Teenager with lap belt eccymoses on the abdomen after a motor vehicle accident

Radiograph of Chance fracture — AP (left) and lateral (right) radiographs of the lumbar spine show a three column fracture of the L3 vertebral body.

Teenager who cannot move their left shoulder after being pushed into a metal beam

Radiograph of anterior shoulder dislocation with Hills-Sachs lesion — AP (upper left) and axillary (above right) radiographs of the left shoulder show the left humeral head to be displaced anteriorly and medially in relation to the glenoid fossa. Post-reduction AP radiograph of the left shoulder (below) shows a defect in the posterolateral aspect of the humeral head.

The diagnosis was an anterior shoulder dislocation with a Hills-Sachs lesion post reduction.

Teenager with shoulder pain after a football injury

Radiograph of anterior shoulder dislocation — AP (above) and axillary (below) radiographs of the right shoulder show the right humeral head to be displaced anteriorly and medially in relation to the glenoid fossa.

The diagnosis was an anterior shoulder dislocation.

Teenager hit in the right thigh 1 month ago with a shot put

Radiograph of myositis ossificans — AP (left) and lateral (right) radiographs of the femur show an amorphous area of calcification anterior and lateral to the femur.

The diagnosis was myositis ossificans.

School ager with ankle pain after a fall

Radiograph and CT of triplane fracture — AP (left upper) and lateral (right upper) radiographs of the ankle show a sagittal fracture through the tibial epiphysis, an axial fracture through the physis, and a coronal fracture through the tibial metaphysis. This is better demonstrated on the coronal (lower left) and sagittal (lower right) CT 2D reconstructions without contrast of the ankle.

The diagnosis was a triplane fracture (Salter-Harris Type III fracture).

Preschooler who cannot bear weight after falling on a trampoline

Radiograph of trampoline fracture — AP (left) and lateral (right) radiographs of the knee show a cortical irregularly in the lateral and anterior contour of the tibial metaphysis.

The diagnosis was a trampoline fracture.

Toddler who will not bear weight after falling from a slide

Radiograph of toddler fracture — AP (left) and lateral (right) radiographs of the tibia and fibula show a thin spiral lucency in the diaphysis of the tibia.

The diagnosis was a toddler fracture.

Teenager with ankle pain after crashing his sled into a fence

The diagnosis was a Tillaux fracture (Salter-Harris Type III fracture) of the ankle.

Teenager with foot pain developing after beginning a vigorous program of running

Radiograph of stress fracture — AP radiograph of the foot obtained at presentation (left) shows a mild amount of perisoteal reaction around the diaphysis of the second metatarsal that is much better seen on the repeat radiograph from 1 month later (right).

The diagnosis was a stress fracture of the second metatarsal.

Teenager with wrist pain after a fall

Radiograph of scaphoid fracture — AP radiograph of the wrist shows a thin lucent line through the center of the scaphoid bone. On physical exam the patient had point tenderness over this area.

The diagnosis was a non-displaced scaphoid fracture.

Preschooler who tripped and fell and cannot stand up

Radiograph of a pathologic fracture through a fibrous cortical defect — AP and lateral radiographs of the distal femur show a thin linear lucency running obliquely through a large, lucent, well corticated lesion in the femoral metaphysis.

The diagnosis was a non-displaced pathologic fracture through a fibrous cortical defect.

Preschooler with forearm pain after a fall

Radiograph of Monteggia fracture dislocation — AP and lateral radiographs of the elbow show a fracture of the ulnar diaphysis and a dislocation of the radial head.

The diagnosis was a Monteggia fracture dislocation.

Preschooler with forearm pain after an all terrain vehicle accident

Radiograph of Galeazzi fracture dislocation — AP radiograph (left) of the forearm shows a fracture of the radial diaphysis and lateral radiograph (right) shows a dislocation of the distal radial ulnar joint.

The diagnosis was a Galeazzi fracture dislocation.

Teenager with wrist pain after falling on an outstretched hand

Radiograph of Colles fracture — AP and lateral radiographs of the wrist show a comminuted distal radius metaphyseal fracture with dorsal angulation of the distal fracture fragment.

