6: Radiology - UST, CT & MRI and lower limb

Question 1

Are upper or lower limb fractures associated with higher morbidity and mortality?

Answer 1

Lower limb fractures

Question 2

What are some serious complications of immobility due to a lower limb fracture?

Answer 2

Dehydration / starvation

DVT and PE

Pneumonia

Question 3

Why is CT superior to X-ray for viewing overlapping structures?

Answer 3

X-ray is one image - overlapping bones can’t be separated

CT is cross-sectional - image can be moved forwards and backwards

Question 4

Which two scans also show soft tissue injuries?

Answer 4

Ultrasound

MRI

Question 5

What name is given to the dark stripe across bone characteristic of a fracture on X-ray?

Answer 5

Lucency

Question 6

Lower limb fractures often involve impaction - what does this look like on X-ray?

Answer 6

Sclerosis (dense white)

Question 7

Where are three common sites for lower limb impaction fractures?

Answer 7

Femoral neck

Tibial plateau

Calcaneus

Question 8

Pelvic ring fractures typically involve (one / more than one) bone.

Answer 8

more than one bone

as with all bony ring fractures

Question 9

Who tends to suffer high energy pelvic ring fractures?

Answer 9

Young people

Question 10

What are the typical mechanisms of high energy pelvic ring fractures?

Answer 10

RTA

Falls from height

Question 11

What scan is used if more than one fracture is suspected e.g in a pelvic ring fracture?

Answer 11

CT scan

Question 12

If a pelvic ring fracture is caused by a low energy event, it is described as a ___ fracture.

What is a possible cause in elderly patients?

Answer 12

pathological

osteoporosis

Question 13

Low energy pelvic ring fractures are difficult to see on X-ray. What scan is used to pick them up?

Answer 13

MRI scan

Question 14

What is the imaging technique used to view pelvic soft tissue injuries?

Answer 14

MRI scan

Question 15

What are two examples of acute pelvic soft tissue injuries?

Answer 15

Muscle tears

Tendon avulsion

Question 16

Hip dislocations tend to occur (anteriorly / posteriorly).

Answer 16

posteriorly

Question 17

What bony feature tends to fracture in hip dislocations?

Answer 17

Acetabular rim

Question 18

What are the two main classifications of femoral fractures?

Answer 18

Intracapsular

Extracapsular

Question 19

Where on the femur do intracapsular fractures occur?

Answer 19

Neck to head

Question 20

Where on the femur extracapsular fractures occur?

Answer 20

Inferior to neck - greater trochanter and below

Question 21

Which type of femoral fracture can disrupt the blood supply to the femoral head?

What may this cause?

Answer 21

Intracapsular

Avascular necrosis

Question 22

What surgical procedure can be carried out to repair an intracapsular femoral fracture with associated AVN?

Answer 22

Hemiarthroplasty

i.e replacing the head of the femur and nothing else

Question 23

Extracapsular femoral fractures aren’t associated with AVN. What surgical technique is used to repair these fractures?

Answer 23

Internal fixation

i.e screws, rods, plates

Question 24

What type of femoral fracture is very obvious on X-ray?

Answer 24

Femoral shaft fracture

Question 25

(**Fractures / soft tissue injuries**) of the knee are more common. What imaging techniques are used to view them?

Answer 25

**Soft tissue injuries** **Ultrasound** , **MRI scan**

Question 26

What soft tissue structures should be viewed on a lateral X-ray of the knee?

Answer 26

**Quadriceps tendon** **Suprapatellar fat pad** **Patellar tendon**

Question 27

What space fills with effusion following a soft tissue injury of the knee?

Answer 27

**Suprapatellar space**

Question 28

When are **simple effusions** seen? When is **lipohaemarthrosis** seen?

Answer 28

**Simple effusion** - fractures **Haemarthrosis** - meniscal / ligament tears (extremely painful)

Question 29

What aspect of the **tibia**, close to the knee joint, commonly fractures?

Answer 29

**Tibial plateau**

Question 30

What imaging technique best shows tibial plateau fractures?

Answer 30

**CT scan**

Question 31

Which imaging technique is used to find **extensor mechanism** injuries?

Answer 31

**Ultrasound**

Question 32

What type of meniscal tear may displace and cause a locked knee?

Answer 32

**Bucket handle meniscal tear**

Question 33

What do torn ligaments typically look like on MRI?

Answer 33

**White, blurry mess**

Question 34

What type of connective tissue is damaged in OA?

Answer 34

**Hyaline cartilage**

Question 35

What is a bony ring found in the **leg**?

Answer 35

**Tibia,** **fibula** and **talus** together

Question 36

How do **ankle fractures** usually occur?

Answer 36

**Inversion / eversion** of foot

Question 37

What types of X-ray are taken for ankle fractures?

Answer 37

**AP** (opposite to CXR) and **lateral**

Question 38

The site of a fracture is often hinted at by the ___ \_\_\_ ___ around it.

Answer 38

**soft tissue swelling**

Question 39

What tends to be disrupted in **children**?

Answer 39

**Epiphyseal growth plates**

Question 40

If **joint spaces** are larger than they should be, what may be damaged?

Answer 40

**Ligaments**

Question 41

What bony prominences of the ankle should be examined for fractures?

Answer 41

**Medial** and **lateral malleoli**

Question 42

What other malleolus may also be fractured? Where specifically is it found?

Answer 42

**Posterior malleolus** **Posteroinferior tibia**

Question 43

The base of which metatarsal commonly fractures?

Answer 43

**5th**

Question 44

Which foot bone commonly **fragments** when it fractures? What is the radiology name for fragmentation?

Answer 44

**Calcaneus** **Comminution**

Question 45

As in the upper limb, what are commonly mistaken for fractures?

Answer 45

**Growth plates** **Sesamoid bones**

Question 46

What is the **fabella** and where is it found?

Answer 46

**Sesamoid found within the gastrocnemius posterior to the knee**

Question 47

Where in the foot are sesamoid bones **definitely** found?

Answer 47

**1st metatarsal head**

Question 48

Which scan is used to view ligament tears because it is easier for patients and changes in real time?

Answer 48

**Ultrasound**

Question 49

Injury of which ankle tendons are viewed by ultrasound?

Answer 49

**Achilles tendon** **Medial and lateral complexes**