But there are also little pieces ofbone, that have avulsed at least 10mm away. However the CT shows a thin fracture line through the anterior side of the vertebral body and also through the spinous process. Modifiers are other factors which can affect the decision of appropriate treatment: Multiple rib fractures at the same levels. This fracture is the second most common distal humerus fracture in children. There is widening between the spinous processes. Typical mechanism: punching (most common) fall Study the superior biceps-labrum complex and look for sublabral recess or SLAP-tear. W B Saunders Co. (2003) ISBN:0721691757. The integrity of the posterior ligamentous complex plays an important role in the TLICS. 2019;42(1):69-73. A total of more than 4 points indicates surgical treatment. it will be either 4 or 4+3= 7 points. Musculoskeletal Imaging,The Requisites (Expert Consult - Online and Print), 4th ed (2013). This is all based on the premise that a fracture caused by forward flexion should be treated by undoing the flexion by positioning the patient in an extension brace, or by surgical intervention correcting the spinal column in extension. Clavicular fractures are common and account for ~5% (range 2.6-10%) of all fractures 2,3. 2 points for morphology. For unstable distal clavicular fractures, a coracoclavicular screw fixation could be performed 6. Sagittal One of the spinous processes is in two pieces and the two pieces are widely separated. Emerg Med J. even greater mobility of the os acromiale after surgery and worsening of the impingement (4). 4. Full Text Association Between Hemorrhage Control Interventions and Mortality in US Trauma Patients With Hemodynamically Unstable Pelvic Fractures 30, 2022. These descriptions may thus be misleading. Here a fracture that just looks like another compression fracture on the lateral view. Differentiating stable buckle fractures from other distal radius fractures: the 1-cm rule. 1. Fractures of the ankle joint: investigation and treatment options. Study the cartilage. Notice the rigid spine and how easily this major injury can be overlooked. They all attach to the greater tuberosity. Indirect MR arthrography of the shoulder: use of abduction and external rotation to detect full- and partial-thickness tears of the supraspinatus tendon. Subsequent modifications of the Denis classification have recognized that with an intact posterior ligamentous complex (PLC), two-column unstable injuries can be successfully treated non-surgically (3). Morphology and PLC are scored separately. In these cases the PLC is always involved, resulting in a total of 7 points for the TLICS-score. McGraw-Hill Medical. Epidemiology. The PLC is injured with a fracture through the adjacent spinous processes. intramedullary titanium elastic nail) has shown to result in a better cosmetic outcome and higher rates of union. Patients with a rigid spine are more at risk for translation or distraction. Fractures through the posterior elements (red arrows). Alao D, Guly HR. On these axial images a Buford complex can be identified. Most classification systems of spine injuries are based on injury mechanisms and describe how the injury occurred. Radiographics. 2002;33 (6): 503-5. This is the severe variant of a compression fracture with higher risk of neurologic deficits. WebInjury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery.Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team. In type II there is a small recess. Types of Fractures in Children. Finally a posterior spondylodesis was performed. It is seen in 11% of individuals. W B Saunders Co. (2003) ISBN:0721691757. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. The American Journal of Medicine - "The Green Journal" - publishes original clinical research of interest to physicians in internal medicine, both in academia and community-based practice.AJM is the official journal of the Alliance for Academic Internal Medicine, a prestigious group comprising internal medicine department chairs at more Pediatric wrist buckle fractures. Notice MGHL, which has an oblique course through the joint and study the relation to the subscapularis tendon. When there are several fractures, each level has to be scored separately. It was later modified and popularized by the Swiss orthopedic surgeon,Bernhard Georg Weber (1929-2002),in 1972 2. In some cases it is difficult to decide whether you are dealing with distraction combined with a compression fracture or with a compression fracture with PLC-injury. All we see is a cortical disruption in the upper anterior wall of the vertebral body and slight loss of height ventrally. Look for impingement by the AC-joint. The axial MR-images show an os acromiale with degenerative changes, i.e. Should we just splint and go? The outcomes of treatment will vary from patient to patient, depending on the following: Pattern and severity of the fracture; Other injuries associated with the trauma Patient's age and bone quality; Patient's general health, including smoking status. McGraw-Hill Medical. ISBN: 9781451114744. Trimalleolar fractures refer to a three-part fracture of the ankle. Clavicular fracture. The key point in this case is that you should not describe this morphology as burst - 2 points. The Journal of Pediatrics is an international peer-reviewed journal that advances pediatric research and serves as a practical guide for pediatricians who manage health and diagnose and treat disorders in infants, children, and adolescents.The Journal publishes original work based on standards of excellence and expert review. Notice the biceps anchor. The treatment will depend on the PLC integrity and the neurological status. Topics covered include: trauma systems and management; surgical procedures; epidemiological studies; You have to decide what you think is the main issue: the collapse of the vertebral body or the distraction. The image shows the typical findings of a sublabral recess. