Complications of Fractures

In the early stages, bone fractures may be “invisible” on standard images. MRI is much more sensitive for fractures. Because BMO persists for up to 6 months, “missed” fractures can also be detected with MRI. Evaluations of the impact of trauma by standard imaging often do not show the full status. In particular, fractures of the ulnar styloid, the sigmoid notch of the DRUJ, and the anterior and posterior border of the radial epiphysis are often masked on standard images. Standard images may show a number of non-healing fractures. MRI additionally shows the surrounding BMO and subcortical cysts of the pseudarthrosis. Fractures of the DRUJ are often detected (to) late and can lead to disabling damage. Successful reduction of a luxation of the DRUJ does not exclude bony sequences (second ulnar groove), tendinous (ECU), or ligamentous lesions (rul). MRI can not only diagnose fractures but also differentiate them from other pathologies, such as avascular necrosis. The CMC-III joint space may be altered by trauma and cause a secondary carpal boss. A severe impaction of the radius may go undetected on standard recordings. The TP joint is often neglected in an emergency setting. A FOOSH lesion may go undetected. This also applies to the hamulus of the hamate bone. Posttraumatic bending of the distal U may lead to a negative ulnar variance and secondary impingement. Posttraumatic deformation of the ulnar styloid can lead to a secondary stylotriquetral abutment. Salter-Harris fracture epiphysiolysis of the distal R can lead to premature closure of the radial growth plate, ultimately resulting in a positive ulnar variance. Due to chronic microtrauma, small scattered ossification bridges cross the growth plates. This may eventually lead to premature closure of the growth plates. Good fracture consolidation in a correct position can hide significant tendon changes, such as tendon luxation. The actual condition of cartilage requires 3D evaluation. Evaluation of trauma after surgery is challenging. Even after a common Pouteau fracture, several other lesions may be present that hinder rehabilitation.