General principles in
Musculoskeletal X-ray
ALI B ALHAILIY
Definition
• A fracture is present
when there is loss of
continuity in the
substance of a bone.
• The term covers all bony
disruptions, ranging
from the situation when a
bone is broken into one or
many fragments
Causes of fracture
• Fractures are caused by the application of stresses
which exceed the limits of strength of a bone.
• Violence is the commonest cause
• 1- direct violence
• a bone may be fractured by being struck by a moving
or falling object.
• 2- indirect violence.
• twisting or bending stress is applied to a bone, and
this results in its fracture at some distance from the
application of the causal force.
Types of fracture
• 1-Pathological fracture
• Sometimes fracture may
occur in an abnormal or
diseased bone.
• That will reduce the
strength of the bone
then the force required
to produce fracture is
reduced.
Bone
cyst
2-Fatigue fractures (stress
fractures)
• Stresses, repeated with
excessive frequency to a
bone, may result in fracture.
• It is hairline in pattern and are
often not diagnosed with
certainty until there is callus
formation, or increased
density at the fracture site.
• 3-6 weeks after the onset of
symptoms
Healed fatigue fracture
through the second
metatarsal bone
3- Open and closed fractures
• Closed fracture: (a) the
bone is
• broken, but there is no
external wound.
• A fracture not
communicating with the
external environment
• The overlying skin are intact
• Open fracture: A fracture
with break in the overlying
skin and soft-tissues,
• leading to the fracture.
4- Simple transveres
fractures
• Transverse fractures run
either at right angles to
the long axis of a bone
(1), or with an obliquity
of less than 30°.
• 5- Multifragmental
fractures
• There are two
fragments or more.
4
5
6- Avulsion fractures :
produced by a sudden muscle
contraction
• the muscle pulling off the portion
of bone to which it is attached.
• Common examples include:
• (1) Base of fifth metatarsal.
• (2) Tibial tuberosity (quadriceps).
• (3) Upper pole of patella
(quadriceps).
• (4) Lesser trochanter (iliopsoas).
7-Fracture-dislocations
• present when a joint has
dislocated and there is in
addition a fracture of one
of the bony components of
the joint.
• fracture-dislocation of the
shoulder, where there is an
anterior dislocation with a
fracture of the neck of the
humerus.
• Injuries of this kind may be
difficult to reduce and may
be:
• unstable. Stiffness and
avascular necrosis are two
common complications
Describing the level of a fracture
• The anatomical divisions of a long bone
include:
• the epiphysis (E), epiphyseal plate (EP),
and diaphysis or shaft (D). Between the
latter two is the metaphysis (M).
• A fracture may be described as lying
within these divisions, or involving a
distinct anatomical part, e.g.
• A = fracture of the tibial diaphysis OR
?????
• B = fracture of the femoral neck;
• C = fracture of the greater trochanter;
• F = supracondylar fracture of the femur
OR ?????????????????????.
Describing the level of a fracture
• For descriptive purposes a
bone may be divided into
thirds. In this way:
• A = fracture of the mid third
of the femur;
• B = fracture of the femur in
the distal third;
• C = fracture of the femur at
the junction of the
• middle and distal thirds.
• D = fracture of the distal
metaphysis of radial bone
Musculoskeletal X-ray General principles
• Please have on the systemic approach and
viewing principles tutorials at:
• http://radiologymasterclass.co.uk/tutorials/m
usculoskeletal/principles/bones_joints_xray_page4.html
X RAY FINDINGS
Phalangeal dislocations
Forced hyperextension of the
thumb or finger joints is the
usual cause for these injuries.
Normally the distal segment is
displaced posteriorly
Bennett’s fracture
• It is a fracture of the base
of the first metacarpal
bone which extends into
the carpometacarpal
(CMC) joint.
• This intra-articular fracture
is the most common type
of fracture of the thumb
• A vertical lucent line is
seen intersecting the
proximal articular surface
of the first metacarpal
bone
Scaphoid Fracture
Scaphoid Fracture
• Usually fractures through the waist (middle) of the scaphoid
bone
• Mechanism – fall on dorsiflexed outstretched hand
• May not be evident for up to 10 days post trauma
• Very well diagnosed clinically – pain and tenderness in
anatomical snuff box
• Poor healing fracture due to complicated blood supply
• Most easily diagnosed via the PA ulnar deviation with
angulation projection
Scaphoid fractures
• How many
projections for
scaphoid # ?
Or…
PA
PA
PA
DEV
OBL
LAT
General setup of 24 x 30 cm cassette for patients
who have defined trauma to scaphoid or follow up
films or minimal injury
Colles’ fracture.
Colles’ Fracture
• # of the distal end of the radius (3cm from joint) +/# of the styloid process of the ulna
• Dorsal angulation of the distal fragment – ventral
angulation of proximal radius
• Most common form of wrist fracture – females,
middle aged and older
• Caused by fall on outstretched hand (FOOSH)
Smith’s Fracture
• Reverse Colles’ #
• Hyperflexion with fall on back of hand
• Fracture of the radius with ventral
displacement of distal fragment and dorsal
angulation of proximal radius
Galeazzi’s Fracture
•
•
•
•
# of the mid shaft of the radius
Dislocation of the distal radioulnar joint
Fall on outstretched hand with elbow flexed
High incidence of nonunion and a limitation on
pronating or supinating the hand
Please read about
• Salter–Harris fractures ?
• Types with figures ?
• http://cal.vet.upenn.edu/projects/saortho/ch
apter_11/11mast.htm
Thank You