Medical Imaging Studies I

(HTI 28102)

Tutorial 4
Upper Extremities
2024-25

Mr. Stephen Kwok

Ms. Gisele Cheung
Common Abbreviations

CA Child abuse
S/F Slip and Fell
Hx History
I/F, M/F, R/F,L/F Index, middle, ring, little finger
NAI Non accidental injury
LUL Left upper limb
OA osteoarthritis
OR, CR Open Reduction, Close Reduction
OT Operative Theatre
ORIF Open Reduction Internal Fixation
P/E Physical examination
POP Plaster of Paris
OPD Out-patient department
P&P Pin and Plate
RA Rheumatoid Arthritis
T/A Traffic Accident
Hands
 Bone age
• Carpal bones absent in newborn
• Ossification occurs throughout
childhood
• Epiphyses complete fusion at 18-
20 years of age
• Indicators of skeletal age in child
• Access the skeletal versus the
chronologic age of a child

LEFT side PA hand

Hand (DP-Dorsi-palmar)
Identification
Image Criteria: • Correct patient
Marker
• Present and distal/lateral to anatomy
Anatomy(ROI)
• Entire hand should be demonstrated (distal
phalanges to distal 1” of radius and ulna,
lateral borders of hand)
Collimation
• 4-sided collimation, & equal to anatomy
demonstrated
Relative Position
• No rotation is evidenced by the symmetric
appearance of the metacarpal shafts and
phalanges (2nd -5th )
• Thumb demonstrates 45 degrees PA oblique
position
Hand (DP-Dorsi-palmar)
Relative Position
Image Criteria: • IP, MCP and CM joints are demonstrated
as open spaces
• Phalanges are demonstrated without
foreshortening
• No soft tissue overlap from adjacent
fingers
Exposure
• Correct density and contrast that you can
visualise sharp borders, trabeculae
markings, and soft tissue outlines of
phalanges

Aesthetics
• Fingers up at the center of IR

Pathology
• Have I answered the clinical question?
• BOLTS
 Hand Identification
• Correct patient
(Oblique) Marker
• Present and distal/lateral to anatomy
Image Criteria: Anatomy(ROI)
• Entire hand should be demonstrated
(distal phalanges to distal 1” of radius and
ulna, lateral borders of hand
Collimation
• 4-sided collimation, & equal to anatomy
demonstrated
Relative Position
• 2nd – 5th MC midshaft demonstrated more
concavity on one side than the other
• Midshafts of metacarpals should not
overlap
• No overlap on 1st and 2nd MC heads, some
overlap of 3rd, 4th and 5th MC heads
 Hand
Relative Position (Cont.)
(Oblique) • IP and MCP joint are opened
Image Criteria: • Phalanges are demonstrated without
foreshortening
• Thumb is in PA oblique position

Exposure
• Correct density and contrast that you can
visualize sharp borders, trabeculae
markings, and soft tissue outlines of
phalanges

Aesthetics
• Fingers up at the center of IR

Pathology
• Have I answered the clinical question?
• BOLTS
 Hand (Lateral - Fan lateral)
Demonstrate:
➢ Fractures and dislocations of the phalanges, anterior/posterior
displaced fractures, and dislocations of the metacarpals

➢ Pathological processes such as osteoporosis and OA in phalanges

➢ Phalanges are the area of interest

“Fan” lateral projection

Thumb
Thumb (AP/PA)
Identification
Image Criteria: • Correct patient
Marker
• Present and distal/lateral to anatomy
Anatomy(ROI)
• Entire thumb should be demonstrated (distal
phalanges and proximal phalanges,
metacarpal, base of metacarpal and CMC
joint), even trapezium bone
Collimation
• 4-sided collimation, &equal to anatomy
demonstrated
Relative Position
• MCP joint is at the centre of the field
• IP, MCP and 1st CMC joints are demonstrated
as open
• Superimposed of the medial palm soft tissue
over the proximal 1st MC and CM joint is
minimal
Thumb (AP/PA)
Image Criteria: Relative Position
• No rotation is evidenced by
• Symmetric appearance of shafts of
phalanges
• Equal concavity on both sides of the
phalangeal shaft of metacarpal shaft
• Equal soft tissue width on each side of
phalanges
• Sharp outline of the bony cortical, no motion
Exposure
• Correct density and contrast that you can
visualize sharp borders, trabecular markings and
soft tissue outlines of phalanges
Aesthetics
• Thumb up at the centre of IR
Pathology
• Have I answered the clinical question?
• BOLTS
Thumb (Lateral)
Identification Image criteria:
• Correct patient

