At the bony cortices, for any evidence of a subtle break or buckle.
At the trabecular pattern for any distuption. The prominence of the trabecular pattern varies between patients.
For sclerosis; this is evidence of impaction.
Don’t forget to scrutinise the lateral as this projection is often overlooked:
An anterior compression force results in disruption of the SI joints (>4mm), diastasis of the symphysis pubis (>5mm) and external rotation of the hemipelvis. Also known as an “open book” injury:
A lateral compression force results in oblique fractures of the pubic rami bilaterally (with overlapping fragments), impacted fractures of the sacral foramina ipsilateral to the force, with infolding of the hemipelvis:
A vertical shearing injury results in vertical, unilateral fractures of the pubic rami, vertical fracture of the sacral foramina on the same side (or fractured ileum paralleling SI joint/disruption of the SI joint) with the hemipelvis usually displaced superiorly:
A straddle injury refers to a force against the perineum. This results in fractures of all pubic rami bilaterally with the central fragment displaced superiorly.
Crest of ileum (Quadratus lumborum)
Anterior superior iliac spine (Sartorius):
Anterior inferior iliac spine (Rectus femoris)
Ischial tuberosity (Hamstrings)
Lesser trochanter (Iliopsoas):
|Osgood Schlatter's||Tibial tuberosity|
|Scheuermann's||Vertebral epiphysis (apophyseal rings)|
Bone is expanded.
The cortex is thickened.
The trabeculae is coarse.