Cervical Spine
Jefferson’s Fx Axial (impaction) Compressive
Hangman’s Fx (Traumatic spondylolisthesis)
Clay Shoveler’s Fx
Extension Teardrop Fx
Flexion Teardrop Fx
Simple Wedge Compression Fx
Burst Fx
Bilateral Facet Dislocation
Unilateral Facet Dislocation
Avulsion Fx
Duverney’s Fx
Malgaigne’s Fx
Bucket Handle Fx
Straddle Fx
Sprung Pelvis (Open book)
Pelvis Insufficiency Fx
Increased ADI ; Prevertebral Swelling;
Force (burst)- auto
accident/diving
Hyperextension; abrupt
deceleration from high speed
Abrupt Hyperflexion; pulls from
traps & rhomboids
Hyperextension avulsion
Hyperflexion and Axial
Compression (burst)
Axial load and Forced hyperflexion
Vertical compression to the head
Flexion Distraction Injury
Flexion Distraction with Rotation
Pelvis & Sacrum
Vertical Shear
High energy trauma
Abnormal bone under normal
daily stress
lateral masses obliterated/laterally
displaced
M/c at C2; Anterior Displacement
Prevertebral Swelling; teardrop fx often
associated
M/c at C7 (T1 & C6); double spinous
sign; stable; no neuro deficit
M/c at C2; Unstable
Larger fragments than extension fx
Retropulsion (neuro effects); Unstable
Stable; M/c C5, C6, C7; anterior body
height <3 mm than posterior height
Vertical Fx line; posterior displaced
fragments place pressure on cord
“jumped facet” “Perched/locked facet”
Unstable
Bow-tie sign; Stable
Stable
Unstable; ipsilateral
Unstable; contralateral
Unstable
Unstable; assess genitourinary
M/c postmenopausal osteoporosis
2nd M/c radiotherapy/corticosteroids
(RA, SLE); Honda sign on bone scan
 Thoracolumbar Spine
Simple Compression Fx Hyperflexion with axial load
Osteoporotic Compression Fx
Pathologic Compression Fx
(Vertebra Plana)
Burst Fx High impact force
Chance Fx Flexion Distraction injury
TVP Fx Blunt trauma, psoas avulsion,
lateral flexion-extension injury
Pars Fx Repeated hyperextension
Upper Rib Fx (Ribs 1-3) Rare- occur with severe trauma
(weightlifters, stress fx of 1st rib
in throwing athletes)
Middle Rib Fx (Ribs 4-9) M/c rib fxs
-Golfer’s Fx strike the ground
rather than the ball- abrupt
termination of swing
precipitates fx at lateral rib
-Passion/Bear hug Fxover
enthusiastic hug- osteopenia
predisposes elderly to these
Lower Rib Fx (Ribs 10-12) Uncommon
Cough (post-tussive) Fx stress
fractures of the lower anterior
ribs with violent coughing—ribs
6 & 7 M/c
Kummell Delayed post-traumatic
vertebral collapse
Step off defect, zone of condensation;
wedge shaped; M/c T12-L1
Codfish deformity; osteopenic; Dowagers
hump, anterior wedge
Flattening in uncommon regions, missing
pedicle, bone destruction, infiltrates
posterior aspect of pedicle
Retropulsion (bulging), interpedicular
widening
Unstable; anterior & posterior disruption;
minimal wedging deformity
Retroperitoneal injuries associated; 2nd m/c
fx in lumbars; L2 & L3 M/c; horizontal fx line
Usually stable
Common at the rib angle
Need oblique viewsTransverse or oblique
Fx line; cortical offset; callus formation
-Ultrasonography best modality
Complicationspneumothorax,
subcutaneous emphysema, diaphragmatic
elevation, splenic laceration, trachea, aorta,
great vessels, brachial plexus, spine injury
Often found at lateral aspect of the rib;
Flail Chest2 fxs involving same rib
paradoxical motion during respiration
Check for kidney damage (IV pyelogram
and/or CT)
Vertebral AVN; intravertebral vacuum
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 Complicationsmust be reduced quickly-AVN; M/c=Sciatic
*Abduction of thigh at impactfx of nerve paralysis (peroneal branch); Myositis ossificans; post-
posterior acetabular lip (CT) traumatic degenerative arthritis

Anterior Hip Forced abduction and extension of
Dislocation the femur
SCFE (adolescent coxa Type I Salter Harris epiphyseal fx;
vara/epiphysiolisthesis Upward displacement, external
) rotation and adduction of the neck
on the head