Marker
• Present and distal/lateral anatomy

Anatomy(ROI)
• Entire thumb demonstrated (distal
phalanges, proximal phalanges, whole
metacarpal and CMC joint)

Collimation
• 4-sided collimation & equal to anatomy
demonstrated
Thumb (Lateral)
Image criteria:
Relative Position
• IP and MCP joints are demonstrated as open spaces
• Thumb in true lateral with the concave appearance at
the anterior aspect of the proximal phalanx and
metacarpal bone
• Phalanges are not foreshortened
• 1st proximal MC is only slightly superimposed by the
2nd proximal MC
• Sharp outline of the bony cortical, no motion

Exposure
• Correct density and contrast that you can visualise
sharp borders, trabeculae markings and soft tissue
outlines of phalanges
Aesthetics
• Thumb up at the center of IR
Pathology
• Have I answered the clinical question?
• BOLTS
Q.1 Please indicate the projections of Radiograph A and B
and comment whether they can fulfill the image criteria.

A B
Fingers

Index, Middle, Ring and Little

Fingers (PA)
Image criteria:

Identification
• Correct patient

Marker
• Present and distal/lateral to anatomy

Anatomy(ROI)
• Entire finger should be demonstrated
(distal phalanx to distal metacarpal, lateral
borders of finger)

Collimation
• 4-sided collimation, & equal to anatomy
demonstrated
Fingers (PA)
Relative Position
Image criteria: • No rotation is evidenced by the symmetric
appearance of soft tissue and shafts of phalanges

• IP and MCP joints are demonstrated as open spaces

• Phalanges are seen without foreshortening

• No soft tissue overlap from adjacent digits

• Sharp outline of the bony cortical, no motion

Exposure
• Correct density and contrast that you can visualise
sharp borders, trabeculae markings and soft tissue
outlines of phalanges
Aesthetics
• Finger up, PIP at the center of IR
Pathology
• Have I answered the clinical question?
• BOLTS
 Identification
Fingers • Correct patient
Marker
(Lateral) • Present and distal/lateral to anatomy

Image criteria: Anatomy(ROI)

• Entire finger should be demonstrated (distal phalanx
to distal metacarpal, lateral borders of finger)

Collimation
• 4-sided collimation, & equal to anatomy demonstrated

Relative Position
• Finger in true lateral position (evidence by the anterior
surface of the middle and proximal phalanges midshaft
concavity and posterior surface slightly convexity
• IP joints are demonstrated as open spaces
• Phalanges are not foreshortened
• No soft tissue overlap to adjacent fingers
• Sharp outline of the bony cortical ==> no motion
 Fingers
(Lateral)
Image criteria:
Exposure
• Correct density and contrast that you can visualise
sharp borders, trabeculae markings and soft
tissue outlines of phalanges

Aesthetics
• Finger up, PIP joint at the center of IR

Pathology
• Have I answered the clinical question?
• BOLTS
✓ Keep the finger as close as ✗ finger is angled
possible to IR ✗ Limited visualization of the IP and
✓ Maintain the finger parallel to the MCP joint spaces
IR
Any comments on these 2 radiograph ?

I/F (Lat)
Any abnormality ?
L M/F
Wrist
 Wrist
8 carpals (2 rows of 4 bones)
trapezium trapezoid capitate hamate
scaphoid lunate triquetrum pisiform

Surface landmarks:
•Radial styloid
•Ulnar styloid
•Anatomical snuffbox
 Normal Radiographic Anatomy of Wrist

Arc III
Arc II
Arc I

• Normal Alignment of the proximal and distal carpal rows

• The articular surfaces of the carpals form 3 smooth arcs
• Disrupted arc may indicate a ligamentous injury or fracture at the site of
the broken arc
Source
Wrist (PA)
Image Criteria: Identification
• Correct patient
Marker
• Present and distal/lateral to anatomy
Anatomy(ROI)
R • Distal radius and ulna, carpals and proximal
metacarpals
• Lateral soft tissue margins
Collimation
• Proximal half of the metacarpals and distal
1/3 radius and ulna should be demonstrated
• 4-sided collimation, & equal to anatomy
and soft tissue are demonstrated
 Relative Position
• Ulnar and radial styloid is in profile
•
Wrist (PA) •
Radioulnar articulation is open
Superimposition of the MC bases is limited
Image Criteria: • Sharp outline of the bony cortical, no
motion

