Trauma of the appendicular skeleton

Abstract

Trauma to the appendicular skeleton is exceedingly common. An understanding of normal radiographic anatomy is therefore essential in interpreting images of the appendicular skeleton. Certain anatomic sites are associated with particular injuries, and knowledge of the injuries that are common at those sites is important. Problems in the diagnosis of trauma of the appendicular skeleton arise due to incomplete or inadequate examinations. In multitrauma patients, shortcuts are often taken to decrease the examination time. The examinations are frequently incomplete and the images obtained may be marginal or subopitimal. Consequently, attempts to interpret such images may lead to diagnostic errors. Incorrect diagnosis also may result from a failure to appreciate abnormalities or the significance of abnormalities on imaging studies. In addition, many errors are secondary to an inadequate or incomplete history; it has been shown that, when the history is specific, the miss rate in cases of subtle injury can be reduced by approximately 50% [1]. In addition to detecting acute injuries, in many cases radiologists are called upon to do follow-up imaging in patients with persistent pain following trauma. In these cases, the fracture may have been initially occult, or subtle findings may have been overlooked. Chronic repetitive trauma is another cause of skeletal injury in which radiographic abnormalities may not be detectable on the initial images and for which follow-up studies are frequently necessary. The ACR has developed appropriateness criteria to help address this issue [2]. © 2005 Springer-Verlag Italia.