Case # 2014A
The ABCs of how to handle a trauma femur.
While these images (6 in all) may never be nominated for inclusion
into the hall of fame of imagery at the next international radiological
conference in the highly regarded communities of Chunchula, AL or
Rolling Fork, MS or Climax, GA, they are nonetheless of sufficient
diagnostic quality to render a diagnosis of a bi-lateral displaced
transverse distal femoral fracture- both femurs.
Two important points are worthy of remembering: (1) The femur is the
longest and strongest bone in the human body and when fractured,
pain is often substantial. So speed in performing the exam along with
the ability to think outside of the box is of paramount importance. (2)
These images provide an excellent example of how this long fractured
bone is radiographically approached, and why so many fractures do
not necessarily fit the textbook approach to performing many of the
so-called routine radiographic procedures – more thinking outside of
the box.
C. Newell
Image A
A fair attempt to perform an AP
position of the Rt. proximal
femur. However, the position of
the lesser trochanter is very
prominent along with blurring of
the intertrochanteric line is
indicative of inadequate internal
rotation of the hip joint. Thus this
image is somewhat obliqued
which, although doubtful, could
indicate an attempt to acquire a
semi-frog position. However,
additional images will suggest
why this image is imperfect.
Note the presence of C.M. in the
distal right ureter. Perhaps a
bladder laceration was
suspected, but no extravasation
is seen. Good news!
C.M.
Image B
The AP projection clearly demonstrates
the degree of displacement in this
transverse fracture of the distal right
femur. A good image, particularly in light
of the pain and limited mobility the
patient must have experienced.
There is overlap images of the Right femur
in the AP position (proximal and distal
images), so the radiographer succeeded in
demonstrating both joints – the rule one
must follow in radiographing long bones.
Image C
A lateral projection of the right
femur demonstrates a distal
transverse fracture.
Notice the rotation of the
condyles. While the lateral
indicates displacement, the
rotation distorts the degree of
displacement. Nonetheless,
there is no doubt that
displacement exists despite the
imperfect superimposition of
the condyles. This is confirmed
by viewing the distal AP femur
previously discussed.
Image D
AP position of the Lt. femur. As
was the case with the AP right
femur, the position of the lesser
trochanter is very prominent
along with blurring of the
intertrochanteric line is
indicative of inadequate internal
rotation of the hip joint.
Note the presence of the
stabilizing/splint device.
Although bowel gas is
superimposed over the C.M.
filled bladder, no extravasation is
seen. More good news!
For the corpus spongiosum
observers via radiographic
images , try to remember that all
radiographic images possess
magnification.
Image E
Thinking out of the box. This is a cross-table AP projection of the distal femur that
demonstrates a distal transverse fracture of the left femur with substantial
displacement. While I was not present at the time these images were taken, I can
assure you that the patient’s body position dictated this approach. Perhaps more
importantly to note, this approach would have certainly been far less painful for the
patient as opposed to moving/rotating the femur to its normal position. Well done
and most informative! Can you picture how this image was achieved?
Ouch!
Image F
Lateral left femur demonstrating a
mid-shaft transverse fracture.
As was the case in image C, notice the
rotation of the condyles. While the
lateral indicates displacement,
rotation of the condyles distorts the
degree of displacement, causing the
fracture to appear overlapped.
Nonetheless, there is no doubt that
displacement exists despite the
imperfect superimposition of the
condyles. This is confirmed by viewing
the distal AP femur in image E.
By now you should understand why
various images are imperfect - bilateral femoral fractures – correct!
In short, this was likely a difficult
study to perform.