11/4/2018 SUBTLETIES OF LOWER EXTREMITY TRAUMA IMAGING SPEAKER DISCLOSURES
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1 SUBTLETIES OF LOWER EXTREMITY TRAUMA IMAGING Charles S. Resnik, M.D. Professor of Radiology University of Maryland School of Medicine Upon completion of this presentation, participants will be better able to recognize the various imaging appearances of lower extremity trauma, including hip, knee, ankle, and foot injuries. SPEAKER DISCLOSURES 88 YEAR OLD WOMAN, ACUTE RIGHT HIP PAIN I have no relevant commercial relationships to disclose. I have no relevant conflicts of interest to disclose. August YEAR OLD WOMAN, ACUTE RIGHT HIP PAIN PELVIC INSUFFICIENCY FRACTURE Usually occurs in elderly patients Normal stress on abnormal bone Osteoporosis Radiation therapy Minor or no trauma Acute or chronic pain August 17 July 28 1
2 PELVIC INSUFFICIENCY FRACTURE Sacrum Pubis Proximal femur Acetabulum Ilium Ischium Often multiple ACUTE LEFT HIP PAIN ACUTE LEFT HIP PAIN GAS BUBBLES IN THE HIP JOINT ON CT: BALTIMORE BUBBLE (AJR 1995; 164: 931) SUBACUTE LEFT HIP PAIN Positive in 13 of 16 dislocations 12 within 4 hours of reduction Positive in 2 of 64 non-dislocations Gunshot wound, degloving injury May be the only evidence of dislocation 2
3 SUBACUTE LEFT HIP PAIN ACUTE LEFT HIP PAIN GARDEN CLASSIFICATION OF FEMORAL NECK FRACTURES Stage I: Stage II: Stage III Stage IV: incomplete complete, undisplaced complete, partially displaced complete, fully displaced 3
4 BISPHOSPHONATE INSUFFICIENCY FRACTURE Lateral proximal femoral shaft Localized cortical thickening Transverse radiolucent cortical fracture Complete displaced fracture Minor or no trauma Acute or chronic pain Often bilateral 59 YEAR OLD MAN, KNEE PAIN 1 WEEK 59 YEAR OLD MAN, KNEE PAIN 1 WEEK 4
5 SUBCHONDRAL INSUFFICIENCY FRACTURE (spontaneous osteonecrosis of the knee: SONK) Usually occurs in elderly patients Female more frequently than male Normal stress on abnormal bone Osteoporosis Minor or no trauma Acute or chronic pain Medial femoral condyle SUBCHONDRAL INSUFFICIENCY FRACTURE Radiographs Initially normal or osteoarthritis May progress to subchondral collapse Magnetic Resonance Imaging Bone marrow edema Curvilinear subchondral defect May progress to subchondral collapse 18 year old, chronic knee pain 5
6 6
7 MAISONNEUVE FRACTURE (DANIS-WEBER C3) 1. Rupture of anterior tibiofibular and interosseous ligaments 2. Rupture of posterior tibiofibular ligament or fracture of posterior tibia 3. Spiral fracture of proximal fibula 4. Rupture of deltoid ligament or fracture of medial malleolus LAUGE-HANSEN CLASSIFICATION OF ANKLE FRACTURES Supination adduction (Danis-Weber A) Supination external rotation (Danis-Weber B) Pronation abduction (Danis-Weber C1) Pronation external rotation (Danis-Weber C2) Maisonneuve fracture (Danis-Weber C3) 7
8 TRIPLANE FRACTURE OF DISTAL TIBIA Sagittal fracture: vertical, mid-epiphysis Coronal fracture: vertical, posterior metaphysis May include variable portion of epiphysis Axial fracture: across anterolateral physis 8
9 9
10 LISFRANC FRACTURE/DISLOCATION Homolateral Divergent 10
11 STRESS FRACTURE Cortical bone Cortical linear radiolucency Periosteal reaction Cancellous bone Medullary linear sclerosis Stress fractures Fatigue Abnormal stress on normal bone Insufficiency Normal stress on abnormal bone SPEAKER DISCLOSURES I have no relevant commercial relationships to disclose. I have no relevant conflicts of interest to disclose. I do have one unrelated disclosure: I am the Vice Chairman of the Board of Directors of Challenger Center for Space Science Education 11
12 THE CHALLENGER CENTER MISSION: Engage students and teachers in dynamic, hands-on exploration and discovery opportunities that strengthen knowledge in science, technology, engineering, and mathematics (STEM), inspire students to pursue careers in these fields, and provide an outlet to learn and apply important life skills. One student at a time, Challenger Center inspires the kind of curiosity that leads to further exploration and success in STEM fields. Vicki Chandler, Chair, National Science Board Committee on Honorary Awards 12
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