Exposure
• Correct density and contrast that you can
visualize sharp borders and trabecular
R markings
• Scaphoid fat stripe is demonstrated

Aesthetics
• Fingers up, Carpal bones are at the center
of IR

Pathology
• Have I answered the clinical question?
• BOLTS
Wrist (Lateral)
Image Criteria:
Identification
• Correct patient

Marker
R • Present and distal/lateral to anatomy

Anatomy(ROI)
• Distal radius and ulna, carpals and proximal (mid)
metacarpals
• Lateral soft tissue margins

Collimation
• Proximal half of the metacarpals and distal 1/3 radius
and ulna
• 4-sided collimation with equal to anatomy
demonstrated
Wrist (Lateral)
Image Criteria:
Relative Position
• Ulnar head superimposed over distal radius (TRUE
LATERAL)
• Proximal 2nd-5th metacarpals superimposed
• Sharp outline of the bony cortical, no motion blur
R
Exposure
• Correct density and contrast that you can visualize
sharp borders and trabecular markings
• Pronator fat stripe is demonstrated

Aesthetics
• Fingers up, carpal bones at the center of IR

Pathology
• Have I answered the clinical question?
• BOLTS
 Pronator Quadratus fat strip

Normal fat pad

➢ Pronator quadratus sign: displaced or bowed fat pad anterior to pronator quadratus muscle
➢ Indirect sign for subtle distal radial fracture/trauma
Source
Q.2 Assess the Radiograph C in terms of the patient positioning

• Distal end of radius and ulna are not

superimposed

Problem :
external/internal rotated ?

• Contrast and density are adequate to

demonstrate the pronator fat strip and soft
tissue of the posterior aspect of the wrist

C
Elbow
 Elbow (AP)
Image Criteria:
Identification
• Correct patient

Marker
• Present and distal/lateral to anatomy

Anatomy(ROI)
• Entire elbow joint should be demonstrated
• Distal 1/3 humerus to proximal 1/3 of
radius and ulna

Collimation
• 4-sided collimation equal to anatomy and
soft tissues are demonstrated
L
Image Criteria:
Relative Position
• Elbow joint space is opened
Elbow (AP)
• No rotation is evidenced by
• Medial and lateral epicondyles in profile
• Slightly superimposition of radial head
over ulna (about 0.25 inch/0.6cm)
• Radial tuberosity is in profile medially
• No motional blur with sharp cortical
outline demonstrated
Exposure
• Correct density and contrast that you can
visualise sharp borders, trabecular
markings

Aesthetics
• Humerus superior
• Elbow joint at the center of IP
L
Pathology
• Have I answered the clinical question?
Elbow (Lat-Lateromedial )
Image Criteria:

Identification
• Correct patient

Marker
• Present and distal/lateral to anatomy

Anatomy(ROI)
• Entire elbow joint should be
demonstrated (distal 1/3 humerus to
proximal 1/3 of radius and ulna)

Collimation R
• Collimation with equal to anatomy
demonstrated
Elbow (Lat-Lateromedial )
Image Criteria:
Relative Position
• Elbow joint opened and flexed at 90 degree

• 3 concentric arcs/rings are formed by the

trochlear sulcus, capitulum and trochlear

• Radial head superimposed by coronoid process R

Exposure
• Correct density and contrast to demonstrate
trabecular markings

• Soft tissue, anterior, posterior and supinator fat

pads are demonstrated

Aesthetics
• Humerus superior, elbow joint at the center of IR

Pathology
• Have I answered the clinical question?
• BOLTS
Suspected Fracture
1. Positive fat pad sign
• Anterior fat pad has the appearance of sail
sign
• Positive posterior fat pad
2. Fracture line seen
3. Additional view required
• Radial head view
• Oblique views
 Fat Pads
Located between the synovial and fibrous layers of the elbow joint capsule
On Lateral flexed elbow (with 90°) :
– 3 fat pads
• Anterior fat pads (anterior to distal humerus)
• Posterior fat pads (normally being obscured, only seen upon injury)
• Supinator fat strip (parallel to anterior aspect of the proximal radius)
– Sail sign: Elevated fat pad

Video
Q.3 Please have comments on Radiograph D & E in terms of
the patient positioning and photographic quality

