Musculoskeletal Trauma, Fractures, Dislocations, and Stress Injuries — WACS Viva & Clinical Scenarios (Musculoskeletal and Trauma Imaging)

Exam-style musculoskeletal trauma, fractures, dislocations, and stress injuries viva scenarios with examiner probes and model answers for Radiology candidates.

Scenarios covered

• SCENARIO 1: A 9-year-old child presents to the emergency department following a fall onto an outstretched hand with severe distal forearm pain, swelling, and focal tenderness over the distal radial physis. Describe the radiographic features that differentiate Salter-Harris Type I through Type V physeal injuries, identify the specific types associated with the highest risk of premature physeal closure and growth arrest, and state the mandatory radiographic projection and follow-up principles required in paediatric skeletal trauma.
• SCENARIO 2: An adult passenger involved in a high-speed road traffic collision presents with haemodynamic instability and severe pelvic pain. An emergency trauma pelvis radiograph shows widening of the pubic symphysis by 3.5 cm and widening of the left sacroiliac joint. Detail the classification of this injury using the Young-Burgess and Tile systems, outline the mechanical stability of the pelvic ring, identify the anatomical structures at risk of catastrophic haemorrhage, and explain the imaging protocol for escalating from plain radiography to contrast-enhanced multi-detector computed tomography.
• SCENARIO 3: A 28-year-old construction worker falls from a height of 4 metres, sustaining acute neck pain and upper extremity paraesthesias. Cross-table lateral and multi-detector computed tomography (MDCT) views of the cervical spine reveal a fracture through the posterior elements and vertebral body of C6 with 4 mm anterior subluxation of C6 on C7. Apply the Denis three-column model and cervical spine injury scoring principles to assess mechanical and neurological stability, detail the radiological signs of anterior and posterior ligamentous complex rupture, and specify the role and timing of urgent mag
• SCENARIO 4: A 22-year-old rugby player sustains an acute anterior shoulder dislocation. Following closed reduction, plain radiographs and subsequent magnetic resonance arthrography (MRA) are requested to assess joint stability. Detail the radiographic and MRI/MRA appearances of bony and soft-tissue Bankart lesions, Hill-Sachs deformities, and anterior labroligamentous periosteal sleeve avulsions (ALPSA), and explain the concept of on-track versus off-track glenoid engagement in predicting recurrent shoulder instability.
• SCENARIO 5: A military recruit presents with progressive, severe left groin and proximal thigh pain exacerbated by weight-bearing, with initial negative plain radiographs. Discuss the pathophysiology and biomechanical differences between fatigue and insufficiency fractures, describe the sequential diagnostic imaging algorithm involving multiplanar MRI and CT, and delineate the characteristic imaging features distinguishing a tension-side from a compression-side femoral neck stress fracture.