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-10800, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":10800,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/torus-fracture-1/questions/1998?lang=us"}. A torn PLC has a tendency not to heal and can lead to progressive kyphosis and collapse. The anterior labrum is absent in the 1-3 o'clock position and there is a thickened middle GHL. Assuming the neurological exam was normal, this patient would still get 7 points. TLICS score based on imaging is 7 points: In this case there is severe compression of the vertebral body. However the most important findings are the horizontal fractures of the posterior elements. Rarely, a torus fracture may refer to the fracture of an oral torus, and there is potential for the two terms to be confused 10. Musculoskeletal eponyms: who are those guys? How would you describe the morphology and the PLC? There is not much else happening here. Sometimes a cast may be applied, but often a splint is all that is required with a period of rest and immobilization. Notice that the supraspinatus tendon is parallel to the axis of the muscle. Failure of one of the acromial ossification centers to fuse will result in an os acromiale. Notice smooth undersurface of infraspinatus tendon and normal anterior labrum. WebAbout Our Coalition. The images are of a patient with a typical bamboo spine as a result of ankylosing spondylitis. Mainwaring BL, Daffner RH, Riemer BL. Notice red arrow indicating a small Perthes-lesion, which was not seen on the standard axial views. 2003;10 (2): 71-5. Due to the tension by the anterior band of the inferior GHL labral teras will be easier to detect. TLICS also facilitates appropriate treatment recommendations. The glenohumeral joint has a greater range of motion than any other joint in the body. ADVERTISEMENT: Supporters see fewer/no ads. There are a number of factors that affect prognosis 23: location 9. distal pole: the excellent likelihood of union (~100%) waist: ~10-20% chance of non-union; proximal pole: ~30-40% chance of non-union; vertically oriented fracture line; fragment displacement of 40 (5): 1355-1382. Saura-Ingles A, Garcia-Ballesta C, Prez-Lajarin L, Lpez-Jornet P. Fracture in the Chin Area: An Unusual Case of Mandibular Torus Fracture. Minimally Invasive Orthopaedic Trauma. Plint AC, Perry JJ, Tsang JL. A compression fracture gets 1 point. On the AP-view notice the subtle widening of the interpedicular distance compared to the levels above and below. Orthopedics. 5 (2): 65-73. These images illustrate the differences between an sublabral recess and a SLAP-tear. The level with the highest TLICS score usually will be decisive for the therapy of choice. If it appears that the fracture is unstable and cannot be held in place and good alignment with just a splint or cast, an open reduction and internal fixation (ORIF) may be needed. In the TLICS classification however this is a burst fracture, i.e. Jeray KJ. They are self-limiting and typically do not require operative intervention, although a manipulation may be required if the angulation is severe. Look for supraspinatus-impingement by AC-joint spurs or a thickened coracoacromial ligament. 2011;45 (5): 454-8. This most commonly occurs at the distal radius or tibia following a fall on an outstretched arm;the force is transmitted from carpusto the distal radiusand the point of least resistance fractures,usually the dorsal cortex of the distal radius. It is also known as backfire fracture or lorry driver fracture 1. 7. 28 (7): 693-6. CJEM. fracture may arise as proximally as the level of fibular neck and not visualized on ankle films, requiring knee or full-length tibia-fibula radiographs (Maisonneuve fracture) unstable: usually requires ORIF; Weber C fractures can be further subclassified as 6. J Orthop Traumatol. Look at the images. Buckle fractures in children: Is urgent treatment necessary? Avulsion fractures or transverse fractures of spinous processes or articular facets. However notice the following: Even though there is not much displacement at this moment, we should probably call this translation injury. The affected femoral head will appear larger if the dislocation is anterior, and smaller if posterior. Widening of the interpedicular distance, often a result of the sagittal fracture, is seen in 80% of burst fractures. Unable to process the form. When it is complicated by a burst, it gets an additional 1 point, resulting in 2 points. These normal variants are all located in the 11-3 o'clock position. The facet joints act against rotational forces. In the ABER position the inferior glenohumeral ligament is stretched resulting in tension on the anteroinferior labrum, allowing intra-articular contrast to