Interesting films from the week 1

So here are a couple of choice selections from results box this week. Some are pretty subtle, some less so.  Apologies that the picture quality is not quite up to PACS, but it should be good enough....

Click on the "Read more" for the answers.  Feedback as always, to Simon on simon.horne@nhs.net


Have fun!

Case 1: fall on to shoulder, very painful to examine, tender over scapula wing ?dislocation ?scapula #

Lucency along the greater tuberosity, (possibly a small step on the modified axial at the same point) highly suspicious for a greater tuberosity fracture.  Click here for more on tuberosity fractures.

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Case 2:  Fell from horse 2 hours ago, hallux tender and deformed.

Minimally displaced fracture of the proximal phalanx that extends into the IP joint.

Case 3:  Fall, admitted to CDU with recognised facial and hip injuries.  What other investigation is indicated now and why?

Isolated greater trochanter fracture may be caused by the isolated action of gluteus, but this is uncommon.  More commonly the fracture extends into the neck - MRI series have shown that the majority are associated with partial or complete intertrochanteric neck of femur fractures ( try this and this for example) and so it is often recommended that we perform a CT/MRI.

Case 4: fell directly onto knee 1/7 ago, now unable to WB, tender medial and lateral joint line ? bony injury

What is the injury?  What clinical test helps guide operative vs non-operative management?

There is a fracture of the lateral part of the patella.  There was a matching good going haemarthrosis on the lateral.   Generally, fractures of the patella with less than 3mm of displacement and an intact straight leg raise are managed conservatively.  More detail here.  It is unusual to be so clearly a lateral piece only and raises the possibility of a bipartite patella, which can be confused with a fracture but is normal in around 1%.  More info here.