Mayo Radiology

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RADIOLOGICAL EVALUATION OF TRAUMA The radiologic modalities used in analyzing injury to the musculoskeletal system are as follows:  Conventional radiography, including routine views (specific for various body parts), special views, and stress views  Digital radiography, including digital subtraction arthrography and angiography (DSA)  Fluoroscopy, alone or combined with videotaping  Tomography (particularly trispiral tomography)  Computed tomography (CT)  Arthrography, tenography, and bursography  Myelography and diskography  Angiography (arteriography and venography)  Scintigraphy (radionuclide bone scan)  Magnetic resonance imaging (MRI) Radiography, Fluoroscopy, and Conventional Tomography In most instances, radiographs obtained in two orthogonal projections, usually the anteroposterior and lateral, at 90 degrees to each other are sufficient (Fig. 4.1). Occasionally, oblique and special views are necessary, particularly in evaluating fractures of complex structures such as the pelvis, elbow, wrist, and ankle (Figs. 4.2 and 4.3). Stress views are important in evaluating ligamentous tears and joint stability (Fig. 4.4). Certain special modalities are used more often in evaluating different types of injuries in specific anatomic locations. Fluoroscopy and videotaping are useful in evaluating the kinematics of joints. Tomography (zonospiral or trispiral) is useful in confirming the presence of a fracture (Figs. 4.5 and 4.6), delineating the extent of a fracture line and assessing the position of the fragments. It is also valuable in monitoring the progress of healing. Computed Tomography CT is essential in the evaluation of complex fractures, particularly in the spinal and pelvic regions (Fig. 4.7). The advantages of CT over conventional radiography are its ability to provide three-dimensional imaging, excellent contrast resolution, and accurate measurement of the tissue attenuation coefficient. The use of sagittal, coronal, and multiplanar reformation provides an adde