Imaging Pitfalls

It cannot be emphasised enough that standard recordings and MRI should always be evaluated together as a “unit”. Subtle changes and alarms from both techniques can influence the choice of technical approach, (final) evaluation of trauma and therapeutic choices. Subtle abnormalities are sometimes overlooked on standard views. MRI is a very sensitive tool in the traumatic context due to its early detection of BMO. The detection of obvious BMO and even a fine transverse fracture line may prompt a review of standard views. Subtle abnormalities on standard recordings should also prompt further evaluation of trauma. Sometimes, a small fracture with cortical buckling is noted. Severe swelling at some distance is noted later. MRI shows a fracture at the base of the processus styloideus with surrounding BMO. The ulnar insertion of the TFCC is also torn.