get between the labral tear and the glenoid. Fractures can occur at any part of the clavicle. Burst is the result of compression with severe axial loading. On a MR-arthtrogram a sublabral foramen should not be confused with a sublabral recess or SLAP-tear, which are also located in this region. The non-union rate in operative fixation is approximately 2%, with other operative complications including pneumothorax, supraclavicular nerve injury (approximately 19%) and hardware failure/prominence 9. Notice rotator cuff muscles and look for atrophy. Once you realize that, it should not confuse you. The supraspinatus, infraspinatus and teres minor muscles and tendons are shown. The fact that these little pieces of bone have been so severely displaced means there has to be a major injury. Macheras G, Kateros KT, Savvidou OD, Sofianos J, Fawzy EA, Papagelopoulos PJ. Look for excessive fluid in the subacromial bursa and for tears of the supraspinatus tendon. A New Type of Occult Wrist Fracture? This means that a patient can be treated non-surgically. 2008;15 (6): 391-8. What are the findings? 2011;12 (4): 185-92. Notice that there are 3 vertebrae involved. The horizontal fractures on the posterior side and the increased interspinous distance indicate distraction, which means a higher score for morphology. Check for errors and try again. On the sagittal CT and MRI there are no signs of posterior ligamentous injury. The Journal Look for HAGL-lesion (humeral avulsion of the glenohumeral ligament). Dyan V. Flores, Paola Kuenzer Goes, Catalina Meja Gmez, Darwin Fernndez Umpire, Mini N. Pathria. (2018) Medicine. It aims to reduce deaths and long-term health problems by Ossification of the spinal ligaments and calcification of the annulus fibrosus alter the biomechanics of the spine, creating long lever arms and limiting the ability to absorb even minor impacts. In type I there is no recess between the glenoid cartilage and the labrum. The TLICS-score is high, because there is distraction and injury to the PLC. The size of the head of the femur is then compared across both sides of the pelvis. Classification. The anterosuperior labrum is absent in the 1-3 o'clock position and the middle glenohumeral ligament is usually thickened. Furthermore, the word stability itself is ambiguous and may refer to direct osseous stability; it may refer to neurological stability and finally, to long-term (ligamentous) stability. 20 (3): 819-36. Ankle joint dislocation treating dislocated trimalleolar fractures accompanied with the complex posterior malleolus fracture without separation of the tibiofibular syndesmosis. by Michael Zlatkin. fractures involving a single facial buttress, Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture), Watson-Jones classification (tibial tuberosity avulsion fracture), Nunley-Vertullo classification (Lisfranc injury), pelvis and lower limb fractures by region. ISBN:1405104600. 7. (2009) ISBN:1416022201. by Clare J. Groves et al. A simple compression fracture is the most common form of injury and is seen in 90% of cases. Cortical buckle fractures occur when there is axial loading of a long bone. You could argue that these fractures of the spinous processes indicate distraction, i.e. ISRN Rheumatology Radiology. Notice superior labrum and attachment of the superior glenohumeral ligament. Musculoskeletal eponyms: who are those guys? Indian J Orthop. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Gaillard F, Qureshi P, Roberts D, et al. Additionally, cosmetic concerns may be an indication for internal fixation to avoid unsightly deformity. (2018) Pediatric Radiology. There are two classification systems 5,6. fracture may arise as proximally as the level of fibular neck and not visualized on ankle films, requiring knee or full-length tibia-fibula radiographs (Maisonneuve fracture) unstable: usually requires ORIF; Weber C fractures can be further subclassified as 6. The total score predicts the need for surgery as is shown in the TLICS algorithm. Rotator cuff tears The PLC is injured with edema of the interspinous ligament and a torn flaval ligament (3 points). The MRI demonstrates rupture of the flava ligaments, interspinous and supraspinous ligaments as well as fracture of the posterior elements and compression of the vertebral body. The posterior vertebral cortex is intact. In this case of translation there is bilateral facet dislocation and also a horizontal fracture of the spinous process. An os acromiale must be mentioned in the report, because in patients who are considered for subacromial decompression, The level with the highest TLICS score will determine the type of treatment. When the PLC is definitely injured on CT, it can already be scored as 3. Check for errors and try again. Torus fracture. Retropulsion of a body fragment and the percentage of narrowing of the spinal canal. 1. Xing W, Xing WY, Xing SL, Xing WL, Xing KZ, Xing ZC, Xing ZZ, Xing. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Vertebral bodies show marrow edema as a result of a fracture. The ABER view is also very useful for both partial- and full-thickness tears of the rotator cuff. This sublabral recess can be difficult to distinguish from a SLAP-tear or a sublabral foramen. The supraspinous ligament is a strong, cordlike ligament which connects the tips of the spinous processes from C7 to the sacrum. The Spine Journal is the #1 ranked spine journal in the Unable to process the form. