Fracture x-rays

Question 1

What type of fracture is displayed ? [1]
Explain how you can tell [4]

Answer 1

Intracapsular fracture - Subcapital - AP:
1. Shortened femoral neck
2. Increased density of femoral neck (due to impacted bone)
3. Less troch. is more prominent
4. Shenton’s line is disrupted

Question 2

Which type of Garden classification is shown [1]

I
II
III
IV

Answer 2

III - Complete - partially displaced

Question 3

Which type of Garden classification is shown [1]

I
II
III
IV

Answer 3

I - Incomplete or impacted bone injury with valgus angulation of the distal component

Question 4

What type of Garden classification is this? [1]

Answer 4

IV - Complete - totally displaced

Question 5

What type of Garden classification is shown here? [1]

Answer 5

II - Complete (across whole neck) - undisplaced

Question 6

What classification of Garden fracture is this? [1]

Answer 6

Garden IV fracture
* Loss of Shenton’s line
* Complete fracture of the full diameter of the femoral neck
* Total displacement of the 2 fracture components

Question 7

Describe the type of fracture depicted [1]

Answer 7

Intertrochanteric fracture
* A fracture line runs between the trochanters
* There is comminution with separation of the lesser trochanter
* Note the fracture does not involve the femoral neck

Question 8

Describe the type of fracture depicted [1]

Answer 8

Subtrochanteric fracture
This fracture passes distal to the trochanters
The femoral neck remains intac

Question 9

Describe what has happened in this x-ray [1]

Answer 9

Question 10

Describe the fracture in this x-ray [1]

Answer 10

Question 11

Describe this x-ray [1]

Answer 11

Transverse fracture with rotational displacement and shortening

Question 12

Describe the anatomical components to the knee joint [+]

Answer 12

Question 13

Describe the fracture seen in this X-ray [1]

Answer 13

Lateral tibial plateau fracture
* The fracture fragment is displaced and depressed from its normal position (dotted line)

Question 14

What type of fracture is depicted [1]

Answer 14

Comminuted fractures of the tibial and fibular shafts with medial displacement and posterior angulation

Question 15

What type of fracture is depicted [1]

Answer 15

Tibial stress fracture
* Periosteal stress reaction are signs of stress injury (often not present on the initial X-ray)
* History of chronic pain worsened by activity

Question 16

The ankle is stabilised by multiple ligaments not visible with X-ray.

What are they? [3]

Question 17

What type of Weber’s fracture classification is pictured? [1]

Answer 17

Weber A = Distal to ankle joint (this case)

Question 18

What type of Weber’s classification is this? [1]

Answer 18

B

Question 19

What type of fracture is shown? [1]

Answer 19

Potts fracture

Question 20

Answer 20

Radiographs demonstrating a disruption of the distal tibiofibular syndesmosis along with a fracture of the proximal fibula, consistent with a Maisonneuve fracture.

Question 20

Name for this fracture? [1]

Answer 20

Pilon fracture
- These fractures involve the distal tibia and its articular surface.

Question 21

Answer 21

A Lisfranc injury is a tarsometatarsal fracture dislocation characterized by traumatic disruption between the articulation of the medial cuneiform and base of the second metatarsal.
* Diagnosis is confirmed by radiographs which may show widening of the interval between the 1st and 2nd ray.

Question 22

What’s going on in this x-ray? [1]

Answer 22

Calcaneal fracture - Lateral view

Question 23

Answer 23

Question 24

Answer 24

Question 25

Where is the fracture? [1]

Answer 25

Question 26

Name the fracture depicted [1]

Answer 26

Subcapital fracture - AP

Question 27

Answer 27

Neck of femur - Transcervical fracture - AP

Question 28

Answer 28

Question 29

Answer 29

Question 30

Answer 30

Question 31

Answer 31

Question 32

Answer 32

Question 33

Answer 33

Question 34

Answer 34

Question 35

Answer 35

Question 36

Answer 36

Question 37

Which Weber's classification? [1]

Answer 37

B

Question 38

Which Weber's classification? [1]

Answer 38

C

Question 39

Which Webers classification? [1]

Answer 39

Question 40

What should you suspect from this x-ray? [1]

Answer 40

Question 41

This x-ray X ankle instability = ?

