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    Module

    Fracture general principles

    The basics principles of radiological fracture evaluation.

    Fracture general principles
    Radiology Expert
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    Description of Fractures 

    Descriptions based on typical fracture types (fig. 6/7).

    Various fracture types.
    Figure 6. Various fracture types.
    Spiral fracture en avulsion fracture of the quadriceps tendon Spiral fracture en avulsion fracture of the quadriceps tendon
    Figure 7. Spiral fracture of distal fibula (a). Avulsion fracture of the quadriceps tendon with retraction of the muscle (b) .
    Click image to see overlay

    Note: the above fracture types are less applicable in non-tubular bones (e.g. fractures of the calcaneus and carpal bones). In this case the terms ‘horizontal, vertical, coronal, sagittal or axial’ fracture lines are more appropriate.

    Essential information: 

    • Location: proximal, middle, distal
    • Type of fracture line (see fig. 6) 
    • Position
    • Extent of dislocation (=displacement); medial, lateral, anterior, posterior, volar/dorsal, radial/ulnar.
    • Angulation (= at angles)
    • Rotation
    • Shortening (particularly in oblique fractures)

    Practical information to add to a fracture description:

    • To avoid confusion, the following terms are used for the hands: volar (= palmar side) & dorsal (= back of hand). Use radial and ulnar for lateral and medial respectively.
    • Dislocation and angulation are usually described from the perspective of the distal fracture fragment.  See figure 8 as an example.
    Description fracture dislocation Description fracture dislocation
    Figure 8. AP image (a) and lateral image (b) of the right lower leg/ankle. Extra-articular transversal fracture of distal tibia with dorsolateral dislocation over a half shaft width.
    Click image to see overlay

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    Literature: sources and author

    Text & Illustrations

    drs. A. van der Plas, MSK radiologist Maastricht UMC+
     
    Sources:

    • Radiologic reporting of skeletal trauma.M J MJ Pitt and D P DP Speer Radiol Clin North Am 28(2):247-56 (1990)
    • B.J. Manaster et al. The Requisites – Musculoskeletal Imaging. 2007
    • N. Raby et al. Accident & Emergency Radiology – A Survival Guide. 2005.

    24/01/2014 

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