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Bickle I, Lustosa L, Iqbal S, et al. However, the vast majority (~75%; range 69-85%) occur in the midshaft, at or near the junction of the middle and outer third with distal clavicle fractures (15-20%) and medial clavicle fractures (<5%) less common 3,8. Since the integrity of the PLC depends mostly on ligamentous structures, MR is sometimes needed to adequately diagnose pathology of the PLC, especially when there is no dislocation or disruption on CT. MRI has a tendency to overdiagnose PLC injury (4). Images in the ABER position are obtained in an axial way 45 degrees off the coronal plane (figure). Hill Sachs lesions are only seen at the level of the coracoid. If there was a lot of fluid in the joint, we should call this indeterminate. It is important to note that occult fractures may be present in the apparently normal radiograph; this is relatively common in children and also occasionally seen in adults 2. There are 3 types of attachment of the superior labrum at the 12 o'clock position where the biceps tendon inserts. This guideline covers assessing and managing pelvic fractures, open fractures and severe ankle fractures (known as pilon fractures and intra-articular distal tibia fractures) in pre-hospital settings (including ambulance services), emergency departments and major trauma centres. Weber C Fractures. WebGuidelines and Measures provides users a place to find information about AHRQ's legacy guidelines and measures clearinghouses, National Guideline Clearinghouse (NGC) and National Quality Measures Clearinghouse (NQMC) However labral tears may originate at the 3-6 o'clock position and subsequently extend superiorly. The following suggest complete healing : Radiology Key. 2. (2018) Orthopedic Traumatology. Tears of the supraspinatus tendon are best seen on coronal oblique and ABER-series. by Alexander R. Vaccaro et al. It was later modified and popularized by the Swiss orthopedic surgeon,Bernhard Georg Weber (1929-2002),in 1972 2. Case 13: bilateral neonatal clavicle fractures, Case 15: birth trauma - left clavicle fracture, Case 17: fractured clavicle and bent ORIF cannulated screw, Neer classification of clavicle fractures, Allman classification of clavicle fractures, Robinson classification of clavicle fractures, Gustilo Anderson classification (compound fracture), Anderson and Montesano classification of occipital condyle fractures, Traynelis classification of atlanto-occipital dissociation, longitudinal versus transverse petrous temporal bone fracture, naso-orbitoethmoid (NOE) complex fracture, cervical spine fracture classification systems, AO classification of upper cervical injuries, subaxial cervical spine injury classification (SLIC), thoracolumbar spinal fracture classification systems, AO classification of thoracolumbar injuries, thoracolumbar injury classification and severity score (TLICS), Rockwood classification (acromioclavicular joint injury), Neer classification (proximal humeral fracture), AO classification (proximal humeral fracture), AO/OTA classification of distal humeral fractures, Milch classification (lateral humeral condyle fracture), Weiss classification (lateral humeral condyle fracture), Bado classification of Monteggia fracture-dislocations (radius-ulna), Mason classification (radial head fracture), Frykman classification (distal radial fracture), Hintermann classification (gamekeeper's thumb), Eaton classification (volar plate avulsion injury), Keifhaber-Stern classification (volar plate avulsion injury), Judet and Letournel classification (acetabular fracture), Harris classification (acetebular fracture), Young and Burgess classification of pelvic ring fractures, Pipkin classification (femoral head fracture), American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture), Cooke and Newman classification (periprosthetic hip fracture), Johansson classification (periprosthetic hip fracture), Vancouver classification (periprosthetic hip fracture), Winquist classification (femoral shaft fracture), Schatzker classification (tibial plateau fracture), AO classification of distal femur fractures, Lauge-Hansen classification (ankle injury), Danis-Weber classification (ankle fracture), Berndt and Harty classification (osteochondral lesions of the talus), Sanders CT classification (calcaneal fracture), Hawkins classification (talar neck fracture), anterior superior iliac spine (ASIS) avulsion, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, avulsion fracture of the proximal 5th metatarsal, angulation and fracture end displacement (including direction), degree of overlap (measurement is useful), associated findings and relevant negatives. Epidemiology. Hoogervorst P, van Schie P, van den Bekerom M. Midshaft Clavicle Fractures: Current Concepts. Rarely, a torus fracture may refer to the fracture of an oral torus, and there is potential for the two terms to be confused 10. Look for variants like the Buford complex. Pylon fractures of the ankle: a distinct clinical and radiologic entity. Torus fractures,also known as buckle fractures, are incomplete fractures of the shaft of a long bone that is characterized by bulging of the cortex. This guideline covers assessing and managing pelvic fractures, open fractures and severe ankle fractures (known as pilon fractures and intra-articular distal tibia fractures) in pre-hospital settings (including ambulance services), emergency departments and major trauma centres. Goost H, Wimmer MD, Barg A et-al. 10. 