CT of fractures

Author: Mikael Häggström

File:CT of a pertrochanteric fracture.jpg

CT of a hip fracture

Planning

Indication in trauma

CT in trauma is generally the first choice with suspected sudden physical injury to the head, abdomen and/or pelvis. X-ray in trauma is generally the first choice for the upper and lower limbs, but CT or MRI of fractures are possible next steps in remaining fracture suspicion despite a normal X-ray. CT can also better map complicated fracture systems, mainly for pre-operative planning.

Further information: Trauma#Choice of modality

Settings

Thin slices. No need for contrast CT unless indicated by other suspected conditions.

Evaluation

Use a bone window and look for fracture lines through the bone cortex. Rarely, compression fractures are seen as a radiodense line:

• X-ray of subtle compressive hip fracture, labeled.jpg

  X-ray showing a suspected compressive subcapital hip fracture as a radiodense line

• CT of subtle compressive hip fracture.jpg

  CT scan shows the same, atypical for a fracture since the cortex is coherent

• T1 TSE MRI of hip fracture.jpg

  T1-weighted, turbo spin echo, MRI confirms a fracture, as the surrounding bone marrow has low signal from edema.

Also, use a soft tissue window to look for hematomas or other apparent injuries.

Misalignment

Types of fracture misalignment: Displacement Angulation Distraction (making bone longer) Impaction or shortening Rotation

Specific locations

• CT of ankylosing spine and fracture.png

  CT of neck fractures