This document discusses various fracture mimics that can be mistaken for fractures on radiological imaging. It provides examples of normal anatomical variants like accessory ossicles, apophyses, epiphyseal plates, bipartite patellas, nutrient canals, and excrescences that should not be confused for fractures. It also mentions artifacts like Mach lines and factors like overlying skin lacerations that can simulate fractures. The document aims to help differentiate actual fractures from normal anatomical variants and artifacts.

1. Fracture Mimics
DR MUHAMMAD BIN ZULFIQAR
PGR III FCPS Services institute of Medical
Sciences/ Services Hospital Lahore
Special thanks to Learning Radiology

2. Aim
• To differentiate between fracture mimics and
fractures

3. Accessory Ossicle
• Multiple ossification
centers are
common in epiphyses
and are
smooth and well-
corticated

4. Apophysis
• Apophysis of the
5th MT runs in a
longitudinal
direction;
fractures are
usually
transverse

5. Normal
Epiphyseal Plate
• Don't confuse the
undulations
of the humeral
epiphyseal plate
for a fracture

6. Bipartite
Patella
• Bipartite patella
almost always
affects the upper
outer pole of
patella; 57% are
bilateral

7. Nutrient
Channel (Canal)
• Nutrient channels
or canals run
diagonally only in
the cortices of
certain bones

8. Normal
Excrescence
• Radial spur is
normal variant
occurring on
the lateral
aspect of the
radius at the
site of the
physis

9. Normal
Apophysis
• The apophysis of
the tibial tubercle
(tuberosity) fuses
at age 14-18 years

10. Limbus
Vertebra
• Most commonly
affects
anterosuperior
border of single
vertebra
in lumbar spine

11. Normal
Excresence
• This is a normal
bony
excresence from the
scaphoid that
can be mistaken for
a fracture

12. Sesamoids
• Sesamoids are
ossicles
embedded in a
tendon that aid in
movement; they
are common in
the feet and
hands

13. Skin
Laceration
Air beneath
lacerations may
superimpose
on the bone
simulating
fractures; look
at multiple
projections

14. Apophysis
• The greater
and lesser
trochanters
are
apophyses
which fuse at
15-20
years of age -

15. Lack of Fusion
• Hyoid Bone fuse
later in life
usually by age
40; it is therefore
common to see
and unfused
hyoid

16. Mach Lines
• "Mach Lines“
are optical
illusions which
produce a black
line where none
exists; they are
common at the
base of the dens

17. Accessory
Epiphyses
• In a child, when
in doubt, think
of obtaining the
opposite side.

18. • Synchondrosis
• 3 main temporary J oints in pelvis: ilio-pubic,
ischio-pubic and ilio-ischial; bilateral and
usually symmetric

19. Costovertebral Junction
• Every rib
attaches to the
spine at the
costo-vertebral
junction; not
to be
confused with
a fracture

20. Accessory Ossicle
• Os Acetabuli
Marginalis Superior
Normal variant
May be bilateral

21. Multiple Ossification Centers
• The calcaneal
apophysis
frequently has
multiple centers
of ossification and
appears denser
than rest of
calcaneus

22. Sesamoids
• There are almost always
sesamoids of the thumb;
they are well-corticated
and smooth-edged, unlike
fractures

23. Accessory
Ossicle
• Os Trigonum-
accessory ossicle
just posterior to
the talus normally
found in 5-15% of
people

24. Os Trigonum-accessory ossicle

25. THANKS