6. www.wheelessonline.com. Unlike other classifications, the TLICS is an easy scoring system that depicts the features important in predicting spinal stability, future deformity, and progressive neurologic compromise. 7. Pitfalls in diagnosing a compression fracture are: The images show two cases of osteochondrosis. When you plan the coronal oblique series, it is best to focus on the axis of the supraspinatus tendon. coracoacromial arch and coracoacromial ligament, glenohumeral ligaments - SGHL, MGHL, IGHL (anterior band). 4+3 points. 1. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. The teaching point is: pay careful attention to little pieces of bone. The small size of the glenoid fossa and the relative laxity of the joint capsule renders the joint relatively unstable and prone to subluxation and dislocation. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Datir A, Ramsey, MD A, Lustosa L, et al. The disc space is markedly widened about four times the normal level. 8. It has a role in determining treatment. Citations may include links to full text content from PubMed Central and publisher web sites. First look at the first CT-images and decide what is going on. Prop 30 is supported by a coalition including CalFire Firefighters, the American Lung Association, environmental organizations, electrical workers and businesses that want to improve Californias air quality by fighting and preventing wildfires and reducing air pollution from vehicles. Bipolar clavicular fractures occur when there are both distal and medial clavicular injuries, most commonly a distal clavicle fracture in combination with an anterior sternoclavicular joint dislocation 8. Radiology 2005;236:601, by Bharti Khurana Vertebral fractures and concomitant fractures of the sternum, Management of Acute Spinal Fractures in Ankylosing Spondylitis, Integrity of the Posterior Ligamentous Complex. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Trimalleolar Ankle Fractures. 2005;199(1):27-9. fractures involving a single facial buttress, Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture), Watson-Jones classification (tibial tuberosity avulsion fracture), Nunley-Vertullo classification (Lisfranc injury), pelvis and lower limb fractures by region. You can see the edema related to the fracture of the vertebral body and the massive edema in the paraspinous muscles. This type of fracture includes all fractures that are the result of displacement in the horizontal plane: side-to-side motion, either left-to-right or anterior-to-posterior or side-to-side rotary motion of one vertebral body with respect to another. Unable to process the form. The axial CT and MRI in the same patient show the displaced fragment pressing on the thecal sac. Trimalleolar fracture. Hill JM, Mcguire MH, Crosby LA. 2018;3(6):374-80. Anderson and 9. Notice the fibers of the inferior GHL. Unable to process the form. 8. Traditionally midshaft fractures of the clavicle have been treated with immobilization and a sling or figure-of-8 dressing, and in most cases, results are said to be excellent with low non-union rates and minimal functional impairment 3. posterior element. (2009) ISBN:1416022201. Typically, fractured clavicles occur as the result of a direct blow to the shoulder. Study the cartiage. The angled buckle fracture in pediatrics: a frequently missed fracture. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-2283, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":2283,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/weber-classification-of-ankle-fractures/questions/2549?lang=us"}. In addition to reporting the presence of the fracture a number of features should be sought and in many instances commented upon as relevant negatives: Look for tears of the infraspinatus tendon. 10. 3. Dtsch Arztebl Int. WebFracture compression increases the contact area across the fracture and increases stability of the fracture. In this case the main findings are the horizontal fractures of the posterior elements. Skeletal Trauma. Sometimes it will be possible to determine PLC injury on CT, but MRI may be necessary. 2 points combined with the PLC injury making a total of 5 points. Discussion: based on only these two images it is hard to say whether this is burst with PLC-injury or maybe distraction on the posterior side. 4. That is until we zoom in and look at the distance between the spinous processes. When there is a distraction on the posterior side, the PLC is always involved, making a total of 4+3=7 points. In both cases the patient is a surgical candidate. Gustilo Anderson classification (compound fracture), Anderson and Montesano classification of occipital condyle fractures, Traynelis classification of atlanto-occipital dissociation, longitudinal versus transverse petrous temporal bone fracture, naso-orbitoethmoid (NOE) complex fracture, cervical spine fracture classification systems, AO classification of upper cervical injuries, subaxial cervical spine injury classification (SLIC), thoracolumbar spinal fracture classification systems, AO classification of thoracolumbar