Rolando fracture is a three part or comminuted intra-articular fracture-dislocation of the base of thumb (proximal first metacarpal). It can be thought of as a comminuted Bennett fracture.
The mechanism is usually an axial blow to a partially flexed metacarpal, such as a fistfight. ...
The Rotterdam CT score of traumatic brain injury is a relatively recently described classification aimed at improving prognostic evaluation of patients admitted with acute traumatic brain injuries.
It was published in 2006 1 and is gaining in popularity. Along with the Marshall classification ...
The Roy-Camille classification of fractures of the odontoid process of C2 depends on the direction of the fracture line 1.
The level of fracture line as described by the Anderson and D’Alonzo classification, is not predictive of the degree of instability or the risk of non-union. This classific...
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 ...
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.
Scaphoid fractures account for 70-80% of all carpal bone fractures 1. Although they occur essentially at a...
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 important because of the risk of avascular necrosis if displaced fractures a...
Scaphoid non-union is one of the complications of scaphoid fracture because of the unique anatomy of the scaphoid and its vascular supply.
There are four types of non-union:
fibrous (delayed union): stable with no deformity or collapse
cystic: unstable and early collapse patterns
Scapholunate dissociation represents a significant ligamentous wrist injury that is important to identify on imaging. There is disruption of the scapholunate ligament with resultant instability. The condition may also be known as rotary subluxation of the scaphoid.
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 not only increased energy imparted to the bone at the time of injury but also an increasingly worse prognosis 1. The most common fracture of the...
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
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) tear.
Contrary to the more common causes of an ACL tear, wh...
Semimembranosus tendon avulsion is a specific type of avulsion injury that can occur in the knee.
Mechanism of injury
External rotation and abduction of flexed knee or valgus force applied to the tibia. Associated injuries include anterior cruciate ligament (ACL) rupture and tear o...
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...
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 ...
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...
In a shoulder 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 the following articles:
anterior shoulder dislocation (95%...
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 in-depth reference article: shoulder series.
Skull fractures usually occur following significant head injury and may herald underlying neurological pathology.
This is a summary article; we do not have a more in-depth reference article.
base of the skull
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 abnormalities in adolescence and is bilateral in around 20% of cases.
Smith fractures, also known as a Goyrand fracture in the French literature 3, are fractures of the distal radius with associated palmar angulation of the distal fracture fragment. Classically, these fractures are extra-articular transverse fractures and can be thought of as a reverse Colles frac...
The solid abdominal viscera 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 stomach, small bowel...
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
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. Fewer than 200 cases of sple...
Splenic trauma can occur after blunt or penetrating trauma or secondary to medical intervention (i.e. iatrogenic). The spleen is the most frequently injured organ after blunt trauma.
Patients may present with left upper quadrant/left chest pain, left shoulder tip pain (re...
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
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
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 haematoma is a form of perirenal haematoma 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) ...
Subcutaneous or surgical emphysema, strictly speaking, refers to air in the subcutaneous tissues. But the term is generally used to describe any soft tissue emphysema of the body wall or limbs since the air often dissects into the deeper soft tissues and musculature along fascial planes.
Subdural haemorrhage (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 diagnos...
Subdural hygromas refer to a cerebrospinal fluid (CSF) accumulation in the subdural space. In many cases it is considered an epiphenomenon of head injury when it is called a traumatic subdural hygroma.
The vast majority of patients are asymptomatic, however some symptoms...
Subgaleal haematoma describes scalp bleeding in the potential space between the periosteum and the galea aponeurosis.
It most commonly occurs after vacuum assisted delivery, but may also be seen following head trauma. In patients with intracranial haemorrhage or skull fractures, the incidence o...
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).
Supracondylar fractures are a classic paediatric 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% are seen in children younger than 10 years of age, with a peak ...
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).
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
Temporal bone fractures are usually a sequela of blunt head injury, generally from severe trauma. Associated intracranial injuries, such as extra-axial haemorrhage, shear (or diffuse axonal) injury, and cerebral contusion are common. Early identification of temporal bone trauma is essential to m...
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
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 ...
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 rapid recognition and treatment is required if a cardiorespiratory arrest is to be a...
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...
Thoracic aortic injury is the most common type of traumatic aortic injury and is a critical life-threatening, and often life ending event. It can result from either blunt or penetrating trauma:
blunt trauma (more common)
rapid deceleration (eg. motor vehicle accident, fall from great height)
The thoracolumbar injury classification and severity score (TLICS) has been developed by the Spine Trauma Group to overcome some of the perceived difficulties regarding the use of other thoracolumbar spinal fracture classification systems for determining treatment 1.
There are several thoracolumbar spinal fracture classification systems:
three column concept of thoracolumbar spinal fractures (Denis classification)
thoracolumbar injury classification and severity score (TLICS)
McAfee classification of acute traumatic spinal injuries is based on the three column concept of the spine. CT is needed for accurate assessment.
wedge compression: isolated anterior column compression
stable burst: anterior and middle column compression but posterior column i...
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 (you guessed it) toddlers. It is a potentially difficult diagnosis to establish on account of both the symptoms and imaging findings being subtle.
The term has sometimes a...
Torus fractures, also known as buckle fractures, are incomplete fractures of the shaft of a long bone that is characterised 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...
Traumatic 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 o...
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 ...
Transverse temporal bone fractures are orientated perpendicular to the long axis of the petrous temporal bone, with the line of force running roughly anterior to posterior. A more current classification of the extent of temporal bone fractures describes the integrity of the otic capsule rather t...
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 in combination with other 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 classifi...
Trauma films are ubiquitous in an orthopaedic 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 fracture will only be visible on one view.
It is important to recognise that ...
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 (TAWH) represents traumatic disruption of musculature and fascia of anterior abdominal wall without skin penetration.
Traumatic abdominal wall hernia (TAWH) is caused by blunt trauma to the abdomen.
In adults, it usually results from road traffic acci...
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 (SCI) 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 ...
Traumatic subarachnoid haemorrhage (tSAH) is a common injury, and trauma is the most common cause of subarachnoid haemorrhage (SAH).
Traumatic subarachnoid haemorrhage occurs in ~35% (range 11-60%) of traumatic brain injuries 1.
Traumatic subarachnoid haemorrhage is ...
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...
Trochanteric fracture is a fracture involving the greater and/or lesser trochanters of the femur.
Fractures in these region can be classified as:
greater trochanteric avulsion fracture
lesser trochanteric avulsion 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.
Usually these kind of fractures occur as the result of a fall on an outstretched arm and are often associated with a d...
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 haematuria as it may be absent in up to 25% of patients 5, 6. Classic cl...
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 categorised into five types depending on the location and extent of the rupture.
This is commonly seen but sometimes not classed as true rupture, since it in...
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 ...
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...
Volar intercalated segmental instability (VISI) is a type of instability involving the wrist. It is less often encountered than dorsal intercalated segmental instability (DISI).
It presents in most cases with nonspecific wrist pain and a "clunking" on the ulnar deviation ...
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...
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 ...
Zygomaticomaxillary complex (ZMC) fractures, also known as a tripod, tetrapod, quadripod, malar or trimalar fractures, are seen in the setting of traumatic injury to the face. They comprise fractures of the:
inferior orbital rim, and anterior and posterior maxillary sinus walls