Download - skull fractures vs accessory sutures
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Dr. Surendra BishnoiDNB Resident(1st Year),Saifee Hospital, Mumbai.
Pediatric skull fractures : Imaging Pearls
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7 year old boy with H/O Fall.No Neurological deficit.
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Axial CT scan of Brain in Bone window setting
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3 year old female ,trauma, neurological deficit . CT Brain Plain
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3D CT
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Accessory sutures in children below 4 years of age
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Skull sutureSclerotic Edges
Sharp Lucent
Fracture Line
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Skull sutureSclerotic edges Sharp
lucent
Fracture Line
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Skull suture Zig Zag
Linear
Fracture Line
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Zig Zag Vs Linear Line
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Zig Zag vs Linear
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Skull suture Joins Other Sutures
CrossesFracture Line
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Skull suture Joins Crosses
Fracture line
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Skull sutureBilateral/symmetrical
Unilateral/Asymmetrical
Fracture Line
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Skull sutureBilateral/Symmetrical
Unilateral/Asymmetrical
Fracture Line
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Widening of fracture line
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Plain film radiography can suffice
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Imaging
• Plain film radiography is often the most cost effective, initial imaging modality of choice for evaluating fractures in suspected cases of non-accidental trauma.
• Head CT is obtained in cases where there is clinical suspicion for intracranial injury.
• 3-D reconstructions are often requested from the 3-D lab for patients with complex head CT findings.
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Five Point formula. Symmetrical, Zig-Zag
with Sclerotic border and merging pattern is Suture.
Clinical scenario and embryological anatomy is best supplement.
Take Home Message
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References1. Sanchez T, Stewart D, Walvick M, Swischuk L (2010) Skull Fracture vs. accessory sutures: how can we tell the difference? Emergency Radiology 17 (5): 413 – 418. 2. Glass RB, Fernbach SK, Norton KI, Choi PS, Naidich TP (2004) The Infant Skull: A Vault of Information . Radiographics 24, (507 – 522). 3. Mulroy MH, Loyd AM, Frush DP, Verla TG, Myers BS, Bass CR (2012) Evaluation of pediatric skull fracture imaging techniques . Forensic Science International 214: 167 – 72.
4. Choudhary AK, Jha B, Boal DK, Dias M (2010) Occipital sutures and its variations: the value of 3D-CT and how to differentiate it from fractures using 3D-CT? Surgical Radiology Anatomy 32: 807 – 816.
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