Abdominal trauma is usually divided into blunt and penetrating trauma.
Findings of abdominal trauma
splenic trauma: most common
gastrointestinal tract (bowel) trauma:
proximal jejunum is most commonly affected by blunt trauma,...
Acute aortic syndrome (AAS) describes the presentation of patients with one of a number of life threatening aortic pathologies that give rise to aortic symptoms.
The spectrum of these aortic emergencies include:
aortic intramural hematoma
penetrating atherosclerotic ulcer
Avulsion fractures of the knee are numerous due to the many ligaments and tendons inserting around this joint. They include 1:
anterior cruciate ligament avulsion fracture
posterior cruciate ligament avulsion fracture
avulsion of the medial collateral ligament
origin of MCL avulsion fracture...
Barton fractures are fractures of the distal radius. It is also sometimes termed the dorsal type Barton fracture to distinguish it from the volar type or reverse Barton fracture.
Barton fractures extend through the dorsal aspect to the articular surface but not to the volar aspect. Therefore, i...
Birth trauma relates to those conditions caused by both physical/mechanical and hypoxic injuries.
Birth trauma occurs in ~5 per 1000 births 2.
Blunt traumatic neck injury is uncommon because it is usually protected by the head, shoulders, and chest. This term is generally used to refer to injuries of the neck besides to cervical spine injuries, which are common.
Blunt injury to the neck is most commonly from motor vehicle ...
Butterfly fragments are large, triangular fracture fragments seen commonly in comminuted long bone fractures. The term is commonly used in orthopedic surgery, and results from two oblique fracture lines meeting to create a large triangular or wedge-shaped fragment located between the proximal an...
Cerebral herniation, also referred to as acquired intracranial herniation, refers to shift of cerebral tissue from its normal location, into an adjacent space as a result of mass effect.
There are a number of different patterns of cerebral herniation which describe the type of herni...
Cervical spine fractures can occur secondary to exaggerated flexion or extension, or because of direct trauma or axial loading.
The cervical spine is susceptible to injury because it is highly mobile with relatively small vertebral bodies and supports the head which is both heavy and...
Cervical spine injuries can involve the cervical vertebral column, intervertebral discs and cervical spine ligaments, and/or cervical spinal cord. The cervical spine accounts for ~50% of all spinal injuries.
5-10% of patients with blunt trauma have a cervical spine injury 1.
Chance fractures, also referred to as seatbelt fractures, are flexion-distraction type injuries of the spine that extend to involve all three spinal columns. These are unstable injuries and have a high association with intra-abdominal injuries.
They tend to occur from a fl...
Fractures of the coronoid process of the ulna are uncommon and often occur in association with elbow dislocation.
Fracture of the coronoid process is thought to result from elbow hyperextension with either avulsion of the brachialis tendon insertion or shearing off by the...
A coup-contrecoup injury is a term applied to head injuries and most often cerebral contusions and traumatic subarachnoid hemorrhage. It refers to the common pattern of injury whereby damage is located both at the site of impact (often less marked) and on the opposite side of the head to the poi...
Diaphragmatic rupture often results from blunt abdominal trauma. The mechanism of injury is typically a motor-vehicle collision.
Given that the most common mechanism is motor vehicle collisions, it is perhaps unsurprising that young men are most frequently affected. The estimated ...
The term disarticulation refers to the disconnection of all or part of a limb from the body, specifically through a joint. This is in contrast to amputation, which is the disconnection or removal of the structure through a bone.
Epicondyle fractures are common injuries in children. They represent 10% of all elbow fractures in children and usually occur in boys after a fall on an outstretched arm.
Medial epicondyle fractures comprise most of these injuries. They can usually be treated with splinting and early physiother...
There are numerous eponymous fractures which are named after the people who first described their existence 1:
Bankart fracture: glenoid
Barton fracture: wrist
Bennett fracture: thumb
Bosworth fracture: ankle
Chance fracture: vertebral
Charcot joint: foot
Chopart fracture: foot
Facet dislocation refers to anterior displacement of one vertebral body on another. Without a fracture, the only way anterior displacement can occur is by dislocation of the facets.
Facet dislocation can occur to varying degrees:
The injury usua...
Facial fractures are commonly caused by blunt or penetrating trauma at moderate or high levels of force. Such injuries may be sustained during a fall, physical assault, motor vehicle collision, or gunshot wound. The facial bones are thin and relatively fragile making them susceptible to injury.
Fall onto an outstretched hand (FOOSH) is a common mechanism for wrist-forearm fractures, in certain cases with involvement of elbow structures, particularly in children.