Answer 41

Question 42

Answer 42

Question 43

Name for this fracture? [1]

Answer 43

Question 44

Answer 44

Question 45

On a calcaneal fracture, what are you spefically looking for? [1]

Answer 45

**Calcaneus fracture - Reduced Bohler's angle - Lateral**

Question 46

Answer 46

Question 47

Answer 47

Question 48

What is the type of fracture? [1] What is the mechanism of impact that causes this impact? [1]

Answer 48

**Boxer's fracture** - The X-ray shows a transverse fracture through the neck of the right fifth metacarpal bone, which is consistent with a Boxer's fracture. - The mechanism of injury is almost always a result of direct impact to a clenched fist against a solid surface (eg. human face or wall).

Question 49

An x-ray is requested and reported as "vertical pattern patella fracture with minimal displacement". What is the most appropriate management plan?

Answer 49

**Conservative management with cricket pad splint and full-weight bearing**

Question 51

Answer 51

Maisonneuve injury

Question 52

Answer 52

**Lisfranc Injury**

Question 53

Answer 53

Galeazzi fracture

Question 54

Answer 54

The radiograph shows AP and lateral projections of a transverse patellar fracture

Question 55

Answer 55

X-ray features consistent with a **Bennett** **fracture** include **an intra-articular fracture of the base of the first metacarpal bone**. The mechanism for this injury is forced abduction of the thumb.

Question 56

Answer 56

**Monteggia fracture** X-ray features of a Monteggia fracture include an ulnar shaft fracture with an associated radial head dislocation. T

Question 57

Answer 57

Bennett fracture

Question 58

Describe this x-ray [1]

Answer 58

**Acromioclavicular joint disruption**

Question 59

Describe this x-ray [1]

Answer 59

**Shoulder - Normal Y-view** The Y-view is so named because of the Y shape of the scapula formed when looking at it laterally The humeral head is correctly aligned - it overlies the glenoid and is positioned posterior to the coracoid

Question 60

Describe this x-ray [1]

Answer 60

**Anterior shoulder dislocation - AP view** - Humeral head and glenoid surfaces are not aligned - The humeral head lies below the coracoid

Question 61

Answer 61

Question 62

What pathology is depicted? [1] Describe the findings in this x-ray [1] How would the patient present? [1]

Answer 62

**Posterior shoulder dislocation - AP view** - **The glenohumeral joint is widened** - Following posterior dislocation the **humerus is held in internal rotation**

Question 63

Describe this pathology [1]

Answer 63

**Glenoid fracture - (Bony Bankart)**

Question 64

What angulation is the fracture? [1]

Answer 64

Question 65

Draw and label normal elbow anatomy [4]

Answer 65

Question 66

Describe this fracture [1]

Answer 66

**Colles fracture:** * **Distal radius fracture - Dorsal displacement**

Question 67

Describe this fracture [2]

Answer 67

**Distal radius fracture - Palmar displacement** * Palmar (volar) displacement and angulation * Shortened radius * This injury is often referred to as a 'reverse Colle's' fracture or **'Smith's' fracture**

Question 68

Answer 68

**Forearm fracture/dislocation - Monteggia type**

Question 69

Paediatric case

Answer 69

**Torus fracture**

Question 70

Answer 70

Question 71

Answer 71

Question 72

Answer 72

Question 73

Answer 73

Question 74

Answer 74

Question 75

Anterior or posterior dislocation? [1]

Answer 75

Anterior

Question 76

Describe this fracture [1]

Answer 76

**Flattening or indentation of the posterior humeral head** following **shoulder** **dislocation** is known as a '**Hill-Sachs' lesion**

Question 77

Answer 77

**Shoulder - Anterior dislocation/glenoid fracture - AP** - A fracture of the **anterior** **glenoid** following **shoulder** **dislocation** is known as a '**bony Bankhart' lesion**

Question 78

Answer 78

Question 79

Answer 79

Question 80

Answer 80

Question 81

Answer 81

Question 82

Answer 82

**Monteggia fracture-dislocation - Lateral**

Question 83

Answer 83

**Galeazzi fracture-dislocation - AP** - A 'Galeazzi' injury is a fracture of the radial shaft with dislocation of the ulna from its articulation with the radius at the distal radio-ulnar joint

Question 84

Answer 84