the 5th metatarsal
avulsion fracture of the proximal 5th metatarsal
os vesalianum or os peroneum
normal apophysis of the proximal 5th metatar...
Fractures of the thumb are important due to huge impact the thumb has on the overall function of the hand, an understanding of the types of fractures that occur is important, as treatment varies with fracture type.
Metacarpal fractures include:
Fragility fractures are those that are the result of forces that would not fracture a normal bone. They can occur in the context of very low energy (i.e. minimal) trauma, or they may be no identifiable preceding trauma. There is overlap between fragility fractures and insufficiency fractures.
Frontal sinus fractures are facial fractures that involve the frontal sinus, either in isolation or more commonly as part of more complex facial fractures. They can result in cosmetic deformity, functional impairment, CSF leak, and/or intracranial infection (e.g. meningitis).
There are several mnemonics for the difference between a Galeazzi and a Monteggia fracture-dislocation:
MUGR (pronounced as mugger)
It is useful to note that it is the head of the non-fractured bone that is dislocated.
GRIMUS helps to remember...
Galeazzi fracture-dislocations consist of fracture of the distal part of the radius with dislocation of distal radioulnar joint and an intact ulna. A Galeazzi-equivalent fracture is a distal radial fracture with a distal ulnar physeal fracture 2.
Galeazzi fractures are primarily e...
Gamekeeper thumb is an avulsion or rupture of the ulnar collateral ligament (UCL) of the thumb. It is essentially synonymous with skier thumb, although the latter has more of an acute injury connotation.
The repetitive breaking-of-necks of small game (rabbits and such) resulted i...
The Genant classification of vertebral fractures is based on the vertebral shape, with respect to vertebral height loss involving the anterior, posterior, and/or middle vertebral body.
grade 0: normal
grade 1: mild fracture, 20% to 25% loss of height
grade 2: moderate fracture, 25% to 40% los...
Glass foreign bodies may be present if they are ingested, inserted or as a result of an injury.
The prevalence of glass foreign bodies in wounds from injury has been recorded at a rate of 1.5% in superficial (subcutaneous) wounds and 7.5% of deeper wounds 1.
Globe rupture is an ophthalmologic emergency. A ruptured globe or an open-globe injury must be assessed in any patient who has suffered orbital trauma because open-globe injuries are a major cause of blindness.
In a blunt trauma, ruptures are most common at the insertions of the intraocular mus...
The Gosselin fracture is a fracture of the distal tibia with a V-shaped fractured fragment and intra-articular involvement.
History and etymology
It is named after Leon Athanese Gosselin (1815–1887), a French surgeon.
Goyrand fracture is another name for a Smith fracture (reverse Barton fracture) and is predominantly used in France or French-influenced countries.
For a discussion of the this fracture refer to the article on Smith fractures.
History and etymology
Named after Jean-Gaspard-Blaise Goyrand: Fre...
Greenstick fractures are incomplete fractures of long bones and are usually seen in young children, more commonly less than 10 years of age. They are commonly mid-diaphyseal, affecting the forearm and lower leg. They are distinct from torus fractures.
Greenstick fractures ...
The Gustilo Anderson classification, sometimes referred to as the Gustilo classification is the most widely accepted classification system of open (or compound) fractures.
The grading system is used to guide management of compound fractures, with higher grade injuries associated with higher ris...
Haematomyelia refers to the presence of intramedullary haemorrhage or haematoma within the spinal cord. This is distinct from extramedullary haemorrhage such as that seen in epidural haematoma.
Although haematomyelia can occur in the setting of trauma, the term is generally used to s...
Haemopneumothorax is a term given when there is concurrent presence of a haemothorax and well as a pneumothorax. It is a variant of a hydropneumothorax.
Approximately 5% of patients with pneumothorax will have concomitant haemothorax 6 .
It is typically seen in the se...
Hangman fracture, also known as traumatic spondylolisthesis of the axis, is a fracture which involves the pars interarticularis of C2 on both sides, and is a result of hyperextension and distraction.
Post-traumatic neck pain after a high-velocity hyperextension injury is ...
High-velocity penetrating brain injuries, in practical terms most often due to cranial gunshot injuries, are a form of penetrating traumatic brain injuries, which are much less common than blunt traumatic brain injuries and distinguished from low-velocity penetrating brain injuries (such as stab...
Hip dislocation is a relatively rare entity and may be congenital or acquired.
Hip dislocations account for ~5% of all dislocations 3.
