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MSK > Trauma Imaging of Lower Limb > Flashcards

Trauma Imaging of Lower Limb Flashcards

1
Q

what is used to show complex features of a fracture if X ray isn’t enough?

A

CT

MRI or US if soft tissue

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2
Q

why is a lower limb fracture more dangerous than upper limb?

A 
higher risks
dehydration and starvation
DVT and PE
pneumonia
much higher death rate, esp if elderly
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3
Q

limitations of X rays?

A

overlapping of anatomical structures (not in CT)
some fractures invisible if either not shown or not displaced
doesn’t show soft tissue injury

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4
Q

how can limitations of X ray be overcome?

A

CT
not affected by these limitations as its cross sectional
MRI gives info about bone marrow so can show un displaced fracture, can also show deep soft tissues
US can show superficial soft tissues

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5
Q

why are fractures visible?

A

as the gap is filled with haematoma so is less dense than bone on X ray

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6
Q

common fracture appearences?

A

fine lucency across normal bone
displacement
impacted sclerotic bone

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7
Q

where is impacted fracture common?

A

tibial plateau fracture
calcaneal fracture
hip?

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8
Q

what is the typical presentation of pelvic ring injury?

A

young people
RTA or fall from a height
usually multiple (affect more than one site - SI joints, pubic symphysis)

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9
Q

how is high energy pelvic injury imaged?

A

X ray if only site of injury

CT if multiple sites or to get more detail of pelvic injury

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10
Q

who gets low energy pelvic ring injury?

A

elderly patients with osteoporosis

due to minor fall or insidious onset

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11
Q

imaging for low energy pelvic ring injury?

A

MRI > CT > X ray

usually multiple injuries

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12
Q

what causes pelvic soft tissue injury?

A

sports injury
usually, acutely, due to muscle tear or tendon avulsion
chronic overuse

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13
Q

common pelvic dislocation story?

A

RTA
contact sports where hip is flexed
typically posterior with acetabular rim fracture

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14
Q

imaging for pelvic/hip dislocation?

A

CT

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15
Q

classification of proximal femoral fractures?

A

intracapsular

extracapsular

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16
Q

intracapsular fractures?

A

interfere with blood supply to femoral head

prone to femoral head AVN or non-union

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17
Q

how is an intracapsular proximal femoral fracture treated?

A

hemiarthroplasty

unless undisplaced or young patient when reduction and screw fixation may be tried

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18
Q

how is proximal femoral fractures imaged?

A

can be invisible on X ray so if high suspicion

  • repeat X ray after 10 days
  • immediate MRI
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19
Q

what causes femoral shaft fracture and what are the risks?

A

high energy
blood loss
fat embolism

20
Q

assessment of knee?

A 
clinical exam
X ray
CT
MRI/US
usually soft tissue, fractures are rarer
21
Q

what can a small avulsed bone fragment indicate in the knee?

A

significant soft tissue injury

22
Q

what usually accompanies a significant soft tissue injury in the knee?

A

effusion which fills suprapatellar space

made of blood etc

23
Q

standard knee trauma X ray?

A

AP
horizontal beam lateral (shows lipohaemarthrosis, blood and fat in suprapatellar recess which is a specific sign of intra articular fracture)

24
Q

knee dislocation on imaging?

A

significant soft tissue disruption
potential for vascular injury
often largery reduced by time of X ray

25
Q

what causes a tibial plateau fracture?

A

usually affects lateral condyle

valgus force with foot planted

26
Q

tibial plateau fracture imaging?

A

CT

27
Q

best imaging for extensor mechanism injury?

A

US

28
Q

best imaging for intr-articular soft tissue injury (e.g meniscal tear)?

A

MRI

29
Q

what can cause knee locking?

A

displaced meniscal tear

bucket handle meniscal tear

30
Q

imaging for hyaline cartilage injury?

A

MRI - can show extent of injury, any loose bodies and assess surgical repair

31
Q

risk with hyaline cartilage injury?

A

early OA

32
Q

why are tibia or fibular fractures usually accompanied by another fracture?

A

as they form a bony ring

33
Q

what usually causes ankle injury?

A

inversion or eversion

34
Q

ankle assessment?

A

examination - check for soft tissue swelling
imaging
- check bony alignment

35
Q

non uniform ankle joint space?

A

indicates instability often with ligamentous injury

36
Q

describe malleolus fractures?

A

may be solitary

in which case they are often small avulsion fractures or undisplaced

37
Q

trimalleolar fractures?

A

medial. lateral and posterior malleolus all affected

38
Q

imaging for complex ankle fractures?

A

CT

39
Q

3 other sites of ankle fracture?

A

talar dome (excessive inversion or eversion)
- best diagnosed via MRI as can be invisible on X ray
5th metatarsal (inversion injury)
- can resemble lateral malleolar
- transverse
calcaneous (falling from height onto heel)
- loss of central peak and increased bone density

40
Q

what can mimic fractures in lower limb?

A 
accessory ossification centres
sesamoid bones (fabella behind knee. at 1st metatarsal head)
41
Q

what can predispose to ankle tendon rupture?

A

diabetes
RA
steroid use

42
Q

common midfoot injuries?

A

TMT joint (Lisfranc)

43
Q

describe Lisfranc injury?

A

loss of congruity between metatarsal bases

often accompanied by ligamentous avulsion fractures

44
Q

what are the features of an extracapsular proximal femoral fracture?

A

doesn’t affect blood supply to the femoral head so doesn’t cause AVN or non union

45
Q

how is an extracapsular proximal femoral fracture treated?

A

internal fixation using DHS

MSK (66 decks)

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