injuries, thoracolumbar injury classification and severity score (TLICS), Rockwood classification (acromioclavicular joint injury), Neer classification (proximal humeral fracture), AO classification (proximal humeral fracture), AO/OTA classification of distal humeral fractures, Milch classification (lateral humeral condyle fracture), Weiss classification (lateral humeral condyle fracture), Bado classification of Monteggia fracture-dislocations (radius-ulna), Mason classification (radial head fracture), Frykman classification (distal radial fracture), Hintermann classification (gamekeeper's thumb), Eaton classification (volar plate avulsion injury), Keifhaber-Stern classification (volar plate avulsion injury), Judet and Letournel classification (acetabular fracture), Harris classification (acetebular fracture), Young and Burgess classification of pelvic ring fractures, Pipkin classification (femoral head fracture), American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture), Cooke and Newman classification (periprosthetic hip fracture), Johansson classification (periprosthetic hip fracture), Vancouver classification (periprosthetic hip fracture), Winquist classification (femoral shaft fracture), Schatzker classification (tibial plateau fracture), AO classification of distal femur fractures, Lauge-Hansen classification (ankle injury), Danis-Weber classification (ankle fracture), Berndt and Harty classification (osteochondral lesions of the talus), Sanders CT classification (calcaneal fracture), Hawkins classification (talar neck fracture), anterior superior iliac spine (ASIS) avulsion, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, avulsion fracture of the proximal 5th metatarsal, Danis-Weber ankle fracture classification, below the level of the syndesmosis (infrasyndesmotic), usually stable if medial malleolus intact, distal extent at the level of the syndesmosis (trans-syndesmotic); may extend some distance proximally, tibiofibular syndesmosis usually intact, but widening of the distal tibiofibular joint (especially on stressed views)indicates syndesmotic injury, deltoid ligament may be torn, indicated by widening of the space between the medial malleolus and talar dome, variable stability, dependent on the status of medial structures (malleolus/, Weber B fractures could be further subclassified as, above the level of the syndesmosis (suprasyndesmotic), tibiofibular syndesmosis disruption with widening of the distal tibiofibular articulation, fracture may arise as proximally as the level of fibular neck and not visualized on ankle films, requiring knee or full-length tibia-fibula radiographs (, Weber C fractures can be further subclassified as, a fracture above the syndesmosis results from external rotation or abduction forces that also disrupt the joint, usually associated with an injury to the medial side. 20 (3): 819-36. sports, laborer)9. A sublabral recess however is located at the site of the attachment of the biceps tendon at 12 o'clock and does not extend to the 1-3 o'clock position. Reconstruction plate versus minimal invasive retrograde titanium elastic nail fixation for displaced midclavicular fractures. The role of the radiologist is to report the following: One of the key points here is that an incomplete cord lesion will likely benefit more from surgery than a complete lesion; therefore a complete cord injury is scored as only 2 points, while an incomplete cord injury gets 3 points. 8. This classification was first described by the Belgian general surgeon,Robert Danis (1880-1962), in 1949. The MRI also shows disruption of the ligamentum flavum and a partial disruption of the interspinous ligament. This classification was first described by the Belgian general surgeon,Robert Danis (1880-1962), in 1949. Study the labrum in the 3-6 o'clock position. Males are affected more commonly than females with a median age of injury of 56 years. 2005;22 (3): 232-3. 3. 4 points. The Importance of Injury Morphology, the Integrity of the Posterior Ligamentous Complex, and Neurologic Status Here is a patient with distraction on the anterior side. In case of a distraction on the anterior side, however, the PLC may or may not be involved, i.e. The posterior cortex may bulge slightly posteriorly in a simple compression fracture. RadioGraphics 2013; 33:2031-2046, by Vaccaro AR et al. It is either loss of height of the anterior part of the vertebral body or disruption of the vertebral endplate. In case of multiple fractures, you have to score each level separately. Always go for the highest possible score in TLICS. J Fam Pract. The os acromiale may cause impingement because if it is unstable, it may be pulled inferiorly during abduction by the deltoid, which attaches here. A bony Bankart lesion shows besides the soft tissue damage also a fracture of the anteroinferior glenoid rim. Notice that the biceps tendon is attached at the 12 o'clock position. Study the inferior labral-ligamentary complex. Large tears of the rotator cuff may allow the humeral head to migrate upwards resulting in a high riding humeral head. Dislocation of the long head of the biceps will inevitably result in rupture of part of the subscapularis tendon. Edema without clear rupture; high signal intensity of the interspinous ligaments or along the facet joints on T2 SPIR or STIR. 2007;15 (4): 239-48. ongoing local pain, brachial plexus irritation, cosmetic deformity 5. 