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The axial skeleton consists of the bones that form the central axis of the body and includes the skull, sternum, ribs, and vertebra.
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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
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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
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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, and pelvis injuries (Figure 4-5). An associated pneumothorax can be seen on ...