bone path midterm 2nd half Flashcards
(136 cards)
1
Q
Sacral dyslplasia/ agenesis is associtaed with what?
A
scoliosis, myelomeningocele, hip dislocation, foot deformity and has a strong association with maternal diabetes.
2
Q
Iliac apophysis is aka? What is iliac apophysis?
A
Risser’s sign. And is an indicator of skeletal maturity.
3
Q
Where will the iliac apophysis grow from and fuse to?
A
From Lateral ASIS to medial PSIS and will fuse to ilium.
4
Q
What are the grades of rissers sign like?
A
1+= 25%. 2+= 50%. 3+= 75%. 4+= 100% and 5+= fused.
5
Q
What age will fusion of the iliac apophysis take place at?
A
16 in boys and 14 in girls.
6
Q
The pattern of iliac apophysis parallels what?
A
The formation and progression of scoliosis.
7
Q
What is the triradiate cartilage?
A
Area of synchondrosis between ilium, ischium, and pubis.
8
Q
What will the triradiate cartilage look like in pediatrics?
A
Normally will be seen as a radiolucency at the acetabulum.
9
Q
What is the ischial apophysis?
A
Secondary growth center at ischium and is normal to seen in pediatric patients.
10
Q
What is the paraglenoid sulci and it is aka?
A
notched out area at the inferior aspect of the ilium adjacent to the SI joint and it is the insertion point of the SI ligament and is aka preauricular sulci.
11
Q
When is the paraglenoid sulci aka preauricular sulci seen?
A
Common in female pelvis but rarely seen in males.
12
Q
What is the name of the Y or V shaped lucent grooves seen with sclerotic margins in the iliac?
A
Iliac nutrient grooves.
13
Q
Phleboliths are radiopacities with lecent centers that are located where?
A
Pelvic veins.
14
Q
Sacrotuberous ligament ossification is often seen when?
A
In diffuse idiopathic skeletal hyperostosis and flourosis.
15
Q
What is Os acetabuli?
A
An accessor ossicle located adjacent to the superior-lateral aspect of the acetabulum.
16
Q
How can you differentiate an Os acetabuli from a fracture?
A
Os acetabuli will have rounded and corticated appearances.
17
Q
What is synostosis?
A
union of two or more separate bones to form a single bone
18
Q
What is ring epiphyses?
A
unossified cartilage at the inferior and superior anterior vertebral body marigns and this is normal for people under 15 years.
19
Q
What is the most common chest wall anomaly?
A
Pectus excavatum.
20
Q
Pectus excavatum is aka?
A
Funnel chest.
21
Q
What is pectus excavatum aka funnel chest?
A
midline depression of the sternum.
22
Q
What is pectus carinatum?
A
An anterior displacement of the sternum and is aka pigeon breast.
23
Q
Pectus carinatum is associated with what?
A
Marquio’s disease.
24
Q
What is the name of a 1st and 2nd rib synostosis?
A
Serb’s anomaly.
25
What is the rhomboid fossa?
This represents the attachment of the rhomboid ligament to the first rib.
26
How do you position the patient for a AP Pelvis film?
Internally rotate femurs 15 degrees.
27
How is the femoral angle measured and what is normal?
Draw one line parallel to the midaxis of the femoral shaft and one line parallel to the midaxis of the femoral neck and meausre angle inside and normal is 120-130 degrees.
28
What is femoral herniation pit? Aka?
round lucency (seen around femoral neck) that represents reaction to irregular capsule and/or iliopsoas irritation. AKA pitt's pit.
29
What is the clinical significance of femoral herniation pit aka pitts pit?
usually asymptomatic.
30
What is seen at the head of the femur that may look like an anomaly?
Foveas capitus centralis and this is a notch along the axial aspect due to the round ligament.
31
What is putti's triad?
3 things that make up the findings for acetabular dysplasia / congenital hip dislocation. 1. absent/small proximal femoral epiphysis. 2. Lateral femoral displacement. 3. steep acetabular roof.
32
When will acetabular dysplasia/ congenital hip dislocation be diagnosed?
Seen in infancy and done by Ultra sound in first 3 months or x-ray after first 3 months.
33
What are 2 orthopedic tests that can be done fro acetabular dysplasia/ congenital hip dislocation?
ortoloni's and Barlow's tests.
34
What is a bipartite patella?
Failure of complete ossification of the patella results in an isolated segment or segments (tripartite and multipartite if over 3).
35
Where are bipartite patellas most commonly seen at (where is the fragment)?
Superolateral quadrant of the patella.
36
What causes bipartite patellas?
Unknown but chronic trauma during ossification is thought likely NOT DUE TO TRAUMA.
37
Will bipartite patellas be uni or bi lateral?
40-80% of the time they are bilateral.
38
What is a normal notch seen on the lateral femoral condyle?
Popliteal tendon groove.
39
Name the accessory ossicles of the foot?
Os trigonum, Os tibial externum, os supranavicular, OS peroneum.
40
Which accessory ossicle of the foot is most common and which one is injured the most?
Both are Os trigonum.
41
Where will Os trigonum be seen at?
Posterior aspect of the talus.
42
What will advanced imaging show for os trigonum?
