Physical trauma

Conventional radiography is used routinely in the delineation of skeletal injuries, and specialized techniques such as conventional tomography and magnification radiography are generally not required. Xeroradiography and low kilovolt radiography may have some value in assessing musculoskeletal injury, but computed tomography CT and MR imaging have to a large extent replaced these methods. CT is best applied to traumatic abnormalities in regions of complicated anatomy, such as the spine, the bones in the face and pelvis, the glenohumeral and sternoclavicular joints, and the foot. MR imaging can provide a unique perspective on traumatic abnormalities as a result of its ability to reveal the singular signal intensity characteristics of bone marrow. Radionuclide bone imaging is of value in diagnosing stress fractures and can also be used to evaluate the healing response of fractures as well as to delineate early avascularity of bone after fracture, especially in the proximal portion of the femur. Although MR imaging and bone scintigraphy may appear to be equally sensitive in the diagnosis of occult fractures after acute injury, MR imaging has far greater specificity. MR imaging is best employed to evaluate a single region of the body, whereas bone scintigraphy is more effective as a general surveyor of the skeleton, as in the case of multiple injuries or child abuse. Arteriography can help identify posttraumatic vascular abnormalities, including disruption and occlusion of major vessels, arteriovenous fistulae and aneurysms.

Complications of trauma are numerous and include reflex sympathetic dystrophy, osteolysis, osteonecrosis, osteochondrosis, neuropathic osteoarthropathy, heterotopic bone formation, infection and aneurysmal bone cysts.

DR