5. The outcomes of treatment will vary from patient to patient, depending on the following: Pattern and severity of the fracture; Other injuries associated with the trauma Patient's age and bone quality; Patient's general health, including smoking status. Subsequent modifications of the Denis classification have recognized that with an intact posterior ligamentous complex (PLC), two-column unstable injuries can be successfully treated non-surgically (3 ). Since in both cases the TLICS score based on imaging will be high, there is usually an indication for surgical treatment. A distraction injury on the posterior side can lead to a compression fracture on the anterior side. In many cases, however, there is no good correlation with the necessity for surgery. Indian J Orthop. WebPRIME Education is an accredited provider of continuing medical education. Labral tears Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-2283, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":2283,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/weber-classification-of-ankle-fractures/questions/2549?lang=us"}. However, the terms are often used interchangeably. Practical points. Skeletal trauma, basic science, management, and reconstruction. 2006; 240(1):152-160. These are typical findings in translation-rotation fractures. In the TLICS this means 3 points for the morphology and 3 points for the PLC, which makes a total of 6 points indicating the need for surgical stabilization. One of the fractures is a typical avulsion. 4 points for morphology. As long as there is no free fragment with posterior displacement, it is a wedge compression fracture and not a burst fracture. In the Denis classification this would be a three column fracture -anterior/middle/posterior - indicating a very unstable fracture. These type of fractures are more common in children, especially aged 5-10 years, due to the elasticity of their bones. 2009; 38(10):967-975. by Herold T, Bachthaler M, Hamer OW, et al. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Topics covered include: trauma systems and management; surgical procedures; epidemiological studies; surgery (of all The abduction external rotation (ABER) view is excellent for assessing the anteroinferior labrum at the 3-6 o'clock position, 2009;58 (10): E1-6. The main feature is posterior distraction with horizontal fractures of posterior elements (red arrow), Avulsion of a spinous process (yellow arrow), The morphology is of a vertebral fracture with retropulsion of a fragment, i.e. Unable to process the form. Having three parts, this is a more unstable fracture and may be associated with ligamentous injury. WebDue to poor osseous congruency and capsular laxity, the glenohumeral joint is very unstable, which makes it the most frequently dislocated joint in the human body. Coracoclavicular screw fixation for unstable distal clavicle fractures. Using the popular Denis three-column classification may lead to another situation since it uses the terms stable and unstable. WebIt typically takes from 9 to 12 months for an acetabular fracture to completely heal. Look for rim-rent tears of the supraspinatus tendon at the insertion of the anterior fibers. At this level also look for Bankart lesions. by Jaideep J. Iyengar, MD; Keith R. Burnett, MD; Wesley M. Nottage, MD MR is the best imaging modality to examen patients with shoulder pain and instability. burst (2 points). Based on imaging alone, the TLICS score is 5 points and this patient is a surgical candidate. Trimalleolar fractures refer to a three-part fracture of the ankle. Odontoid process fracture, also known as a peg or dens fracture, occurs where there is a fracture through the odontoid process of C2. Wolters Kluwer 2014. Notice that on a 2.5mm axial slice you can miss these fractures. 2011;45 (5): 454-8. The glenohumeral joint has the following supporting structures: The tendon of the subscapularis muscle attaches both to the lesser tuberosity aswell as to the greater tuberosity giving support to the long head Check for errors and try again. Two-thirds of patients with persistent complaints opt for further surgical intervention9. Absolute indications for surgery include open fractures, patients with skin compromise or tenting, associated neurovascular injury or scapular neck fractures 9. Clavicular fractures are most common in young adults and elderly women 8. extra-articular fracture; there may be posterior displacement of the distal segment; more: supracondylar fracture; Lateral condyle fracture. Goost H, Wimmer MD, Barg A et-al. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. It is present in 5% of the population. Now when you look carefully at the lateral view, you will notice that the facets are separated. 5. Mohammed R, Syed S, Metikala S et-al. The abduction and external rotation of the arm releases tension on the cuff relative to the normal coronal view obtained with the arm in adduction. Usually it is an incidental finding and regarded as a normal variant. If the distraction is the main feature, then the morphology is distraction, i.e. Skeletal Radiol. 