Missdiagnosis in the Radiologic Evaluation of Extremity Trauma - PowerPoint PPT Presentation
1 / 19
Title:
Missdiagnosis in the Radiologic Evaluation of Extremity Trauma
Description:
Routine views of the elbow include at least the AP and lateral views ... present at the posterior edge of the distal 6 cm or the tip of either malleolus. ... – PowerPoint PPT presentation
Number of Views:97
Avg rating:3.0/5.0
Title: Missdiagnosis in the Radiologic Evaluation of Extremity Trauma
1
Miss-diagnosis in the Radiologic Evaluation of
Extremity Trauma
- ? ? ? ??
- 92-12-10
2
Part I. The Upper Extremity
3
- 25 y/o male , a victim of MBA
- C.C. right shoulder pain , cant raise his
- right shoulder
- PE
- DDx
- LAB radiology
- Tx
4
Physical Examination
- Inspect from the anterior, posterior, and lateral
positions - Palpation of the shoulder
- The active and passive ranges of motion should be
tested - A thorough neurovascular examination should be
performed
5
1.Clavicle
- Nondisplaced complete fractures may be missed
unless an image is obtained with 15 degrees of
cephalic angulation - Mechanism fall onto an outstretched hand
- Middle one third of the clavicle 80
- Outer one third of the clavicle 15 - associated
with coracoclavicular ligament disruption - Association fracture ribs fracture
6
Acromioclavicular Joint
- Acromioclavicular joint dislocations ( separation
) a fall on an outstretched arm in patients who
are 15 to 40 years of age - A single radiographic view that includes both
joints permits the assessment of symmetry. - Stress views taken with weights suspended from
each wrist will provide the diagnosis
7
- The normal acromioclavicular joint space 3 to 8
mm , varies no more than 2 to 3 mm between the
two joints - In uninjured patients, the inferior cortical
margins of the acromion and clavicle are smoothly
contiguous, - The coracoclavicular distance measures 11 to 13
mm. A difference of more than 3 to 4 mm between
the two sides is abnormal.
8
- Type I is a clinical diagnosis. Despite normal
radiographs, the acromioclavicular ligaments are
stretched or torn. - Type II manifests as widening of the
acromioclavicular joint and/or minor elevation or
posterior subluxation of the distal portion of
the clavicle. These findings indicate isolated
disruption of the acromioclavicular ligament. - Type III represents disruption of both the
acromioclavicular and the coracoclavicular
ligaments, with dislocation of the
acromioclavicular joint and elevation of the
distal clavicle.
9
Scapula
- 5 to 7 percent of all shoulder-girdle fractures
- Tx conservative
10
Glenohumeral Joint
- The most frequently dislocated major joint,
accounting for 40 percent of all dislocations. - Classified as anterior (95 percent), posterior (4
percent) and, rarely, inferior or superior. - Associated injuries include posterior glenoid rim
fractures, lesser tuberosity avulsions and
subscapularis tendon detachment
11
Case 2
- 18 ???, ??????????,???????
- 20??????????,???????
- ????????????????
- Dx muscle strain
- Tx analgesic agent arm sling
12
Elbow
- Routine views of the elbow include at least the
AP and lateral views - Special attention to the contour of the radial
head and the fat pads
13
- Ossification centers in region of elbow.
- Capitellum,3-6m
- Radial head
- Medial epicondyle,5-7y/o
- Trochlea,9-10y/0
- Lateral epicondyle,9-13y/o
14
Radial Head Subluxation
- 20 of upper extremity in- juries in children.
- 1 to 3 years are most often affected, ( 6 months
to 15 y/o ) - Girls are somewhat more commonly afflicted than
boys. - This injury is called nursemaids elbow or pulled
elbow because it results from a sudden
longitudinal pull on the forearm while the
childs arm is in pronation (as when a child is
helped up onto a curb). Stretching of the annular
ligament allows fibers to slip between the
capitellum and the head of the radius, resulting
in an inability of the child to supinate the arm. - X-ray studies are not required
15
Treatment
16
Wrist hand
17
Incomplete Fracture
- Torus ( Buckle ) fracture plastic deformity
- Greenstick fracture cortex disruption
18
Part II. The Lower Extremity
19
Ottawa Ankle Rules (OAR)
- 1.The patient is unable to bear weight for at
least four steps immediately after the injury and
at the time of evaluation - 2.Bone tenderness is present at the posterior
edge of the distal 6 cm or the tip of either
malleolus. take ankle x-ray. - 3.Bone tenderness is present at the navicular or
the base of the fifth metatarsal. take foot
x-ray
