Skip to Main Content

++

AXIAL SKELETAL TRAUMA

++

The axial skeleton consists of the bones that form the central axis of the body and includes the skull, sternum, ribs, and vertebra.

++

SKULL

++

As most trauma patients with suspected head injuries are imaged with computed tomography (CT), skull radiographs are now rarely used to diagnose fractures. Fracture types include simple linear (Figure 4-1) and depressed (Figure 4-2A,B). Patients with skull fractures demonstrate an increased risk for intracranial hemorrhage,1,2 and dural laceration can be seen with the depressed type.3

++
Figure 4-1.

Linear skull fracture. Lateral radiograph of skull shows linear skull fracture in pediatric patient (arrow).

Graphic Jump Location
++
Figure 4-2.

Depressed skull fracture. (A) Lateral radiograph of the skull shows sclerotic double line seen with depressed skull fracture (arrowhead). This finding is often mistaken for artifact. Linear skull fracture is also seen (arrow). (B) Axial CT image of the head showing depression in skull (arrowhead) compared to normal side (white arrow). Linear fracture (black arrow).

Graphic Jump Location
++

TORSO

++

Injury to the sternoclavicular and sternomanubrial joints usually occurs after forceful impact and compression. Sternoclavicular dislocation should be suspected on radiographs where the clavicular heads are seen at different craniocaudal positions (Figure 4-3A). Posterior dislocation of the medial clavicle can compromise structures of the thoracic outlet including the great vessels, brachial plexus, and trachea (Figure 4-3B,C).4 Type I sternomanubrial dislocation, where the sternum is displaced posterior to the manubrium, is often identified on physical examination (Figure 4-4). CT can demonstrate any associated mediastinal injuries.5

++
Figure 4-3.

Disruption of sternoclavicular joint. (A) Frontal chest radiograph shows normally positioned head of right clavicle (arrowheads) compared to superiorly and posteriorly dislocated left clavicular head (arrows). (B) Axial CT image of the clavicles shows normally positioned right clavicular head (arrowhead) and superiorly and posteriorly dislocated left clavicular head (arrow). (C) Axial CT image of the clavicles done in soft tissue algorithm shows superiorly and posteriorly dislocated left clavicular head (arrow) and compression of left subclavian vessels (arrowhead).

Graphic Jump Location Graphic Jump Location
++
Figure 4-4.

Sternomanubrial dislocation. Sagittal CT reformat of the sternum shows type I sternomanubrial dislocation occurring at the sternomanubrial joint (arrow). S, sternum; M, manubrium.

Graphic Jump Location
++

Rib fractures are a frequent finding on chest radiographs obtained on admission to the trauma emergency department or on the CT scan done to evaluate chest, abdomen, ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPhysiotherapy Full Site: One-Year Subscription

Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPhysiotherapy

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.