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PEM Ortho X-ray Curriculum

Common Presentations

Tibial Spine Fractures (see FIGURE 2 and 3)

  • Avulsion of the tibial spine is associated with anterior cruciate ligament injury, or may result from hyperflexion of the knee (e.g. fall off of a bicycle)
  • Present with marked pain, refusal to weight bear & hemarthrosis
  • Also consider patellar dislocation and osteochondral fracture with hemarthrosis
  • Tunnel view
x-ray showing a tibial spine fracture
FIGURE 2: Tibial spine fracture

labeled x-ray

Image showing the three classifications of tibial spine fractures
FIGURE 3:Classification of tibial spine fractures
  • Type I - Non displaced
  • Type II - Elevation with posterior hinge
  • Type III - Displaced and even rotated (II & III required orthopedic consultation)

Distal Femur Fractures

  • FIGURE 4: Non-displaced intercondylar fracture of distal femur extending vertically only appreciated on AP view 
  • Fractures of the distal femur are uncommon
  • Classified as supracondylar, condylar, intercondylar and physeal
  • Most fractures are large and easily seen on AP and lateral radiographs; its usually due to fairly severe trauma
  • This intercondylar fracture is small
x-ray showing an intercondylar fracture
FIGURE 4: Intercondylar fracture

labeled x-ray

Patellar Dislocation

  • Consider sunrise view if there is concern about the patella
x-ray showing patellar dislocation
FIGURE 5: Patellar dislocation
  • FIGURE 5: sunrise view shows a laterally displaced patella (arrow shows its expected location)
  • The patella is rarely fractured in childhood
  • Acute patellar dislocations almost always occur laterally
  • A clinically, swollen knee is kept in flexed position revealing prominent medial femoral condyle
  • chronic recurrent subluxation or dislocation tends to occur in patients with inherent mechanical patellofemoral instability such as genu valgum (knock-knees)
  • post reduction films should be obtained to confirm the position of the patella and to exclude the presence of other fractures

Patellar Fractures

  • Commonly occurs in adolescents
  • It presents as avulsion fractures from dislocations, osteochondritis dessicans due to overuse, symptomatic bipartite conditions, avulsion or "sleeve" fractures and transverse displaced fractures
x-ray showing a patellar fracture
FIGURE 6: Patellar fracture