Fracture Imaging Principles

A 62-year-old woman with osteoporosis presents to the orthopedic clinic with acute right hip pain following a fall on ice. She is unable to bear weight. Plain radiographs (AP pelvis and frog-leg lateral views) are obtained and appear normal with no obvious fracture line. However, the patient's clinical presentation is highly suspicious for a femoral neck fracture. What is the most appropriate next imaging step to confirm or exclude an occult fracture?

A 28-year-old male construction worker presents to the emergency department 6 hours after a fall from scaffolding onto his left wrist. He reports severe wrist pain and swelling. On examination, the wrist is held in a dorsally angulated position. Plain radiographs (PA and lateral views) show a transverse fracture through the distal radius with dorsal displacement and angulation of the distal fragment. However, the radiographs appear technically adequate with no obvious soft tissue artifact. Which imaging modality would be most appropriate as the next step to fully characterize this injury and guide surgical planning?

A 52-year-old woman presents to the orthopedic clinic with a 6-week history of right shoulder pain following a fall on an outstretched hand (FOOSH injury). Initial plain radiographs (AP, lateral, and axillary views) obtained at the time of injury were reported as normal. She now complains of persistent pain and restricted shoulder motion. On examination, there is tenderness over the anterior shoulder and positive apprehension test. A repeat AP radiograph shows a subtle lucency in the anteroinferior glenoid rim. What is the most likely diagnosis, and which imaging modality would best characterize this lesion for surgical planning?

A 28-year-old male presents to the emergency department following a motor vehicle accident with severe right ankle pain and swelling. Clinical examination reveals tenderness over the lateral malleolus and inability to bear weight. An anteroposterior (AP) radiograph of the ankle appears normal. However, the radiologist notes that the medial clear space (distance between the medial border of the talus and the medial malleolus) measures 5 mm on the AP view, compared to 3 mm on the contralateral side. What is the most appropriate next imaging step to confirm the suspected diagnosis?