D E
AP elbow
Limited overlapping of the radial head
==> Lateral rotation/external rotation of the elbow
==> NOT in true AP

Repeat :
Elbow rotate internally to place the inter-
epicondylar plane (imaginary plane between medial
and lateral epicondyles of the humerus) parallel to
IR
D
 AP elbow
Too much overlapping of the radial head and
tuberosity
==> Medial rotation/internal rotation of the elbow
==> NOT in true AP

Repeat :
Elbow rotate externally to place the inter-
epicondylar plane (imaginary plane between medial
E and lateral epicondyles of the humerus) parallel to
IR
Any problems in this radiograph?
Humeral epicondyles are not superimposed
• elbow with the elevated humerus

Without anatomical marker

VS
 Poppy sign

Internally rotated
Externally rotated

source
Forearm
Forearm AP
Image Criteria:
Identification
• Correct patient
Marker
• Present and distal/lateral to anatomy
Anatomy (ROI)
• All carpal bones (wrist joint) and distal humerus
(elbow joint) should be seen
Collimation
• 4-sided collimation, & equal to anatomy
demonstrated
• Wrist, elbow and forearm soft tissue are included

Relative Position
• Radius and ulna are parallel (not cross with each
other)
• Olecranon process is demonstrated within the
olecranon fossa
Forearm (AP)
Image Criteria:
Relative Position
• No rotation
➢ humeral condyles and radial styloid in profile
➢ radial head, neck and tuberosity slightly
superimposed to ulna
➢ radial head over ulna (about 0.25 inch/0.6cm -
slightly superimposition)
• Radial tuberosity is in profile medially
• Wrist and elbow joint spaces are partially open
• Sharp outline of the bony cortical, no motion
• Wrist and elbow joints and soft tissue are demonstrated
• No motional blur
Exposure
• Brightness is uniform across entire forearm
• Correct density and contrast that you can visualise sharp
borders, trabecular markings
Aesthetics
• Fingers up, mid-forearm at the center of IR
Pathology
• Have I answered the clinical question?
• BOLTS
Forearm (Lateral)
Image Criteria:
Identification
• Correct patient

Marker
• Present and distal/lateral to anatomy

Anatomy(ROI)
• Distal humerus, entire radius and ulna and
carpometacarpal area
• Lateral soft tissue margins

Collimation
• Collimation, & equal to anatomy demonstrated
• Wrist, elbow and forearm soft tissue are included
Forearm (Lateral)
Image Criteria:
Relative Position
• Elbow should be flexed at 90 degree
• Radial head slightly superimposed to coronoid process
with radial tuberosity demonstrated anteriorly
• No rotation (true lateral) evidenced by
➢ Anterior aspects of the radial head and coronoid
process are aligned
➢ Both humeral epicondyles superimposed
• Distal radius and ulna are superimposed
Exposure
• Correct density and contrast that you can visualise
sharp borders, trabecular markings
• Fat stripes can be demonstrated
Aesthetics
• Fingers up, mid-forearm at the center of IR

Pathology
• Have I answered the clinical question?
• BOLTS
Q.4 What are the projections of Radiograph F and G?
Please have the comments on them in terms of the patient
positioning.

F G
 AP forearm F
o ? humeral condyles and radial styloid in profile
o ? radial head, neck and tuberosity slightly
superimposed to ulna
o ? radial head over ulna (about 0.25 inch/0.6cm
- slightly superimposition)
 Elbow joint is not in TRUE AP
 Posterior oblique view of wrist (pisiform bone)

o ? Radial styloid and ulna styloid are in profile

o Carpal bones appearance
=> Wrist joint is not in TRUE AP

Overall internal rotation of the forearm

Lateral forearm
o ? Elbow at 90 degree
o ? Radial head should superimpose slightly to G
coronoid process with radial tuberosity
demonstrated anteriorly
o No rotation evidenced by
➢ ? Anterior aspects of the radial head and
coronoid process are aligned
➢ ? Both humeral epicondyles
superimposed
➢ ? Distal radius and ulna are
superimposed

=> Elbow joint is not

 in TRUE Lateral
 in 90 degree
 Wrist joint is not in TRUE Lateral
Without Anatomical marker
Radiographic Contrast and density:
– adequate to demonstrate the wrist and elbow fat stripe (pad)
Humerus
Anatomy
Humerus (AP)
Image Criteria:
Identification
• Correct patient