Some injuries that result from such a fall include:
Fracture-a-la-signature (or signature fracture) is another term used to described a depressed skull fracture.
Fracture-a-la-signature derives its name from forensic medicine because the size and shape of a depressed skull fracture may give information on the type of weapon used. It can be a si...
Fracture-dislocations of the radius and ulna illustrate the importance of including the joint above and below the site of injury on radiographic assessment.
Most forearm fractures (60%) include fracture of the distal radius as well as an ulnar fracture. In some cases, there is associated disloc...
Fractures of the thumb are important due to huge impact the thumb has on the overall function of the hand, an understanding of the types of fractures that occur is important, as treatment varies with fracture type.
Metacarpal fractures include:
Glass foreign bodies may be present if they are ingested, inserted, or as a result of an injury. All glass is radiopaque 7.
The prevalence of glass foreign bodies in wounds from injury has been recorded at a rate of 1.5% in superficial (subcutaneous) wounds and 7.5% of deeper woun...
Hemopneumothorax (or, less commonly, pneumohemothorax) is a term given when there is concurrent presence of a hemothorax and well as a pneumothorax. It is a variant of a hydropneumothorax.
Approximately 5% of patients with pneumothorax will have concomitant hemothorax 6 .
Hangman fracture, also known as traumatic spondylolisthesis of the axis, is a fracture which involves the pars interarticularis of C2 on both sides, and is a result of hyperextension and distraction.
These injuries account for 4-7% of all cervical spine fractures and up to 22% of ...
Hypoglobus refers to the inferior displacement of the globe in the orbit. It may or may not be associated with enophthalmos.
Hypoglobus is most commonly caused by fracture of the orbital floor but may be due to other causes:
silent sinus syndrome
orbital foreign bodies
Gunshot injuries often require imaging assessment, and this evaluation has both clinical relevance (assessment of organ damage, surgical planning and prognostication), and often also forensic implications.
Incidence of gunshot injuries to the head is increasing in some countries, ...
A joint effusion is defined as an increased amount of fluid within the synovial compartment of a joint.
There is normally only a small amount of physiological intra-articular fluid. Abnormal fluid accumulation can result from inflammation, infection (i.e. pus) or trauma and may be an exudate, t...
Large joint dislocation is a not uncommon presentation to emergency rooms. Described in order of comonality:
posterior dislocation of the hip
The liver is one of the most frequently damaged organs in blunt trauma, and liver trauma is associated with a significant mortality rate.
In blunt abdominal trauma, the liver is injured ~5% (range 1-10%) of the time 1,3.
Patients can present with right uppe...
Locked facet joint is a type of facet joint dislocation that results from jumping of the inferior articular process over the superior articular process of the vertebra below and becomes locked in the position.
It can be unilateral or bilateral.
The tip ...
Longitudinal temporal bone fractures are petrous temporal bone fractures that occur parallel to the long axis of the petrous temporal bone. Although more current classifications of the extent of temporal bone fractures focus on the integrity of the otic capsule rather than the fracture orientati...
Petrous temporal bone fractures are classically divided into longitudinal, transverse or mixed fracture patterns depending on the direction of fracture plane with respect to the long axis of the petrous temporal bone. Some features may aid in distinguishing them.
Lunate dislocations are an uncommon traumatic wrist injury that require prompt management and surgical repair. The lunate is displaced and rotated volarly. The rest of the carpal bones are in a normal anatomic position in relation to the radius.
These should not be confused with perilunate disl...
Metaphyseal fractures are fractures that involve the metaphysis of tubular bones. They may occur in pediatric or adult patients.
Examples of metaphyseal fractures:
surgical neck of humerus fracture
distal radial fracture
distal radial buckle frac...
Midcarpal (central carpal) dislocation describes an injury where there is dislocation of the capitate from the lunate, and subluxation of the lunate from the radius. This term is somewhat confusing because some authors use "midcarpal dislocation" to refer generally to perilunate and lunate dislo...
Named fractures are usually eponymous or occupational. The simplest way of spiting them up is by body area:
upper extremity fractures
lower extremity fractures
Nightstick fractures are isolated fractures of the ulna, typically transverse and located in the mid-diaphysis and usually resulting from a direct blow. It is a characteristic defensive fracture when the patient tries to ward off an overhead blow from an assailant (or local law enforcement offic...
Occult fractures are those that are not visible on imaging, most commonly plain radiographs and sometimes CT, either due to lack of displacement or limitations of the imaging study. There may be clinical signs of a fracture without one actually being seen. MRI or nuclear medicine studies are som...
