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Middle Rib Fx (Ribs 4-9) M/c rib fxs Often found at lateral aspect of the rib;
-Golfer’s Fx strike the ground Flail Chest2 fxs involving same rib
rather than the ball- abrupt paradoxical motion during respiration
termination of swing
precipitates fx at lateral rib
-Passion/Bear hug Fxover
enthusiastic hug- osteopenia
predisposes elderly to these
Lower Rib Fx (Ribs 10-12) Uncommon Check for kidney damage (IV pyelogram
Cough (post-tussive) Fx stress and/or CT)
fractures of the lower anterior
ribs with violent coughing—ribs
6 & 7 M/c
Kummell Delayed post-traumatic Vertebral AVN; intravertebral vacuum
vertebral collapse phenomenon
Lower Extremity
Extracapsular Hip Fx
Intertrochanteric
Trochanteric
Subtrochanteric Pathologic Transverse
Intracapsular Hip Fx High incidence of non-union and AVN
Subcapital Impacted or displaced M/c femoral neck fx
Stress or Insufficiency Displaced fxs held in ext. rotation & femoral shaft drawn
(pseudofracture/looserzones/Milkma proximal (short femur)
n lines
Midcervical complete transverse involving both medial and lateral
cortices with displacement
Basicervical Pathologic-common complete transverse involving both medial and lateral
cortices with displacement
Greater Trochanter Falls M/c in elderly
Avulsion Fx
Lesser Trochanter
Avulsion Fx M/c in children or adolescent athlete
Adult- most occur as pathologic fx secondary to METS
Posterior Hip Flexed knee striking the dashboard- 90% of dislocations; Rotates internally
Dislocation MVA Complicationsmust be reduced quickly-AVN; M/c=Sciatic
*Abduction of thigh at impactfx of nerve paralysis (peroneal branch); Myositis ossificans; post-
posterior acetabular lip (CT) traumatic degenerative arthritis
Anterior Hip Forced abduction and extension of Rotates externally; femoral head lies caudal and medial to
Dislocation the femur acetabulum and near obturator foramen
SCFE (adolescent coxa Type I Salter Harris epiphyseal fx; M/c disorder of adolescent hip; varus deformity, adduction
vara/epiphysiolisthesi Upward displacement, external and external rotation of the femur; widening of growth
s) rotation and adduction of the neck plate, abnormal Klein/Shenton lines, reduced epiphyseal
on the head height, widened teardrop, Trethowan’s sign, medial
femoral neck periosteal buttressing
*Tx=Intramedullary metallic fixation device
Distal Femur Fx Young high energy injuries (fall
from significant heights or MVA) with
other injuries
ElderlyWeak bones-- lower-force
event (fall from standing)
Supracondylar fx Distal to femoral shaft, proximal to condyles; transverse or
oblique; comminuted and intra-articular(FBI)
Bumper/Fender Fx Significant impaction Lateral tibial plateau
M/c 50 or older; depression of lateral tibial joint surface
with or w/out vertical radiolucent split of joint margin
Varus stress and internal rotation of Avulsion of lateral tibial at attachment of lateral capsule (IT
Segond Fx the leg when knee is flexed places band); ACL and meniscal (lateral) tears commonly
excess tension on lateral capsule and associated; MRI confirms w/ high signal intensity at site of
ligaments resulting in avulsion lateral tibial insertion
Scapular body Fx High energy blunt trauma M/c type of scapula Fx;
treatment=arm sling; 80-90%
associated with other injuries
(lung and chest)
Anterior GHJ Forced abduction w/ M/c dislocation of the shoulder Complications Brachial plexus
Dislocation external rotation Anterior, medial, and inferior injury; Avulsion/fx of greater tub.;
displacement; 95% of shoulder Bankart & Hill-Sachs; Increase for
dislocations; developing arthritis; Recurrent
shoulder dislocation (risk factors)
*Bankart lesion=anteroinferior
detachment of glenoid labrum seen
in most 1st time dislocations
* Hill-Sachs=Compression fx-
posterolateral humeral head- can
interfere w/ reduction-may require
general anesthesia; MRI detection;
Internal rotation view
Posterior GHJ Forced posteriorly in Rare, Frequently overlooked Complications Avulsed lesser
Dislocation (Triple E internal rotation while Widened joint space; rim sign tuberosity; Tear of subscapularis m.
Syndrome) arm in abduction; (>6mm); humeral head fixed in
convulsion; electrocution internal rot.; tennis racquet; Rarely bilateral If bilateral in
superior displacement; Trough absence of trauma=seizure induced
line (impaction fx of dislocations
anteromedial humeral head;
Overlap of humeral head and
glenoid (Grashey view)
Inferior GHJ Forceful hyperabduction; On x-rayArm elevated and ComplicationsInjuries to axillary n
Dislocation (Luxatio Humeral head displaced abducted, elbow flexed, and artery, rotator cuff and long head
erecti) medial/inferior to forearm rests on top of head of biceps tendon tear common
glenoid
Distal Humerus Fx Complications Ischemic
contracture (Volkmann); Ulnar n.
damage; Malunion
Supracondylar Fx Fx line extends M/c elbow fx in children;
transversely or obliquely conservative care/bracing;
through distal humerus distal fragment displaces
above condyles posteriorly
Intercondylar Fx Fx line extends b/w the Accounts for atleast 50% distal
medial and lateral humerus fxs
condyles and
communicates with the
supracondylar region (T
or Y shape)
Condylar Fx -Single condyle sheared
off due to an angular
force through the elbow
-convex surface of
capitellum susceptible to
compression and
breakage from forces
from radial head
-osteochondral fragment
may be sheared off
convex surface of
capitellum producing
loose body
(osteochondritis
dissecans)
Epicondylar Fx Avulsion injuries from “Little Leaguer’s elbow” in
traction of the common developing kids/adolescents
flexor or extensor
tendons and collateral
ligaments on medial or
lateral epicondyles
Proximal Ulna Fx
Olecranon Fx Direct trauma or an acute 2nd M/c adult elbow fx
flexion avulsion from the Fx line seen on lateral
triceps insertion projection adjacent to inferior
convex surface of trochlea (can
be proximal or distal to this
site); bursa swelling common;
surgical fixation
Coronoid Process Fx Avulsion by brachialis or Uncommonly isolated; usually
by impaction into the in combo with posterior elbow
trochlea fossa; acute dislocation; Seen on Oblique
hyperextension view
Proximal Radius Fx