Marker
• Present and distal/lateral to anatomy

Anatomy(ROI)
• Entire humerus (Glenohumeral i.e. shoulder
joint to elbow joint)
• Humeral soft tissue to be demonstrated

Collimation
• Collimation equal to anatomy and soft
tissues are demonstrated
Humerus (AP)
Image Criteria:
Relative Position
• Medial and lateral epicondyles are visualized in
profile
• Greater tubercle is seen in profile laterally
• Humeral head is seen partially in profile medially
with minimal superimposition of glenoid cavity
• No motion with sharp cortical margins and clear
bony trabecular markings

Exposure
• Uniform brightness across whole humerus
• Correct density and contrast that you can visualise
sharp borders, trabecular markings

Aesthetics
• Humeral head superior

Pathology
• Have I answered the clinical question?
Humerus – Medio-lateral (Lat)
Image Criteria:
Identification
• Correct patient
Marker
• Present and distal/lateral to anatomy
Anatomy(ROI)
• Entire humerus (Glenohumeral i.e.
shoulder joint to elbow joint)
• Humeral soft tissue to be demonstrated
Collimation
• Collimation equal to anatomy and soft
tissues are demonstrated
Humerus – Medio-lateral (Lat)
Image Criteria:
Relative Position
• Lesser tubercle is demonstrated in profile
medially
• Greater tuberosity of humerus superimposed
over the humeral head
• Lateral and medial epicondyles are seen
superimposed
• Humerus is not superimposed to the scapular
Exposure
• Uniform brightness across humerus
• Correct density and contrast that you can
visualise sharp borders, trabecular markings
Aesthetics
• Humeral head superior
Pathology
• Have I answered the clinical question?
• BOLTS
 Patient on stretcher

Latero-medial humerus
Not frequently used

Soft pad used:

Maintain the humers horizontal parallel to IR
Shoulder
Image Criteria:
Shoulder (AP)
Identification
• Correct patient

Marker
• Present and distal/lateral to anatomy

Anatomy(ROI)
• Entire shoulder girdle should be
demonstrated (scapula, clavicle and
proximal humerus in glenohumeral
joint)

Collimation
• Inferiorly - inferior angle of
scapula/proximal third of the humerus
• Medially – medial end of clavicle
• Laterally - include lateral skin margin
of the humerus
Image Criteria:
Relative Position
Shoulder (AP)
• Greater tuberosity is seen in profile on
lateral border of humerus
• Lesser tuberosity located between the
greater tuberosity and the humeral head
• Whole clavicle is demonstrated with
minimal longitudinal foreshorten, shown
next to the vertebral column
• Glenoid cavity is partially demonstrated
with superimposing with humeral head
• Scapular body is demonstrated without
shortening
Exposure
• Correct density and contrast which allow
sharp borders, trabecular markings to be
visualised
Aesthetics
• Scapular in centre of IR
Pathology
• Have I answered the clinical question?
Book
Different rotations of arm allow different
evaluation of the humeral head structures

Internal rotation : Lesser tuberosity in profile medially

External rotation : Greater tuberosity in profile laterally
Any comments on this radiograph ?

- Humerus is positioned supinated position

– Reason?
- Humeral joint opened
– Indicated ?
- Over-rotation of the body trunk
– Reason?
Any pathology/abnormality? L

Fracture of scapula

• Uncommon
• Usually result of direct impact
(Motor vehicle accidents)
• Location of the scapula:
– Scapular body (most common)
– Scapular neck
– Glenoid
– Acromion
– Coracoid
Shoulder – lateral
(Y-view)
Imaging Criteria:
Shoulder – lateral
(Y-view)
Identification
• Correct patient
Marker
• Present and distal/lateral to
anatomy
Anatomy(ROI)
• Proximal humerus, entire scapula
and scapulohumeral joint
Collimation
• Acromion and coracoid process
• Inferior angle of the scapula
Imaging Criteria: Shoulder – lateral
Relative Position (Y-view)
• Body of scapula should be seen in profile in
lateral projection without rib superimposition
• Scapular without longitudinal foreshortening
• Portion of the clavicle is seen at the same level
with superior scapular angle (same transverse
level)
• Acromion and coracoid process should appear
nearly symmetric upper limbs of the ‘Y’
• Humeral head should appear over the base of
the ‘Y’ (if not dislocated)
Exposure
• Correct density and contrast that you can
visualise sharp borders, trabecular markings
Aesthetics
• Shoulder in centre of IR
Pathology
• Have I answered the clinical question?
Q.5 What is the projection of Radiograph H?
Please have the comments in terms of positioning of the patient?

