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Radiology 3 > Musculoskeletal 2 > Flashcards

Musculoskeletal 2 Flashcards

1
Q

Lunate dislocation

A

-FOOSH or direct blow to the palm
-Lateral view is key
-“spilled teacup” – lunate rotates toward palm
-Carpals remain aligned with distal radius
-Most severe of carpal dislocations
-Check median nerve
-Lunate rotates toward the palm but all the other carpal bones remain aligned
-The median nerve runs right past this bone
-On AP view - carpals overlap, lose
carpal alignment “arches”, lunate
appears triangular and scaphoid short on AP; lateral “crescent moon”

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2
Q

the wrist

A

3 views - standard
-PA, lateral, oblique

Special views
-All include distal radius
and ulna, proximal
metacarpals

Carpal bone anatomy,
-relationships key

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3
Q

Humerus fracture

A
  • Surgical neck most common single site
  • Impaction, multi sites common
  • Fx anatomic neck = risk of avascular necrosis
  • In combo with or mimics dislocation
  • May require surgery
  • Surgical starts with an S and so does strangle
  • Avascular necrosis comes from fx at anatomica neck
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4
Q

components of the upper extremity

A
  • Shoulder (Scapula, Clavicle)
  • Humerus
  • Elbow
  • Radius/Ulna
  • Wrist
  • Hand, Fingers
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5
Q

Gamekeeper’s thumb

A
  • Acute injury is also called skier’s thumb, breakdancer’s thumb
  • Disruption of ulnar collateral ligament with avulsion fracture at base of proximal phalanx
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6
Q

Acromioclavicular separation

A

Type (Grade) I
-Partial tear of AC with no displacement

Type II
-Disruption of ACL and widening of joint

Type III
-Disruption of AC and coracoclavicular ligaments

Normal AC joint < 8 mm

Normal coracoclavicular distance < 13 mm

  • Weight-bearing views helpful
  • Type 1-3 most common
  • Type 4-6 complex
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7
Q

Distal radius fractures

A 
*Hutchenson’s or
“Chauffeur’s” Fx
-Intraarticular, oblique
Fx of radial styloid
-Scapholunate widening common
-No angulation
*Die-punch or
 Lunate-load Fx
-Intraarticular, medial  distal radius fx, impaction of lunate on radius
-Scapholunate spacing often disrupted
\+/- ulnar styloid fx too
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8
Q

elbow dislocation

A

-3rd most common joint dislocation in adults
-Most common joint dislocation in kids
-Hyperextension
-90% are posterior
-1/2 have associated fx
-Vascular compromise,
nerve injury, hemorrhage, entrapment

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9
Q

Colles fracture

A
  • Most common injury to the distal forearm
  • FOOSH
  • May be impacted
  • Distal radius has dorsal angulation/displacement on lateral view
  • 50% also have an ulnar styloid fracture
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10
Q

Inspect the radial head

A
  • Most common elbow fracture in adults
  • Adolescents common
  • FOOSH injury: “fall on outstretched hand” - arm is extended
  • Can be subtle! (Mechanism, Sx’s, Radiocapitellar line? Posterior Fat Pad?)
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11
Q

Anterior shoulder dislocation

A
  • 95% of shoulder dislocations are anterior
  • Arm held in abduction, external rotation, extension (Cannot internally rotate)
  • Humeral head out, anterior and inferior to glenoid
  • More displacement than posterior dislocation
  • Humeral head fixed in external rotation - greater tuberosity is lateral (in profile)
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12
Q

Scaphoid (navicular) fracture

A
  • Most commonly fractured carpal bone in adults
  • Rare in children
  • FOOSH w/ extreme dorsiflexion of hand, snuffbox tender
  • Midportion (“waist”) fx = risk for AVN of proximal pole
  • Scaphoid view
  • Xrays initially neg in up to 20% who have a fracture
  • VERY IMPORTANT!!!
  • Why is this key? VASCULAR SUPPLY
  • If you break your scaphoid completely at the waist, you can have avascular necrosis of proximal pole
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13
Q

Galeazzi fracture/dislocation

A

-Radius Fx at distal 1/3 w/ distal ulnar dislocation
-Ulna dislocated at
radio-ulnar and
carpal-ulnar joints
-Unstable - requires
ORIF