Distal Femur Fx Young high energy injuries (fall
from significant heights or MVA) with
other injuries
ElderlyWeak bones-- lower-force
event (fall from standing)
Supracondylar fx
Bumper/Fender Fx Significant impaction
Rotates externally; femoral head lies caudal and medial to
acetabulum and near obturator foramen
M/c disorder of adolescent hip; varus deformity, adduction
and external rotation of the femur; widening of growth
plate, abnormal Klein/Shenton lines, reduced epiphyseal
height, widened teardrop, Trethowan’s sign, medial
femoral neck periosteal buttressing
*Tx=Intramedullary metallic fixation device
Distal to femoral shaft, proximal to condyles; transverse or
oblique; comminuted and intra-articular(FBI)
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

 the leg when knee is flexed places
Segond Fx excess tension on lateral capsule and
ligaments resulting in avulsion
ACL Tear Hyperextension (or impaction) during
rotational movement (pivot-shift)
PCL Tear
Arcuate Sign Avulsion fx of proximal tip of fibula
avulsion of LCL, biceps femoris,
popliteus tendon at posterolateral
corner
Patellar Avulsion Fx Sudden eccentric contraction of
quadriceps-long-standing patellar
tendon irritation due to repetitive
microtrauma (running/jumping
athletes)
Patellar Dislocation Tibial fixation with internal rotation
of the femur in flexion (Trauma, lig.
Laxity- Ehlers-Danlos, FTD, increased
Qangle)
Osteochondritis
Dissecans
Lateral Malleolus Fx Outward/external rotation of the foot
Medial Malleolus Fx
Maisonneuve Fx (3rd Forceful inversion/Pronation/external
malleolus) rotation
Calcaneus Fx Compressive (stress) & Non-
compressive (avulsive)
Lisfranc Fx Fall with longitudinal compression or
a twisting force through the forefoot
March Fx Stress Fx
Jones/Dancers Fx Forceful inversion and plantar
flexionAvulsion force from
peroneus brevis tendon and lateral
cord of plantar aponeurosis
Avulsion of lateral tibial at attachment of lateral capsule (IT
band); ACL and meniscal (lateral) tears commonly
associated; MRI confirms w/ high signal intensity at site of
lateral tibial insertion
*Stieda Fx=MCL Avulsion
Lateral Femoral notch sign=Deep notch (impacted
osteochondral fx)
Horizontal crescent of bone drawn proximally and lying
about head of fibula
Usually Unilateral; M/c is transverse or slightly oblique
involving midportion of patella seen on frontal projection;
DDX developmental bipartite/tripartite patella
Altapatellar tendon rupture (corticosteroid)
Baja Quadriceps tendon ruptured
M/c lateral dislocation; Osteochondral Fx associated (Flake
Fx); VMO=dynamic stabilizer; Medial patellofemoral
ligament passive primary restraint to lateral translation
M/c locations= lateral aspect of medial femoral condyle &
medial talar dome; osteochondral fragment
Oblique fx extending from inferior anterior margin upward
and backward to posterior margin of the shaft of the distal
fibula
Non-union m/c
Fx of proximal fibular shaft
Boehler’s angle normally 28-40°
Tarsometatarsal fracture-dislocation; normal should be less
than 2-3 mm; CT; M/c accompanying fx at the base of the
2nd metatarsal and lateral cuboid surface
Classically 2nd metatarsal (can be any wt-bearing
metatarsus)
M/c of bony injuries of the foot=Fx of the base of the 5 th
metatarsal
Transverse Fx line; Causes symptoms in the area of the
ankle mortise
 Upper Extremity
Clavicular Fx Direct trauma to
shoulder (birth, sports,
traffic accidents)
Middle clavicle fx force
to distal end of S-shaped
clavicle creates shearing
effect at the middle 3rd
producing the fx
ACJ Dislocation Direct blow to shoulder
(football, rugby, hockey);
FOOSH (bicycle, horse)
Rockwood Injury to ACJ capsule but
Classification- Type I coracoclavicular lig. Intact
ACJ Dislocation Mild sprain
Rockwood Subluxation of the ACJ-
Classification- Type II stretched but intact ligs.