Y view shoulder
o Scapular is not demonstrated in profile
o Clavicle and the superior scapular angle are
not in the same transvers level
o Super-imposition to the humerus shaft
➔ problem in
o degree of obliquity
o level of centering
o rule out
▪ fracture of scapula
▪ dislocation of humerus

➔ Abduction of the arm to avoid the

overlapping of scapular by the humerus
H
Q.6 On Radiograph I, please identify the medial, lateral border
and superior scapular angle, please have comments in terms of
the patient positioning.
Shoulder – lateral
(Y-view)
• Scapular is not in the profile
• Insufficient body obliquity
• Clavicle and the superior scapular angle
are not in the same transvers level

I
Any abnormality?
Humeral head Humeral head
AP: lie medial and inferior to the Lat: lie anterior and inferior to both
glenoid fossa coracoid process and the glenoid fossa
 Shoulder (Axial view)
Lateral view of proximal humerus in relationships to
scapulohumeral cavity
Imaging Criteria:
Identification
• Correct patient
Marker
• Present and distal/lateral to anatomy
Anatomy (ROI)
• Glenoid cavity, coracoid process, scapular
spine, acromion process and 1/3 of
humerus
Collimation
• Proximal 1/3 of humerus
• Coracoid process
• Both anterior and posterior skin margin
 Shoulder (Axial view)
Imaging Criteria:
Relative Position
• Acromioclavicular (AC) joint superimposed with head
of the humerus
• Lesser tuberosity in profile and directed anteriorly
• Coracoid process in profile and projecting above the
clavicle
• Coracoid process and lesser tubercle of humerus seen
in profile
• Scapulohumeral (shoulder) joint is opened
• The spine of the scapula is seen on the edge below the
scapulohumeral joint L
Exposure
• Correct density and contrast for demonstrating joint
space between the humeral head and glenoid
Aesthetics
• Shoulder in the center of IR
Pathology
• Have I answered the clinical question?
• Any anterior and posterior glenohumeral dislocations
Reference : Core radiology : a visual approach to diagnostic imaging / Jacob Mandell. Cambridge University Press, 2013.
Common types of
FOOSH injuries
Fall on outstretched hand (FOOSH)
• Scaphoid fracture
• Distal radial fracture (Colles’ fracture /
Smith fracture)
• Radial / Ulnar styloid fracture
• Radial head fracture
• Scapholunate ligament tear / dislocation
– bilateral PA Clenched fist projection
• Distal radioulnar joint fracture
• Hook of hamate fracture
 Colle’s fracture
❑ Distal radius (Within one and a half inches of
radius) fracture with dorsal angulation

❑ Due fall on an outstretched hand (FOOSH) with

wrist dorsiflexed

❑ “dinner fork” deformity of the wrist

 Smith’s fracture
➢ Reversed Colle’s fracture

➢ Demonstrated of the volar angulation of the distal fragment

Galeazzi fracture-dislocation

- Fracture of the distal third of the radius with ulnar

dislocation at the distal radioulnar joint
 Treatment
Splint /Cast:
maintain the displacement
Fiberglass Cast

Plaster of Paris (POP) - outdated

 Treatment
1. Close Reduction (CR): refers to nonsurgical
manipulation or traction of the fracture fragment /
displaced fracture fragment under Local
Anesthetic (LA) /General Anesthetic (GA)

2. Open Reduction (OR): involves internal

manipulation of the fragments with open wound

3. Surgical treatment:
• Kirschner (K-wires) wires, plates, intramedullary
rods (IM nail), bone screws for internal fixation at
the fracture site
• CRPP + external fixation w/wo bone grafting
• ORIF (Open reduction internal fixation) :
✓ Open Reduction with percutaneous pinning
✓ Open Reduction with plate fixation
✓ Open Reduction with external fixation
 Fracture in children
Torus fracture
Greenstick fracture
Torus (Buckle)
• Common injuries in children L
(6-10) results from fall on an
outstretched hand
• Incomplete fractures of the
shaft of long bone/ distal
radius
• Usually seen with young
children as their bone is
softer
• Characterized by buckling of
the cortex
 Greenstick Fracture L
• Usually seen in young child

• A incomplete fracture occurring in long bone of a child

• Convex side of a bowing bone

L
Quiz
END