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14
Q

Scapholunate dissociation

A
  • “David Letterman” sign – space between front teeth.
  • SL ligamentous disruption
  • Scaphoid rotates - seen on end on AP view
  • Very subtle injury but if you miss it, the person loses function
  • N means navicular which is the same as scaphoid
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15
Q

triquetrum fracture

A
  • 2nd most common
  • FOOSH, dorsal pain
  • Usually avulsion fx dorsal surface
  • Triquetrum is the most dorsal carpal bone seen on lateral view
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16
Q

“swan neck” deformity

A
  • Fixed extension at PIP
  • Flexion at DIP (Follows untx’d)
  • Volar plate and Mallet
  • Finger fractures (Autoimmune arthritis)
  • Autoimmune arthridities: rheumatic arthritis, psoriatic arthritis, SLE arthritis, scleroderma
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17
Q

The elbow

A
  • Elbows are special…
  • AP, Lateral - standard views
  • Special Views (Medial, Lateral oblique, Capitellum (capitulum))
  • Reading elbow films (Fractures easily missed, Organized approach reduces miss rate)
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18
Q

Smith’s fracture

A

Volar angulation and displacement

Fall on flexed wrist

Impacted distal radius on this pt

19
Q

inspect the distal humerus

A
  • Supracondylar fx’s: kids
  • Fracture above the epicondyles
  • 60% all elbow fractures in pediatrics
  • Hourglass on lateral?
  • Anterior Humeral Line?
  • Posterior Fat Pad?
20
Q

Complications: shoulder dislocations

A

Fracture/Dislocation

Hill-Sachs Fx/Deformity

  • Repeated anterior dislocations
  • Fx/Impaction deformity of posterolateral humeral head
  • Humeral head impingement under anterior glenoid rim
  • Predisposes to future dislocations
Bankart Fx (often post-reduction)
-Small fracture of glenoid rim; tear, detachment of labrum common

Avulsion fx greater tuberosity

Joint instability, axillary nerve injury

21
Q

Bennett’s fracture

A
  • An intra-articular fracture-dislocation of the base of the thumb
  • Abductor policus longus pulls thumb downward avulsing it off it’s base
22
Q
  • AP oblique: gashey

- Axillary view

A
  • AP Oblique view is used to look at the glenoid and the humeral head
  • Axillary view: Useful in shoulder dislocations and evaluation of glenohumeral joint. This view requires abduction of the shoulder
23
Q

Boxer’s fracture

A
  • Closed fist punch
  • 4th or 5th metacarpal neck (technically - not shaft, not intra-articular)
  • Volar angulation of metacarpal head - describe in degrees
  • Flat knuckle, rotational defect of affected digit on flexion
  • Reduce >30deg angulation
24
Q

radius and ulna

A
  • Proximal, shaft, distal
  • Joint above and below level of injury for dislocation
  • Fracture type?
  • Joint dislocation?
  • Open or closed?
25
Q

Rolando fracture

A
  • Comminuted: Intra-articular Fx, Base of thumb, Metacarpal
  • Abductor Policus Longus
  • Conminuted, Rolando (she has never met anyone named Rolando who was not complicated)
26
Q

Distal phalanx and tuft fracture

A

Usually crush injury to
fingertip: xray all

Check ligament function

Nailbed injury + Fx
= open fracture*

Distal phalanx fx is proximal

Tuft Fx distal tip

This is the only open, compound fracture that does not go to the operating room

27
Q

Mallet finger

A

Avulsion Fx, base of DIP, at extensor insertion

Untreated results in mallet deformity

28
Q

Axillary views in dislocations

A

-Posterior: Humeral head is opposite to the coracoid process and posterior to glenoid
-Anterior: Humeral head
overlaps the coracoid*
process

29
Q

Posterior shoulder dislocation

A
  • Posterior - 5%, but 50% misdiagnosed! High force; direct blow, seizure, MVA or fall, Arm held in adduction, internal rotation (Cannot externally rotate)
  • Can be tricky! Clues on special views
  • Arm held in internal rotation, adduction
  • Humeral head = “light bulb” or “ice cream on a cone” on AP view
  • Humeral head is lateral, some overlap with glenoid
30
Q

Monteggia fracture/dislocation

A
  • Fracture of the ulna with radial head dislocation - 4 types
  • Radial head displaces anteriorly into the antecubital fossa - most common
  • Radiocapitellar line
  • Unstable - requires ORIF
31
Q