ACJ Dislocation Moderate sprain
Rockwood Disrupted
Classification- Type III coracoclavicular
ACJ Dislocation ligaments (>1.2cm) and
acromiclavicular lig.-
Severe sprain
Rockwood Posterior dislocation of
Classification- Type the clavicle
IV ACJ Dislocation
Rockwood Exaggerated type III
Classification- Type V injury
ACJ Dislocation
Rockwood Clavicle displaced
Classification- Type downwards and lodges
VI ACJ Dislocation below the coracoid,
posterior to
coracobrachialis tendon
Greater Tuberosity Avulsion, fractured by
Fx (Flap Fx) direct trauma, fractured
during anterior
dislocation
Proximal Humeral Fx Direct Trauma; avulsion
M/c midshaft (middle clavicle 95% Childhood & adolescent fxs heal
fx- w/ displacement there’s w/out sequelae
elevation of medial fragment) Adult ComplicationsNon-union;
M/c Birth Fx Malunion, Degenerative arthritis,
AP projection w/ 15° cephalad Post traumatic osteolysis;
angulation (weighted for Comminution; Fx displacement;
undisplaced fxs) Neurovascular damage
Normal ACJ 4-6 mm; *Neer Classification 4 parts:
coracoclavicular 1.2cm Humeral head, Greater tubercle,
Lesser tubercle, Humeral shaft
-Count displacement of fxs
- >1 cm displacement
-Fragment >45°angulation
Normal x-ray; 1°
symptom=pain; minimal
widening of joint space
Outer end of clavicle slightly
elevated; Widened ACJ but
clavicular ligaments intact-
normal coracoclavicular
distance; may present with
small bump over injury
Seen on axillary or Y view
Clavicle lies subcutaneously
Exceedingly rare
Humeral head dislocated
anterior inferior to subcoracoid
position
View in external rotation
Surgical Neck fx M/c in adults Complications Delayed union; non-
(Comminuted- Anteromedial union; brachial plexus injury; axillary

Proximal Shaft Fx
-If fx occurs proximal to
pec major attachment
the humeral head will
abduct and rotate
-Between the pec major
and deltoid the prox
fragment will adduct
-Distal to deltoid the prox
fragment will abduct
Scapular body Fx High energy blunt trauma
Anterior GHJ Forced abduction w/
Dislocation external rotation
Posterior GHJ Forced posteriorly in
Dislocation (Triple E internal rotation while
Syndrome) arm in abduction;
convulsion; electrocution
Inferior GHJ Forceful hyperabduction;
Dislocation (Luxatio Humeral head displaced
erecti) medial/inferior to glenoid
Distal Humerus Fx
Supracondylar Fx Fx line extends
transversely or obliquely
displacement of distal fragment
b/c pull of pec major m.)--
Uncommon in children (buckle
or torus fx of surgical neck or
prox shaft m/c)
M/c type of scapula Fx;
treatment=arm sling; 80-90%
associated with other injuries
(lung and chest)
M/c dislocation of the shoulder
Anterior, medial, and inferior
displacement; 95% of shoulder
dislocations;
Rare, Frequently overlooked
Widened joint space; rim sign
(>6mm); humeral head fixed in
internal rot.; tennis racquet;
superior displacement; Trough
line (impaction fx of
anteromedial humeral head;
Overlap of humeral head and
glenoid (Grashey view)
On x-rayArm elevated and
abducted, elbow flexed,
forearm rests on top of head
M/c elbow fx in children;
conservative care/bracing;
artery injury; DJD; residual joint
stiffness; AVN w/ anatomical neck fx
-Surgical neck=best prognosis
-Anatomical neck=worst prognosis
Complications Brachial plexus
injury; Avulsion/fx of greater tub.;
Bankart & Hill-Sachs; Increase for
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
Complications Avulsed lesser
tuberosity; Tear of subscapularis m.