Penetrating traumatic neck injury can be a potentially devastating injury due to the high density of crucial anatomical structures within the neck.
Young males are highly represented in patients with a traumatic neck injury. In one study, 11:1 ratio of males to females were ident...
Phthisis bulbi, also known as end-stage eye, is an atrophic scarred and disorganized globe that may result from a variety of severe ocular insults.
In general, phthisis bulbi involves elderly patients, usually 65-85 years of age 7. Children and adolescents are only rarely affecte...
A pneumothorax does not display classical signs when a patient is positioned supine for a chest radiograph. Instead, the pneumothorax may be demonstrated by looking for the following signs:
relative lucency of the involved hemithorax
deep, sometimes tongue-like, costophrenic sulcus: deep sulcu...
Posterior shoulder dislocations are far less common than anterior shoulder dislocations and can be difficult to identify if only AP projections are obtained. A high index of suspicion is helpful.
Posterior shoulder dislocations account for only 2-4% of all shoulder dislocations (t...
The term retrolisthesis (more rarely the synonyms retrospondylolisthesis or posterolisthesis) refers to posterior displacement (backward slip) of a vertebral body relative to one below. Causes include trauma, facet joint osteoarthritis or congenital anomalies (e.g. underdevelopment of the pedicl...
Rib fractures are a common consequence of trauma and can cause life-threatening complications.
The 4th-10th ribs are the most commonly fractured 1. Fractures of the 1st-3rd ribs are associated with high-energy trauma 3.
When the rib is fractured twice, the term floating rib is used ...
A scalp hematoma usually occurs following an injury at delivery although they are commonly seen with head trauma.
There are three types of hematoma, which are defined by their location within the scalp, particular their location as related to the galea aponeurosis and skull peri...
Scapula fractures are uncommon injuries, representing ~3% of all shoulder fractures.
Mechanisms of injury
requires high energy trauma (e.g. motor vehicle accidents account for 50% of scapular fractures)
direct trauma to the shoulder region
indirect trauma through falling on outstr...
Spinal fractures are usually the result of significant trauma to a normally formed skeleton, or the result of trauma to a weakened spinal column. Examples include:
Jefferson fracture: ring fracture of C1
hangman fracture: bilateral pedicle or pars fracture of C2
Spinal hematomas are a rare clinical entity and are often idiopathic. Prompt diagnosis and treatment are crucial, lest they cause permanent neurological damage.
Identifying the location of the hematoma is important for treatment, as is distinguishing it, to the extent possible, from other entit...
Splenic pseudocysts, also referred as secondary splenic cysts, are acquired cystic lesions not delineated by a true epithelial wall. They represent the majority of the splenic cystic lesions, corresponding to approximately 80% of them (c.f. splenic epithelial cysts). The main causes are:
Splenomegaly refers to enlargement of the spleen. The upper limit of normal adult splenic length is traditionally cited at 12 cm, but lengths upwards of 14 cm can be seen in normal, taller males 7.
Massive splenomegaly is variably defined, including when the spleen is 5 standard deviations abov...
Subluxed facet joint is the mildest form of facet dislocation in which the ligamentous injury leads to partial uncovering of facet joint (c.f. complete uncovering in perched facet). This results in mild anterior displacement of one vertebral body on another (anterolisthesis).
There are many types of talar dislocation given its multiple articulations:
total talar dislocation
Talar fractures are an uncommon injury, accounting for <5% of all foot fractures. Recognition of the unique talar anatomy is important for correct diagnosis.
talar head fractures
talar neck fractures
talar body fractures
talar dome osteochondral fracture
Tension pneumothoraces occur when intrapleural air accumulates progressively in such a way as to exert positive pressure on mediastinal and intrathoracic structures. It is a life-threatening occurrence requiring both rapid recognition and prompt treatment to avoid a cardiorespiratory arrest.
Trauma is a leading cause of mortality in pregnancy. Pregnancy increases the incidence and severity of abdominal trauma in females.
Trauma affects up to 7% of pregnancies, and the incidence of pregnancy in level 1 trauma patients is estimated to be ~2% 1.
Traumatic spinal cord injury can manifest as a wide variety of clinical syndromes resulting from damage to the spinal cord or its surrounding structures. It can result from minor injury if the spine is weakened from disease such as ankylosing spondylitis or if there is pre-existing spinal stenos...
Unilateral facet dislocation is a relatively stable type of facet dislocation.
Flexion/distraction associated with rotation. The inferior articular facet of vertebral above moves over the superior facet of the vertebral below and becomes locked. It usually affects C4-C5 or...