Boutonniere deformity

A
  • Disruption of central slip at PIP – flexed
  • Lateral bands intact, hyperextened DIP
  • Often just ligamentous but look for Fx
  • Result of a ligamentous injury that you didn’t pick up
32
Q

Scapula fractures

A
  • Significant mechanism, high force, direct impact (Fall from height, MVA)
  • Uncommon fracture
  • Associated injuries common
  • Often detected on CXR, AP shoulder
  • Diagnostic imaging: AP with arm in abduction, The “Y View”, Order a CT scan (often complex fx’s), CXR mandatory
  • > 80% involve body, neck or glenoid
  • Isolated acromium, coracoid fx’s less common
  • “Y-view” very useful to detect fx, angulation
33
Q

approach to elbow films

A
  • “Hourglass”? “Fig 8”? True lateral?
  • “Fat pads”? Anterior? Posterior?
  • Anterior humeral line
  • Radiocapitellar line
  • Inspect radial head
  • Inspect distal humerus
  • Inspect olecranon and ulna
  • Is this a true lateral? Do you really have figure 8? Was patient able to give 90 degree handshake
  • More important than the anterior fat pad is the posterior fat pad!!
  • The presence of a posterior fat pad means there is a disruption somewhere and probably a fracture!!
34
Q

Volar plate fracture

A

Hyperextension

Volar plate avulsion
at PIP joint

Dislocation at PIP -
often reduced prior
evaluation

> 30% of articular
surface = unstable,
needs surgical repair

35
Q

Fat pad sign

A
  • Elbow lateral view (Hemarthrosis/effusion, Anterior = normal finding, Anterior that is “lifted” = “Sail Sign” = fracture)
  • Any posterior fat pad after trauma is abnormal = fracture
  • Subtle fx’s (Radial head, Supracondylar)
36
Q

Barton’s fracture

A

Intraarticular fx of distal radius with displacement, angulation and subluxation of radiocarpal joint.

Volar direction in this pt – can be either volar or dorsal

37
Q

AC separation

A

Type 2:

  • AC joint > 8mm wide/displaced
  • Clavicle displaced superiorly
  • No corococlavicular space widening

Type 3:

  • AC joint disrupted
  • Clavicle displaced superiorly
  • Corococlavicular space wide: >13mm (blue arrow)
  • Normal AC joint space = or <8mm
  • Normal corococlavicular space = or <13mm
38
Q

distal radius fx w/ angulation

A

FOOSH mechanism

Angulation/Displacement
-Colles Fx, Smith’s Fx

Barton’s Fx

  • Intra-articular fx dislocation
  • Displaced, subluxed
  • Volar or ventral (anterior)
  • Dorsal (posterior)

Impaction/shortening

39
Q

Clavicle fractures

A
  • AP view, Angled View (15deg cephalad)
  • Middle third #1 Fx site
  • Distal third – common in elderly
  • Medial third <6%
  • Most common Fx in childhood
  • Describe type, displacement, site
40
Q

Luxatio erecta

A
  • Uncommon but distinct shoulder dislocation
  • Inferior glenohumeral dislocation
  • Arm abducted - held above head, can’t move it
  • Significant mechanism required
41
Q

lines of normal alignment

A

Anterior Humeral Line

  • Intersects middle 1/3 of capitellum
  • Must be true lateral
  • Critical in kids

Radiocapitellar Line

  • Bisects capitellum
  • Aligns in all views
  • Check in everyone
42
Q

Perilunate dislocation

A
  • 3x more common than lunate dislocation
  • Lateral: lunate in proper position articulating with radius, capitate and MC’s dislocated
  • “empty teacup”
  • PA view shows “crowded carpals”
  • Often associated with scaphoid, other fx’s, median nerve injury
  • The bones AROUND the lunate dislocate but the lunate stays home
  • This one is very easily missed
43
Q

Shoulder xrays

A

Shoulder series:

  • AP: in external rotation
  • AP in internal rotation (Both common in trauma)
  • “Y” view (Scapula, dislocations) - Y-view: lateral view of the scapula, useful in shoulder dislocations as well as in fractures of the scapula, This view does not require the patient to move the shoulder – can position the patient’s body rather than the arm

AP oblique
-Grashey view: glenoid

Axillary view
-Dislocations, glenoid

Y view = transscapular view (Humeral head should sit right over y)

Radiology 3 (3 decks)

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