Rarely bilateral If bilateral in
absence of trauma=seizure induced
dislocations
ComplicationsInjuries to axillary n
and artery, rotator cuff and long head
of biceps tendon tear common
Complications Ischemic
contracture (Volkmann); Ulnar n.
damage; Malunion
 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

FOOSH (M/c)-impaction M/c elbow fx in adults;

Radial Head Fx of radial head into Mason Classification:
 capitellum *double Type I- Simple, non-displaced
cortical sign*; fall on (<2mm)
abducted arm with some Type II- Simple, displaced
degree of elbow flexion (>2mm)
Type III- Comminuted Essex-
Lopresti Fx-dislocation (+distal
radioulnar dislocation)
Radial Neck Fx Impaction at the junction Sharpened angle on anterior
of the head and neck surface seen on lateral view;
complete fx seen as transverse
fx line w/ varying degree of
displacement
Monteggia Fx FOOSH Fx of proximal ulnar shaft + Tx=ORIF
radial head dislocation
Galeazzi Fx FOOSH w/ elbow in Rare but serious Complications Non-union;
flexion Fx of distal radius + dislocation tendency to re-dislocate
of distal radioulnar joint;
Tx=ORIF
Colles Fx FOOSH w/ wrist Fx of distal radius w/ posterior Complications common and may be
extended (dorsal) angulation of distal severe
fragment; many also have fx of
ulnar styloid (Moore’s Fx)
Incidence increases w/ age
(osteoporosis)
Altered pronator quadratus fat
plane
Smith Fx (Revered Direct blow or Fall with Far less common than Colles’
Colles’) wrist in hyperflexion Distal radius fx with anterior
(volar) angulation of distal
fragment
Barton Fx Forceful hyperextension Intra-articular fx
of the wrist to produce Posterior rim Fx of distal radial
the posterior rim Fx articulating surface with
proximal dislocation of the
carpus
Lateral view see posterior
and proximal displacement of
carpals
Torus Fx Buckled cortex after M/c Fx of the wrist in children
trauma in any long bone between 6-10; key sign is a
localized cortical bulge or
bump; Tx casting or bracing
Radial Styloid Fx Avulsion or impaction of Fx line transverse or oblique;
(Chauffeur Fx) radial styloid by the usually no displacement
adjacent scaphoid
Slipped Radial Shearing force across the Childhood equivalent of Colles’;
Epiphysis growth plate following a Radial epiphysis usually
 forceful hyperextension displaced posteriorly and have
injury a small, displaced metaphyseal
fragment (corner sign)-Salter
Harris type II; Tx by closed
reduction
Scaphoid Fx Various degrees of M/c carpal bone fx Fx of scaphoid proximal pole more
hyperextension and M/c site for occult fx likely to result in major complications
radial flexion (FOOSH) like: AVN, non-union, carpal
instability and radiocarpal
degenerative arthritis
Lunate Dislocation Hyperextension injury M/c carpal to dislocate; tilts
forward and anterior,
disrupting its articulation w/
capitate; seen on lateral view
Scapholunate 2nd M/c carpal to dislocate
Dislocation Moves laterally and rotates
anteriorly; seen on PA view as
circular (ring or signet ring sign)
Diastasis of scaphoid and
lunate (>3-sign