E2569. Scratching the Surface: Avulsion Fractures With Important Clinical Implications
  1. Valerie Vargas Figueroa; University of Puerto Rico
  2. Gerardo Torres Flores; University of Puerto Rico
  3. Christian Irizarry Cruz; Ponce Health Sciences University
  4. Larry Alejandro Vargas; University of Puerto Rico
  5. Gabriel Camareno Soto; Universidad Central del Caribe
  6. Elizabeth Trullenque; University of Puerto Rico
Avulsion fractures are forced detachments of a bone fragment due to tension from its tendo-ligamentous attachment. They may appear small and insignificant, but they are often associated with injuries to adjacent soft tissues, which are often more serious than the fractures themselves. Proper identification of avulsion fractures is imperative to direct appropriate further imaging, management, and to avoid potentially serious complications. The purpose of this exhibit is to review important avulsion fractures throughout the body using multiple imaging modalities and to appropriately identify other more serious injuries involving ligamentous and tendinous structures.

Educational Goals / Teaching Points
The purpose of this educational exhibit is to review the anatomy, mechanism of injury, and clinical implications of different types of avulsion fractures, as well as recognize and describe their radiographic imaging findings. We will also discuss the best imaging modalities for accurate diagnosis to direct management of each avulsion fracture. Finally, we will provide case examples of avulsion fractures in conventional radiography, computed tomography (CT), and magnetic resonance imaging (MRI).

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
First-line imaging for patients with suspected fractures is radiography. However, soft tissue injuries are not easily identified with this imaging modality, for which further evaluation with CT and MRI in patients with suspected soft tissue injury is crucial for a better clinical outcome. This educational exhibit will show different avulsion fractures including their mechanism of injury, pertinent anatomy, and possible associated clinical implications. Using different imaging modalities, including radiography, CT, and MRI, we will describe the imaging findings of various avulsion fractures including the tibial spine, 5th metatarsal base, and dorsal aspect of the base of the distal phalanx (mallet finger), among others.

This educational exhibit will demonstrate the importance of recognizing fractures that may initially appear insignificant but actually require prompt recognition and management in order to avoid possible future complications. We will present key images as well as diagrams to teach the readers how to properly identify different types of avulsion fractures. After viewing this educational exhibit, the reader should be able to identify avulsion fractures efficiently, understand the mechanisms of injuries, and help guide clinicians with management to improve clinical outcomes.