There are numerous patterns of dislocation 1:
posterior hip dislocation (most common ~85%)
anterior hip dislocation (~10%)
Hook of hamate fractures are rare. They occur from the hamate fracturing after blunt trauma, falls, and in sports player (e.g. golf, baseball, racquet sports) from a direct blow while swinging. Stress fractures have also been reported.
os hamuli proprium
Humeral shaft fractures are readily diagnosed and usually, do not require internal fixation.
Humeral shaft fractures account for 3-5% of all fractures 1,3. Although they occur in all age groups, a bimodal distribution is noted. The first peak is seen in the third decade in males ...
Humeral shaft fractures are readily diagnosed and do not usually require internal fixation.
This is a summary article. For more information, you can read a more in-depth reference article: humeral shaft fracture.
3-5% of fra...
Gunshot injuries often require imaging assessment, and this evaluation has both clinical relevance (assessment of organ damage, surgical planning and prognostication), and often also forensic implications.
Incidence of gunshot injuries to the head is increasing in some countries, ...
Incidental findings on trauma CT are defined as findings unrelated to the specific mechanism of injury.
They are reported to be present in 55-75% of patients, with most being within the abdomen and pelvis 1. As the use of whole body CT for trauma increases, there is an associated ...
Infantile cervical ligament oedema can typically be seen when infants have suffered accidental or abusive head and neck trauma. The finding is best seen on sagittal STIR images.
The posterior ligamentous complex refers to the ligamentum flavum and interspinous ligaments. The anteri...
An inferior shoulder dislocation is the least common form of shoulder dislocation. The condition is also called luxatio erecta because the arm appears to be permanently held upward, in fixed abduction. The patient will often present with their hand placed on the head or near it.
Intermediary injuries affect the basal ganglia and/or thalami and are associated with diffuse axonal injury and poor prognosis.
They are a shearing injury of the lenticulostriate arteries and result in haemorrhagic contusions, which are often bilateral.
Interphalangeal joint dislocations are common upper extremity dislocations, and although considered minor injuries by many can result in significant disability.
Most dislocations of the interphalangeal joints are due to hyperextension. The proximal interphalangeal joints are the mos...
Fall onto an outstretched hand (FOOSH) is a very common presentation across all ages. It occurs following sporting injuries, or simply after a fall.
bimodal age and sex presentation
young patients - high energy trauma
older patients - lower energy, e.g. simple f...
Shoulder injury is a relatively uncommon, but important cause for presentation to the Emergency Department. Pain may be the result of acute or chronic injury.
history of trauma?
pain - location, type
range of motion at the shoulder...
Isolated free fluid in trauma may or may not represent a significant injury, and this creates a diagnostic dilemma in determining appropriate treatment for these patients.
The presence of isolated free fluid in trauma occurs in 3-5% of blunt trauma patients 1-4.
Greater trochanteric fractures generally result from forceful muscle contraction of a fixed limb, which usually occurs in those who are young and physically active. It can also be caused by direct trauma.
Generally, isolated trochanteric fractures are seen more so in young, active...
Jefferson fracture is the eponymous name given to a burst fracture of C1. It was originally described as a four-part fracture with double fractures through the anterior and posterior arches, but three-part and two-part fractures have also been described.
A typical mechanis...
Jersey finger (also called Rugby finger or Sweater finger) describes a type of injury where there is avulsion of the flexor digitorum profundus (FDP) at the base of the distal interphalangeal joint (DIP) 1.
Most commonly affects the 4th digit as the FDP insertion into the ring finger is anatomi...
The Johansson classification of periprosthetic hip fractures was the first classification system proposed and is the simplest. It is based on the level of the fracture in relation to the prosthesis.
type I: fracture proximal to the tip of the prosthesis with the stem still in contact with the m...
The Judet and Letournel classification is the most widely used classification of acetabular fractures.
It is based on three radiographic views (anteroposterior view, obturator oblique view and Iliac oblique view) and classifies acetabular fractures into ten major fracture patterns, which cons...
This classification was proposed originally by Hastings and later modified by Keifhaber and Stern in 1998. This classification, along with the Eaton classification, is the most widely accepted classification at the time of writing (August 2016) for the management of volar plate avulsion injuries...
Knee dislocations are rare, but a significant number have serious associated vascular injury. They account for <0.5% of all joint dislocations.
This article discussed tibiofemoral joint dislocation. Please see separate articles for discussion of medial and lateral patellar dislocation.
Large joint dislocation is a not uncommon presentation to emergency rooms. Described in order of comonality:
posterior dislocation of the hip