The diagnosis was a Colles fracture.

Teenager with right hip pain

Radiograph of avulsion of the lessor trochanter — AP radiograph of the pelvis shows avulsion of the apophysis of the right lesser trochanter.

The diagnosis was a pelvis and hip apophyseal avulsion fracture of the lesser trochanter.

Infant who had been abused

Gross pathological image of posterior rib fractures in child abuse — CXR (above) and complete skeletal survey showed no evidence of rib fractures. Gross pathological image (below) shows callus formation along the posterior aspect of the left 4th-8th ribs.

The diagnosis was left 4th-8th chronic posterior rib fractures which were not detected on the skeletal survey in a child abuse patient.

Infant with swollen right leg

Radiograph of femur fracture in child abuse — AP radiograph of the right femur shows a lucency through the diaphysis of the right femur with no associated periosteal reaction. CXR AP shows callus formation around the right 7th and 9th ribs laterally, the right 7th-9th ribs posteriorly, the left 3rd-7th ribs laterally and the left 8th rib posteriorly.

The diagnosis was an acute displaced fracture of the right femur and chronic rib fractures of the right 7th and 9th ribs laterally, the right 7th-9th ribs posteriorly, the left 3rd-7th ribs laterally and the left 8th rib posteriorly in a child abuse patient.

Infant with right hip pain

The diagnosis was an acute nondisplaced fracture of the right femur and chronic right 5th-6th lateral rib fractures in a child abuse patient.

Infant who has been shaken

Radiograph of metaphyseal spur — AP and lateral radiographs of the right knee shows a spur along the lateral aspect of the metaphysis which was proven at autopsy to be a spur and not a fracture.

The diagnosis was a metaphyseal spur proven at autopsy in a child abuse patient.

Infant who has been shaken

Radiograph of classic metaphyseal lesion / bucket handle fracture / corner fracture of the tibia in child abuse — AP radiograph of the right tibia and fibula (left) shows a faint bucket handle irregularity of the distal tibial metaphysis. Lateral radiograph of the right tibia and fibula (right) shows anterior and posterior corner irregularities of the distal tibia metaphysis.

The diagnosis was a classic metaphyseal lesion (bucket handle fracture / corner fracture) of the distal right tibia in a child abuse patient.

Infant with leg pain

Radiograph of classic metaphyseal lesion / bucket handle fracture of the femur and tibia in child abuse — AP radiograph of the lower extremities shows bucket handle irregularities of the metaphyses of the bilateral distal femurs and bilateral proximal tibiae. There is also periosteal reaction of the distal left femur and bilateral tibiae.

The diagnosis was classic metaphyseal lesions (bucket handle fractures) of the bilateral distal femurs and bilateral proximal tibiae in a child abuse patient.

Infant with cough who had experienced a traumatic delivery 4 months ago

CXR of posterior rib fracture due to birth trauma — CXR AP shows clear lungs and an area of callus surrounding the right 7th rib posteriorly.

The diagnosis was chronic right 7th posterior rib fracture caused by a traumatic birth.

Febrile newborn who had a traumatic delivery due to shoulder dystocia 3 days ago

CXR of posterior rib fractures due to birth trauma — CXR AP shows lucent lines without surrounding periosteal reaction through the left 5th-7th ribs posteriorly.

The diagnosis was acute left 5th-7th posterior rib fractures caused by birth trauma.

Infant who fell out of bed

CXR of posterior rib fractures which were initially missed in child abuse — CXR AP (above) from initial skeletal survey was unremarkable. Repeat CXR AP (below) from follow-up skeletal survey 2 weeks later shows interval development of periosteal reaction around the left 8th-9th ribs posteriorly.

The diagnosis was healing left 8th-9th posterior rib fractures in a child abuse patient.

Infant with a large burn on the scalp

3D CT construction of anterior rib fractures in child abuse — 3D CT reconstruction with contrast of the chest shows callus formation around the right 4th-8th ribs and left 4th-9th ribs anteriorly.

The diagnosis was chronic right 4th-8th and chronic left 4-9th anterior rib fractures in a child abuse patient.