Monteggia fracture dislocation

Typically, Monteggia fracture-dislocations occur as the result of a fall onto an outstretched hand (FOOSH).

The Bado classification is used to subdivide the fracture-dislocation into four types which all have different treatment options and prognoses and is based on the principle that the direction in which the apex of the ulnar fracture points is the same direction as the radial head dislocation 3. The direction of radial head dislocation depends on whether abduction or adduction forces were applied during the fall.

As is usually the case, in everyday practice, describing the fracture-dislocation is far more important than remembering the grade.

 

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ACL Tibial Eminence Avulsion

17 year old.  It’s definitely more common to have a frank ACL rupture rather than on avulsion of the tibial eminence in this age group but not all patients “read the textbooks”. Good example of lipohemarthrosis which you can seen on both the coronal T1-weighted images and on the axial T2 fat saturated images.

 

This is devilishly  hard to see on the XR and given away mainly by the large lipohemarthrosis..

 

Extension Teardrop Fracture

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Extension tear drop fracture typically occurs due to forced extension of the neck with resulting avulsion of the anteroinferior corner of the vertebral body. Extension teardrop fractures are stable in flexion, and unstable in extension as the anterior longitudinal ligament is disrupted. Extension teardrop is not considered as severe as flexion teardrop fractures.

Jumped and Locked Cervical Facets

Although this is an uncommon finding, the diagnosis is typically not difficult. Fractures are commonly associated because of the amount of derangement of the cervical spine and ligamentous injury is necessarily present for this degree of displacement.

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The sagittal CT images are degraded because of the patient body habitus however the pathology is visible. No vascular injury was present associated with the substantial derangement.LockedFacets.gif