2015;111 (21): 377-88. fractures involving a single facial buttress, Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture), Watson-Jones classification (tibial tuberosity avulsion fracture), Nunley-Vertullo classification (Lisfranc injury), pelvis and lower limb fractures by region. Since this is not possible with the clavicle, AP and axial views are obtained: In most instances, the fracture is evident clinically and easily identified on radiographs. A sublabral foramen or sublabral hole is an unattached anterosuperior labrum at the 1-3 o'clock position. A burst fracture gets 2 points for morphology in the TLICS. The small size of the glenoid fossa and the relative laxity of the joint capsule renders the joint relatively unstable and prone to subluxation and dislocation. It should always be possible to trace the middle GHL upwards to the glenoid rim and downwards to the humerus. Treatment and prognosis. So here is a typical case of distraction. unstable or oblique fractures; Union rates of surgical management approach. Sambandam B, Gupta R, Kumar S, Maini L. Fracture of distal end clavicle: A review. Hunter TB, Peltier LF, Lund PJ. The posterior cortex of the vertebral body has to be intact and this feature differentiates a simple compression fracture from the more severe burst fracture. The PLC serves as a posterior "tension band" of the spinal column and plays an important role in the stability of the spine (3). Translation/rotation is the result of displacement in the horizontal plane. It is interesting to note that the word chauffeur comes from the French for "someone who warms" the car engine. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-27657. Often unilateral or bilateral facet dislocation is seen in rotational fractures. They occur between the ages of 4 and 10 years. TLICS: distraction injury + PLC disruption. There is severe narrowing of the spinal canal. At surgery the rupture of the supraspinous ligament was confirmed (red and black arrows). These normal variants will usually not mimick a Bankart-lesion, since it is located at the 3-6 o'clock position, where these normal variants do not occur. Conor Kleweno, Edward K. Rodriguez. Now when you describe such a fracture the first word in your report should be distraction, i.e. Dtsch Arztebl Int. 1997;79 (4): 537-9. This has been challenged by some authors, who have found non-union rates of up to 15-17%9 and high rates of a suboptimal outcome, e.g. In some cases it can be difficult to decide whether there is a burst fracture with a torn PLC or distraction with a torn PLC and a compression fracture (figure). Spine (Phila Pa 1976). The mechanism of injury is variable, and can occur both during flexion or extension, and with or without compression 5. The image shows a vertebral fracture with a transverse fracture of the spinous process, but also a fracture of the sternum. There has been a single case report of a torus fracture of the distal radius in an adult 9. Detection of partial-thickness supraspinatus tendon tears: is a single direct MR arthrography series in ABER position as accurate as conventional MR arthrography? Again look at the first MR-images and decide what is going on. The Spine Journal, the official journal of the North American Spine Society, is an international and multidisciplinary journal that publishes original, peer-reviewed articles on research and treatment related to the spine and spine care, including basic science and clinical investigations.. It is a severe injury since there is a high chance of cord injury when its osseous and ligamentous supporting structures are pulled apart. 3. This system divides tibial plateau fractures into six types: Schatzker I: wedge-shaped pure cleavage fracture of the lateral tibial plateau, originally defined as having less than 4 mm of depression or displacement Schatzker II: splitting and depression of the lateral tibial plateau; namely, type I fracture with a depressed base of metacarpal fracture (common). It is important to recognise these variants, because they can mimick a SLAP tear. So we should call this a translation fracture with anterior displacement. The fractures involve the medial malleolus, the posterior aspect of the tibial plafond (referred to as the posterior malleolus) and the lateral malleolus. At this level study the middle GHL and the anterior labrum. Falls, motor vehicle collisions, pedestrian accidents, cycling and diving are common causes of injury 6,7. (2006) ISBN:0071438335. Philadelphia : Lippincott Williams Wilkins, c2007. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. They tend to be unstable and become displaced because of the pull of the forearm extensors. Gardne MJ, Siegel JA. The TLICS consists of three independent parameters: A parameter can be scored 0-4 points and the total score is the sum of these parameters with a maximum of 10 points. Evaluation of the syndesmotic-only fixation for Weber-C ankle fractures with syndesmotic injury. This is an interesting case since non-surgical management was initially attempted in this patient. 1988;168 (1): 215-8. Wolters Kluwer 2014. The term torus is the Latin word meaning protuberance. CT is the best modality for identifying an occipital condyle fracture 6. The Thoraco-Lumbar Injury Classification and Severity score (TLICS) is a classification system for thoracolumbar spine injuries, designed to assist in clinical management. 2. A recess more than 3-5 mm is always abnormal and should be regarded as a SLAP-tear. 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