Radiology #3 Radial & Ulnar Bone Fractures

Why hello! After a lovely lecture today about radial and ulnar bone (the two bones that make up your forearm) fractures in my diagnostic imaging class, and viewing an elbow series today in radiology conference, I've decided to post about four of the different fractures that occur and their mechanism of injury. The top radiograph is normal anatomy of the wrist, so that you may understand or more readily observe the fracture. The thicker of the two bones is radius, and the thinner of the two is the ulna, notice on the lateral projection (the xray on the right, the two bones are super imposed over each other, or line up). The first type of fracture is called a Colles' fracture. A Colles' fracture is a fracture of the distal (more towards the fingers) radius where the fracture fragment is displaced posteriorly. Colles' fractures are also classified as osteoporotic fractures and are usually the first place where a fracture appears in post-menopausal women. This type of fracture usually occurs when someone has fallen on (an) out stretched hand (FOOSH). The second type of fracture is a Smith's fracture aka reverse Colles' fracture where the fracture fragment is displaced anteriorly (palm side of the hand). This type occurs when someone doesn't have time to extend their wrist when falling, usually occurs in elderly patients whose mental capacity is fading. The third type of fracture is called a Galeazzi fracture. It's a fracture of the distal radius that is accompanied by an ulnar dislocation, this also often occurs from a FOOSH type injury, where the fracture radius is shortened. Notice that the "fracture fragment" remains with the carpal bones and the hand. Often radiologists will use the thumb as an indicator as to which direction the fracture will displace. The last type of fracture I'm going to discuss tonight is a Monteggia fracture, it's almost the opposite of a Galeazzi fracture. A monteggia fracture is fracture of the proximal ulna (towards the elbow) with a dislocation of the radius. The more serious of the last two types of fractures that I've listed are the dislocations because soft tissue healing is a longer, less developed process than bone healing. Some of the fractures, depending on the severity are surgical cases where screws, plates, bars, etc will be inserted and then casted. Can you say bad day?

Radiology #2 Stress Fractures

After a very overdue spin class, I decided to talk about stress fractures today, in the hopes that I do not acquire one. Stress fractures are caused by unusual or repetitive stress. Unusual stress may be someone deciding they are going to start training for a marathon, having never been a runner before in their life. Repetitive stress may be in the long term runner who overuses or pushes too hard in a short period of time. A radiograph is often negative for stress fractures within the first 4 weeks of injury but after those 4 weeks, callous formation and periosteal reactions are apparent. Let me define: callous meaning hard & thickened cortical bone (the thick, bright white lines outlining each bone), and periosteal meaning the membrane the covers the outside of the cortical bone. Case: 47 year old female who is a regular walker has been experiencing foot pain for several weeks now, the initial radiograph is negative for fracture.... as there are no breaks in any of the cortical lines. Four weeks later, the aforementioned patient has a follow up radiograph taken, where you notice the callous formation and periosteal reaction. Now it is important to take note that metastasis and infection can also cause periosteal reactions so patient history taking is VERY important in ruling in/out the more serious diagnoses. The second case is of a 37 year old female that complains of foot pain after a biking trip. The radiograph to the left is the initial, the middle is after 1 month, and the far right radiograph is a 3 month follow up. Treatment of stress fractures include: resting the injury site, usually a break from activities for 3+ weeks, icing and proper footwear evaluation.

Sources:

Berger, et al. Stress Fractures. Radiographical Department from the Academical Medical Centre, Amsterdam. http://www.radiologyassistant.nl/en/4615feaee7e0a 23 May 2007

Fractures without Significant Trauma. Department of Radiology, University of Washington. 2007

Radiology #1 Scaphoid Bone Fracture

I have recently found a complete love for radiology! My college is lucky enough to have a brand new digital radiograph system, complete with a conference room where every day, almost all day long, the radiology interns and DACBRs (Doctors of Chiropractic who have a Diplomat from the American Chiropractic Board of Radiologists) read films, present case studies, etc. So from my love for that, not only will my radiology posts educate you, my reader, but will also affirm anything that I have learned, am learning or will learn. Since my cousin has a recent scaphoid bone fracture, I figured it would be the subject of my first radiographic post. The top radiograph (xray) shows normal anatomy of the wrist, and since the scaphoid is a carpal bone (one of the 8 small bones that makes up the wrist) a normal wrist radiograph is applicable. The pink dot is located adjacent to the scaphoid bone. You can clearly see the fracture in the next radiograph (note that these radiographs were taken on two different patients). Scaphoid fractures account for almost 71% of carpal fractures and are extremely unique due to it's vascularization. Usually a fracture of the scaphoid fracture will result in two pieces, like the one in this instance. The bone healing process is mainly dependent upon the blood supply (vascularity) because that's how nutrients arrive to the fracture site, hence healing. In the scaphoid, the blood supply is more proximal (closer to the wrist, farther from the fingers), so depending on where the fracture site is, the distal portion (the fracture piece closer to the fingers) may or may not get the nutrients that are vital to healing. Normal treatments include: casts over the wrist and may or may not include the thumb, surgical implementation of screws and bone grafts to adhere the fractured pieces together.

Sources:

Skeletal Trauma Radiology, University of Virginia. http://www.med-ed.virginia.edu/courses/rad/ext/

Boles, Carol. Wrist, Scaphoid Fractures and Complications. 22 March 2010; http://emedicine.medscape.com/article/397230-overview

Your Orthopedic Connection: Scaphoid Fractures of the Wrist May 2010. American Academy of Orthopedic Surgeons.

Hello Blogspot!

Chiropractic... what is chiropractic? As a politically active chiropractic student even I can say that this is controversial even withIN the profession. My definition of chiropractic is something that I have yet to completely compile, as it is constantly evolving. Chiropractors are the most qualified health care practitioners to take care of neuromusculoskeletal conditions, so yes this would be in my definition but chiropractic care is also applicable to ear infections, gastrointestinal problems, menstruation, etc the list goes on an on. I think everyone in the profession would agree that more research is needed but this thought also goes out to the pharmaceutical research. I would rather have quality research done at actual chiropractic colleges and from highly accredited medical colleges (example: Perceived benefit of Complementary and Alternative Medicine (CAM) for back pain: a national survey. Eisenberg, et al May 2010 JABFM) than studies that are FDA approved only because of the amount of money passing under the table. Chiropractic also falls under a wellness model of health care, and is actually the first profession (other than nutritionists) to fully integrate this into our treatment plans, philosophy and paradigms. If you think that you are 100% healthy because you have zero symptoms (whether it's pain, fever, headache, etc) then you are greatly mistaken.... but this is an entirely different topic altogether. So perhaps after this short discussion my definition of chiropractic thus far is that Chiropractic is a manual treatment therapy associated with treatment of the neuromusculoskeletal conditions and their somatovisceral correlations in the treatment of acute, chronic and wellness patients.