- “ Spinal fractures represent 3% to 6% of all skeletal injuries. Spine trauma is a complex diagnostic area in which the radiological assessment is crucial. Plain radiography is often used as the initial diagnostic modality. However, stabilization of the acutely injured spine is a primary concern. In this respect, computed tomography (CT) is vastly superior to plain film in terms of speed and accuracy. In many trauma centers, CT has replaced plain film as the primary modality for evaluation of spinal trauma.”
Spinal Trauma
Looby S, Flanders A
Radiol Clin North Am 2011 Jan;49(1);129-63 - “In the last 10 years, on a total of 55 patients treated in our institution for benign lesions of the major airway, 20 were with an acute injury; eleven females and nine males with a mean age of 58 years (range of 24–92). Twelve lesions were iatrogenic (orotracheal intubation) and eight were post-traumatic (three blunt traumas, five penetrating traumas). The cervical trachea was involved in 13 cases (one associated to an incomplete esophageal transection and two associated to laryngeal injuries), the thoracic trachea in six cases (four extended to the right mainstem one and to the left).”
Acute major airway injuries: clinical features and management
Mussi A et al.
European j Cardio-Thoracic Surg
Vol 20, issue 1, July 2001; pages 46-52 - “Tracheobronchial injuries are relatively uncommon, often require a degree of clinical suspicion to make the diagnosis, and usually require immediate management. Most penetrating injuries occur in the cervical area. Most blunt injuries occur in the distal trachea or right mainstem, and are best approached by a right posterolateral thoracotomy.”
Traumatic Injury to the Trachea and Bronchus
Karmy-Jones R, Wood DE
Thorac Surg Clin
2007 Feb; 17(1):35-46 - “Tracheobronchial injuries are relatively uncommon, often require a degree of clinical suspicion to make the diagnosis, and usually require immediate management. The primary initial goals are twofold: stabilize the airway and define the extent and location of injury. These are often facilitated by flexible bronchoscopy, in the hands of a surgeon capable of managing these injuries. Most penetrating injuries occur in the cervical area. Most blunt injuries occur in the distal trachea or right mainstem, and are best approached by a right posterolateral thoracotomy.”
Traumatic Injury to the Trachea and Bronchus
Karmy-Jones R, Wood DE
Thorac Surg Clin
2007 Feb; 17(1):35-46 - Sternal Fractures are Associated With
- Pulmonary contusion
- Retrosternal hematoma
- Pneumothorax
- Cardiac contusion (least common) - “Sternal fracture is a common injury in a population where restraints are frequently used. Patients with an isolated sternal fracture do not require cardiac monitoring and those under 40 years of age may be cared for in a short stay ward.”
Sternal fractures: a retrospective analysis of 272 cases.
J Trauma 1993; 35(1):46-54
Brookes JG; Dunn RJ; Rogers IR - “ A retrospective analysis of 515 cases of blunt chest trauma is presented. The overall thoracic morbidity rate was 36% and mortality rate was 15.5%. Atelectasis was the most common complication. Severe chest trauma can be present in the ab- sence of rib or other thoracic bony fractures. Emergency thoracotomies for resuscitation of the patient with blunt chest trauma with absent vital signs proved unsuccessful in 39 of 39 patients.”
Blunt Thoracic Trauma: An Analysis of 515 Patients
Shorr RM et al
Ann Surg Vol 206, No 2,pp 200-205 - “ MDCT cystography should be done when pelvic fluid is present, especially when there are fractures or gross hematuria, to define which of the patients has a bladder rupture and to define the type of bladder rupture.”
Bladder trauma: multidetector computed tomography cystography
Ishak C, Kanth N
Emerg Radiol (2011) 18:321-327 - Indications for CT Evaluation of Pediatric Trauma Patients
- High speed MVA with potential for skeletal trauma and organ injury
- Pelvic fractures
- Intraarticular fractures in the extremities
- Spine fractures
- GSW with suspected vascular and bone injury
- Radiologically occult fractures "In our experience, the role of 3D volume imaging in the evaluation of pediatric fractures and soft tissue injuries continues to evolve as this technique increasingly enables the detection and characterization of abnormalities and provides data that alter decisions about patient care." Pediatric Skeletal Trauma: Use of Multiplanar Reformatted and Three-dimensional 64-Row Multidetector CT in the Emergency Department
Fayad LM, Corl F, Fishman EK
RadioGraphics 2009; 29:135-150 "Given that trauma is a leading cause of morbidity and mortality in children, MDCT plays an important role in the evaluation of potential injury in the pediatric trauma patient." Pediatric Skeletal Trauma: Use of Multiplanar Reformatted and Three-dimensional 64-Row Multidetector CT in the Emergency Department
Fayad LM, Corl F, Fishman EK
RadioGraphics 2009; 29:135-150 "The role of three dimensional volume imaging in the evaluation of fractures and soft tissue injuries in pediatric patients continues to evolve as this technique increasingly enables detection and characterization of abnormalities and provides results that affect decisions about patient care." Pediatric Skeletal Trauma: Use of Multiplanar Reformatted and Three-dimensional 64-Row Multidetector CT in the Emergency Department
Fayad LM, Corl F, Fishman EK
RadioGraphics 2009; 29:135-150 - Complications of Missed Carpal Bone Fractures
- Osteonecrosis
- Nonunion
- Degenerative arthritis
- Persistent pain
- Functional comprimise - "In the proximal carpal row, lumate and triquetrum fractures were often radiographically occult (0% and 20% respectively detected at radiography); whereas in the distal carpal row. Trapezoid, capitate, and hamate fractures were often occult (0%,0%, and 40% detected at radiography respectively)."
MDCT and Radiography of Wrist Fractures: Radiographic Sensitivity and Fracture Patterns
Wellong RD et al.
AJR 2008; 190:10-16 - "Thirty percent of wrist fractures were not prospectively diagnosed on radiography, suggesting that CT should be considered after a negative radiographic finding if clinically warranted. The location of a dorsal scaphoid avulsion fracture emphasizes the need for specific radiographic views or cross sectional imaging for diagnosis."
MDCT and Radiography of Wrist Fractures: Radiographic Sensitivity and Fracture Patterns
Wellong RD et al.
AJR 2008; 190:10-16 - "Thirty percent of wrist fractures were not prospectively diagnosed on radiography, suggesting that CT should be considered after a negative radiographic finding if clinically warranted."
MDCT and Radiography of Wrist Fractures: Radiographic Sensitivity and Fracture Patterns
Wellong RD et al.
AJR 2008; 190:10-16
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