WIDI - CB1549-Skull and Extremities Fractures, possible NAT

Skull and Extremities Fractures, possible NAT

Claim CME Credit

0.5 CME Credit available on completion

POINT OF CARE INFORMATION

This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.

Learning Objectives

As a result of participation in this activity, participants should be able to:

Provide improved patient care.
Greater knowledge of the imaging characteristics of the patient's disease.
Understand a better approach to interpretation of studies.

Faculty Disclosure

Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.

CME Advisory Committee Disclosure:

Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.

Continuing Medical Education Credit

Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CB1549-Skull and Extremities Fractures, possible NAT

History

3-month-old male with head injury of right posterior scalp "soft spot" and decreased oral intake. Parents recall that 1 week ago they recall head trauma to the right parietal region. Recent head CT demonstrated right parietal skull fracture. Evaluate for additional findings of non-accidental trauma.

Exam

Skeletal survey

Prior Study

none

Findings

Skull

There is a non-displaced horizontal linear fracture involving the right parietal bone which spans from the right coronal suture to right lambdoid suture. There is associated moderate right parietal scalp swelling and hematoma. There is slight diastases of the lambdoid suture particularly on the right. Bony mineralization is normal. There is no evidence of craniosynostosis. The paranasal sinuses are normal in development for patient's age.

Spine

There is no evidence for fracture or subluxation. Vertebral body heights and intervertebral disc spaces are maintained. The normal number of vertebral segments are seen. Bony mineralization is normal.

Ribs

There is no evidence for acute or chronic fracture. Bony mineralization is normal. 12 bilateral ribs are present.

The lungs are clear. The mediastinal and cardiac contours are normal. The bowel gas pattern is normal.

Upper and Lower Extremities

There is a thin periosteal reaction along the medial aspect of the left tibia particularly involving the mid diaphysis. There is also irregularity along the medial anterior corner of the left tibial metaphysis concerning for metaphyseal corner fracture. There is no other evidence for fracture or dislocation. Alignment is maintained. Bony mineralization is normal. No periosteal reaction is identified. There is no evidence for fracture on the right side.

Impression

1. Horizontal non-displaced linear fracture involving the right parietal bone which spans from the right coronal suture to right lambdoid suture with associated scalp swelling and hematoma.
2. Thin periosteal reaction along the medial aspect of the left tibia particularly involving the mid diaphysis concerning for occult healing fracture.
3. Irregularity along the medial anterior corner of the left tibial metaphysis representing a metaphyseal corner fracture.

Acuity

Urgent: non-routine communication within 4 hours