ARRS 2022 Abstracts

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E1159. Tip of the Iceberg: A Trainee’s Guide to the Tiny Fractures That Make a Big Difference
Authors
  1. John Choi; MedStar Georgetown University Hospital
  2. Ian Amber; MedStar Georgetown University Hospital
Background
Radiographs are typically the initial images obtained for musculoskeletal injuries. The diagnosis of fractures on radiographs spans a spectrum of difficulty, ranging from an easily identifiable massively comminuted fracture to an incredibly subtle non-displaced fracture. Within this range is a subset of fractures that often appear smaller or more subtle radiographically but whose presence portends a high likelihood of additional radiographically occult fractures and underlying soft tissue injury. Recognizing these fractures along with their commonly associated more extensive pathology is important to ensure that the radiologist recommends the appropriate advanced imaging and follow-up assessment for these patients.

Educational Goals / Teaching Points
The primary goals of this exhibit are to improve the reader’s awareness of subtle fractures with a high association of underlying deeper/occult injury and to highlight radiographic blind spots and indicate situations where the radiologist should recommend cross-sectional imaging and follow up. The secondary goal is to highlight key pre-operative findings relevant to these injuries to improve the utility of radiology reports pertaining to these injuries.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The exhibit will showcase the radiographic and follow-up CT/MRI appearance of the following injuries along with pertinent pre-operative criteria for the following injuries: carpometacarpal fracture/dislocation, Lisfranc fracture/dislocation, Segond fracture, and the “terrible triad” of the elbow.

Conclusion
Musculoskeletal injuries are commonly seen in daily practice, and radiography is a common, low-cost screening tool to diagnose many injuries. It is important for radiologists of all levels and specialties to recognize the subset of small fractures on radiographs that may portend a more severe injury to improve both their identification and follow-up recommendations.