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PEM Ortho X-ray Curriculum



ABCs method - A systematic approach to the interpretation of pediatric c-spine x-rays.
Acromioclavicular joint separation
- Shoulder injury characterized by soft tissue swelling over the AC joint and a widening and a separation of the joint.
Acromioclavicular joint separation type I - Partial tear of the acromioclavicular ligament with no displacement.
Acromioclavicular joint separation type II - Disruption of the acromioclavicular ligament and widening of the acromioclavicular joint.
Acromioclavicular joint separation type III - Disruption of the acromioclavicular and coracoclavicular ligaments and widening of the acromioclavicular and coracoclavicular joints.
Anterior fat pad - In the elbow, usually visualized as a thin radiolucent line on lateral view. Seen just anterior to the coranoid fossa (anterior border of the distal humerus).
Anterior humeral line - In the elbow, it is a along the anterior surface of the distal humerus on lateral view. It intersects the middle to anterior third of the capitellum.
Anterior-posterior flexion injuries - Injury of the cervical spine characterized by anterior vertebral body compression and a teardrop fracture of the lower anterior corner.
Atlantoaxial subluxation - The result of movement between C1 and C2 secondary to a transverse ligament rupture or a fractured dens.
Avulsion fractures - Fracture in which a tendon or ligament pulls of a chip of a bone.
Avulsion injuries - A type of pelvic fracture found often in adolescents resulting from sporting activities following a sudden contraction of an attached muscle.


Bowing fracture
- A fracture where there is a bending deformity without a grossly visible fracture. It is unique to pediatrics.
Bucle/torus fracture - A fracture in which one side of the bone buckles upon itself without disrupting the other side or causing angulation. It is unique to pediatrics.


Cervical distraction injuries -
These may result from rapid accelerations- or deceleration- type accidents.
CRITOE - Sequence in which the elbow ossification centers usually appear (Capitellum, Radial head, Internal epicondyle, Trochlea, Olecranon, and External epicondyle).


Distal femur fractures - These are uncommon and are classifies as supracondylar, condylar, intercondylar and physeal. They are usually due to fairly severe trauma. Elbow dislocation - Relatively rare in children and is typically associated with fractures of the medial epicondyle, coronoid process, radial head and the olecranon.


Extension injuries - Injury of the cervical spine characterized by an upper anterior teardrop fracture, widening of the disc space, posterior element fractures, and anterior displacement of the vertebral body.


Femoral shaft fractures - In young children (under 4 years) this type of fracture is not uncommonly seen in child abuse. In older children it is often due to high impact injuries.
Fractures of the hip - Rare in children and are generally caused by high energy trauma such as a direct blow, axial force, torsion or hyperabduction. Often associated with hip pain, a shortened, externally rotated hip and an inability to weight bear.


Galeazzi fracture - a radial shaft fracture, generally at the junction of the middle and distal thirds accompanied by a disruption of the distal radioulnar joint.
Greenstick fracture - A fracture in which one side of the fracture has broken and the other is angulated. It is unique to pediatrics.


Hairline/fissure fracture - Characterized by a minimal extension into the outer bony layer
Hangman’s fracture - A traumatic spondylolisthesis of C2 that occurs as a result of hyperextension, which fractures the posterior element of C2.
Humeral shaft fractures - Midshaft fractures of the humerus and are most commonly spiral or oblique.  


Jefferson fracture - Burst fracture of the ring of C1 as a result of an axial load.


Klein’s line - Line drawn tangentially to the lateral margin of the femoral neck. It should intersect a portion of epiphysis in the normal hip.


Lateral flexion Injuries - Injury of the cervical spine characterized by an ipsilateral compression fracture and a contralateral avulsion fracture.
Legg-Clave-Perthe’s disease (LCP) - An osteochondrosis affecting the proximal femoral epiphysis. It may be present with a painless limp, or knee pain which often gets worse with increased activity and better with rest. It is typical of children age 4-8years.


