Orthopedics

Irreducible Traumatic Posterior Shoulder Dislocation

Blake Collier, DO^* and Christopher Trigger, MD^*

DOI: https://doi.org/10.21980/J8V884Issue 2:1 No ratings yet.

Radiographs demonstrated posterior displacement of the humeral head on the “Y” view (see white arrow) and widening of the glenohumeral joint space on anterior-posterior view (see red arrow). The findings were consistent with posterior dislocation and a Hill-Sachs type deformity. Sedation was performed and reduction was attempted using external rotation, traction counter-traction. An immediate “pop” was felt during the procedure. Post-procedure radiographs revealed a persistent posterior subluxation with interlocking at posterior glenoid. CT revealed posterior dislocation with acute depressed impaction deformity medial to the biceps groove with the humeral head perched on the posterior glenoid, interlocked at reverse Hill-Sachs deformity (see blue arrow).

Orthopedics Visual EM

Pseudogout and Calcium Pyrophosphate Disease

Andrew Williamson, MD*

DOI: https://doi.org/10.21980/J8QG66Issue 2:1 No ratings yet.

Radiographs of the knee showed multiple radio-dense lines paralleling the articular surface (see red arrows) consistent with calcium pyrophosphate crystal deposition within the joint often seen in calcium pyrophosphate disease (CPPD) also known as pseudogout.

Orthopedics Visual EM

Lunate Dislocation

Jonathan Peña, MD^*

DOI: https://doi.org/10.21980/J86K56Issue 2:1 No ratings yet.

Plain film of the right wrist showed the classic “spilled teacup” consistent with a lunate dislocation. There is a loss of the normal articulation between the distal radius and lunate.

Orthopedics Trauma Visual EM

Pediatric Supracondylar Fracture

Jonathan Peña, MD^* and John R. Marshall, MD^*

DOI: https://doi.org/10.21980/J8T88TIssue 2:1 No ratings yet.

Plain film radiography showed a displaced supracondylar fracture with disrupted anterior and posterior periostea, consistent with a type 3 supracondylar fracture.

Orthopedics Visual EM

Calcaneal Fractures and Böhler’s Angle

Lindsey Spiegelman, MD^* and Mohammed Helmy, MD^{^}

Issue 2:1 No ratings yet.

The right ankle lateral radiograph shows a comminuted, non-displaced fracture of the posterior calcaneus (red arrow) in addition to fracture fragments along the heel pad margin (blue arrow). The left ankle lateral radiograph shows a displaced, comminuted fracture of the mid to posterior calcaneus with extension into the subtalar joint posteriorly (purple arrow). There is subcutaneous air seen anteriorly to the tibiotalar joint space (green arrow) in addition to a joint effusion. Of note, the Böhler’s angle in the left x-ray is 16 degrees which is consistent with a fracture (see red annotation showing Böhler’s angle).

Orthopedics Visual EM

Monteggia Fracture in an Assault Patient

John Jiao, MHS^* and Shannon Toohey, MD, MAEd^*

DOI: https://doi.org/10.21980/J81S3ZIssue 2:1 No ratings yet.

On the axial elbow x-ray, the radial head (red arrow) is dislocated anteriorly from the humerus; the humeroulnar articulation is intact. On the AP forearm x-ray, there is a closed, displaced, comminuted fracture of the ulna (blue arrow).

Orthopedics Visual EM

Hill-Sachs Deformity

Jessa Baker^* and Shannon Toohey, MD^*

DOI: https://doi.org/10.21980/J8Z59DIssue 1:2 No ratings yet.

In the post-reduction film, there is a lateral depression in the humeral head (arrow, a Hill-Sachs deformity). A Hill-Sachs deformity is a cortical depression (fracture) in the humeral head that forms as the humeral head hits the glenoid rim during the dislocation.

Orthopedics Visual EM

Trimalleolar Fracture

Christopher Gilani^* and Shannon Toohey, MD, MA^*

DOI: https://doi.org/10.21980/J8PP46 Issue 1:2 No ratings yet.

Anteroposterior (AP), lateral, and oblique x-ray views were obtained. The AP view revealed a displaced spiral fracture of the lateral malleolus (red) and a vertical fracture of the medial malleolus (blue). The lateral view revealed a displaced fracture of the posterior malleolus, tibial plafond (yellow), and the oblique view showed widening of the distal tibiofibular syndesmosis (green). CT scans confirmed trimalleolar fracture, annotated with the same colored lines (red, lateral malleolus; blue, medial malleolus; yellow, posterior malleolus).

Orthopedics Visual EM

Perilunate Dislocation

John Jiao, MHS^* and Shannon Toohey, MD, MA^*

DOI: https://doi.org/10.21980/J8F59RIssue 1:2 No ratings yet.

In the left lateral wrist x-ray, the lunate is dislocated from the rest of the wrist bones but still articulates with the radius. The capitate does not sit within the distal articulation of the lunate and is displaced dorsally. Additionally, a line drawn through the radius and lunate fails to intersect with the capitate. This is consistent with a perilunate dislocation. This is compared to a lunate dislocation, where the lunate itself is displaced and turned ventrally (spilled teacup) and the proximal aspect does not articulate with the radius.

Orthopedics Visual EM

Femoral Neck Fracture

Jonathan Lee^* and Shannon Toohey, MD, MA^*

DOI: https://doi.org/10.21980/J89G6GIssue 1:2 No ratings yet.

In the anteroposterior view bilateral hip x-ray, there is an evident loss of Shenton’s line on the left when compared to the normal right, indicative of a fracture in the left femoral neck. This correlates with findings seen on pelvic CT, which reveals both a subcapital fracture and transcervical fracture. The neck of the femur is displaced superiorly relative to the head of the femur while the head of the femur remains in its anatomical position within the acetabulum.

Orthopedics Visual EM