Background
As a junior radiology resident rotating through the emergency department, the trainee will encounter many questionable fractures or fractures that are never seen. Additionally, our newfound responsibility is the protection of patients from unnecessary radiation. As a result, we will often question the necessity of additional imaging for pathologies that we are unable to identify on initial radiographs.
Educational Goals / Teaching Points
Identify the most common emergency department fractures that often require additional imaging. Determine which patients will benefit from a positive follow-up study. Identify the additional supporting findings often seen with occult fractures. Identify the common characteristics of occult fractures on CT and MRI.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Recognize the most common occult fractures encountered in the emergency department, distal radius fractures, femoral neck fractures, radial head fractures, scaphoid fracture, and supracondylar fracture. Identify supporting characteristics: abnormal fat pad, lucent lines, sclerotic lines, discontinuous joint articulations.
Conclusion
The junior radiology resident will often read many x-rays in the emergency department that are incongruent with clinical findings. The next step often involves additional imaging that resident radiologists should protocol with a relatively low threshold.