Monteggia fractures - a combination of an ulnar fracture and a radial head dislocation.


Oblique fracture - A fracture which is biocortical and angled in comparison to bony axis.
Osteochondrosis - (osteochondritis) A defective bony formation in the epiphysis, e.g. Osgood-Schlatter.


Patellar dislocation - The patella is rarely fractured in childhood and dislocations often occur laterally. It is often associated with a swollen knee which is kept in a flexed position revealing a prominent medial femoral condyle.
Patellar fractures - Often occur in adolescents and are present as avulsion fractures from dislocations, osteochondritis dessicans due to overuse, symptomatic bipartite conditions, avulsion or “sleeve” fractures and transverse displacement fractures.
Posterior fat pad - in the elbow, it lies over the olecranon fossa, which is deeper and more concave than the coranoid fossa.
Prevertebral soft tissue thickening - Prevertebral soft tissue swelling or thickening resulting from edema or hematoma formation.
Proximal humeral fractures - Characterized by a widening of the epiphyseal line.   
Proximal tibial metaphyseal fracture - It is usually undisplaced of minimally displaced and can result in valgus deformity due to to tibial overgrowth (specially if it occurs before the age of six).
Pseudosubluxation - Anterior displacement of the vertebral bodies in the upper cervical spine of infants and young children. Displacement may involve all four upper vertebral bodies, but usually occurs at the C2-C3 level.


Radial head contour - In the elbow, the slope from the diaphysis to the metaphysis towards the radial head should be gradual and smooth without any sharp angles.
Radial neck fracture - tends to occur in older children and is often associated with localized swelling, ecchymosis, and tenderness over the proximal radius.  
Radiocapitellar line - in the elbow, it is drawn along the central axis of the proximal radius on lateral view.


Salter-Harris (SH) - Fracture defined by whether the epiphysis (end of bone), metaphysis (shaft of bone) and/or physis (growth plate) is involved. It is unique to pediatrics.
Salter-Harris fractures type I - These are a type of ankle fracture that are commonly due to an inversion injury in preadolescents and are often present with tenderness and soft tissue swelling over the growth plate.
Salter-Harris fractures type II - These are a type of ankle fracture in which the triangular fragment of the metaphysic separates from the epiphysis.
Salter-Harris fractures type III - These are a type of ankle fracture often referred to as Tillaux Fracture and are a transitional fracture in children between the ages of 12 and 14.
Salter-Harris fractures type IV - These are a type of ankle fracture often referred to as Triplanar Fracture and are generally unstable which means that they often require open reduction for accurate realignment.
Salter-Harris fractures type V - These are a type of ankle fracture which are uncommon and are due to direct axial compression.
Septic arthritis - Characterized by soft tissue swelling, osteopenia, and joint space widening followed by joint space loss due to effusion and subsequent cartilage destruction. Erosion into adjacent bony structures.
Slipped femoral capital epiphysis (SCFE) - Occurs typically in adolescent males, age 10 through 15 often during their growth spurt.
Spiral fracture - Fracture in which the pieces are rotated or twisted in relation to one another.
Supracondyle fracture - Makes up 60% of all elbow fractures and if the most common cause of traumatic elbow effusion.


Tibial shaft fractures - These are usually accompanied by fibular fractures
Tibial spine fractures - Avulsion of the tibial spine is associated with anterior cruciate ligament injury, or may result from hyperflexion of the knee (e.g. A fall off a bicycle). Present with marked pain, refusal to weight bear and hemarthrosis.
Tibial tubercle avulsion fracture - It often occurs in adolescent males 13 to 16 years of age as a sports related injury.
Toddlers fractures - These are isolated tibial spiral or oblique fractures in a child of 9 to 36months. They may occur with minor trauma.
Transverse fracture
- A fracture which is biocortical and perpendicular to bony axis.


Vertebral compression injuries
- Injury of the cervical spine suggested by isolated anterior wedging, teardrop fractures or burst vertebral bodies.