If symptomatic can show focal uptake on bone scan and signs of edema in soft tissues.
43
Where is Os tibiale externum seen at?
Medial to the navicular.
44
How many sub types of Os tibiale externum are there and which one is most common?
3 subtypes and type II is most common and is triangular with a flat surface abutting the navicular.
45
Where is the Os supranavicular seen at?
Adjacent to the navicular.
46
Where is the Os peroneum seen at?
Near the cuboid.
47
What is tarsal coalition?
a congenital condition of fibrous, cartilaginous, or bony union of 2 or more tarsal bones.
48
What tarsal bone is always invovled in tarsal coalition and what other bones will it be joined to?
Calcaneous will always be part of it and it will connect to either navicular (most common) or talus.
49
What causes tarsal coalition?
congenital- failure of mesenchymal segmentation during early embyronic development or aquired- as a result of infection, trauma, inflammatory arthritis, or surgery.
50
What is the clinical significance of tarsal coalition?
Many cases remain asymptomatic throughout life minor trauma can trigger pain.
51
Tarsal coalition is probably the ________ diagnosis clinically.
missed.
52
What is a loss of the subtalar joint called?
Talocalcaneal synostosis.
53
What is the name a normal lucency in the distal fibula?
Fibular fossa.
54
What is a well-circumscribed radiolucency present in the calcaneus that is normal and what causes it?
Calcaneal pseudocyst and it is caused by the orientation of the calcaneal trabeulae.
55
What is a normal radiolucency that is seen in the greater tuberosity of the humerus called?
Humeral pseudocyst.
56
What is the lucency normaly seen in the clavicle?
The conoid ligament insertion.
57
What will the name be of the timor like appearance of bone that is just the attachment site of the biceps tendon?
Radial tuberosity.
58
What is VATER syndrome?
a syndrome of congenital anomalies that is often seen when multiple congenital anomalies are present.
59
What is negative ulnar variance?
When the ulna is proximal to the perpendicular line (A shortening of the ulna).
60
What 2 things are associated with negative ulnar variance?
Kiennbock's disease, and post traumatic scapholunate disslocation.
61
What is Kienbock's disease?
Sclerosis, collapse, and fragmentation of the lunate.
62
Negative ulnar variance is implicated in what?
avascular necrosis of the lunate.
63
What bones are connected in carpal coalition?
Mainly the Lunate and triquetrum, but can be others.
64
What is the most common developmental anomaly of the hand?
Syndactyly.
65
What is syndactyly?
Fusion of skin between digits or fusion of osseous phalanges of adjacent digits.
66
What is polydactyly?
Extra digits.
67
Polydactyly is most common amoung who?
Blacks.
68
What is a sponyloysis?
AN interruption of the pars which may be either uni or bi lateral.
69
What is spondylolisthesis?
Displacement of a vertebral body in relation to the segment below it and is traditionally an anterior displacement.
70
What are the different ways to grade spondylolisthesis's?
1. Divide sacral base into four areas using 3 lines. Then grades will be 1-5. 5 is when there is a spondyloptosis. 2. Measure displacement then divide by length of the sacral promontory and multiply by 100 and this gives you a percentage. 3. You can just give millimeters of displacement.
71
What is the best way to identify a spondylolisthesis?
Compare posterior vertebral body line (george's Line). Could also use Ulmanns line which is a perpendicular line to the sacral base formthe anterior sacral promontory and if this line intersects through the anteriorinferior margin on L5 then an anterolisthesis should be suspected.
72
What line is better at identifying spondylolisthesis George or Ulmanns?
Ulmanns is more accurate.
73
What are the 6 categories of spondylolisthesis?
Type I- Dysplastic= congenital abnormality. Type II- Isthmic= direct alteration to the pars. Type III- Degenerative= secondary to degenerative arthrosis of the zygaphyseal joints. Type IV- Traumatic= secondary to fracture of areas other than pars. Type V- Pathologic= bone disease. Type VI- Iatrogenic= surgical interventions gone bad.
74
What are the different subtypes of Type II spondylolisthesis?
A- caused by biomechnical stress believed to be stess fractures. B- Elongation of the pars without separation due to healing of a pars fracture. C- acute (as in just happened not repetitive trauma or stress fractures) pars fractures and is rare.
75
What is a common type I spondylolisthesis?
Congenital malformation of the upper sacrum and or the neural arch of the L5 vertebra and is non-spondylolytic.
76
What type of spondylolisthesis is most common?
Type II.
77
What causes a type II spondylolisthesis and what is it aka?
caused by repetitive trauma, stress fractures of the pars and is not a congenital condition. AKA spondylolysis spondlylolisthesis.
78
What is the role of genetics with type II spondylolisthesis?
Certain genetic factors may predispose an individual to the defect, but the defect is aquired.
79
What is seen 13 times more in people with pars defects?
Spina bifida occulta.
80
90% of all spondylolysis spondylolisthesis are found where?
L5.
81
What is the most commonly proposed cause of Type II spondylolisthesis?
Stress fractures.
82
What type of posture can be associated with type II spondylolisthesis?
Hyperextension.
83
Since spondylolysis spondylolisthesis are only found in humans (besides one gorilla) what is the causal factors?
Upright posture with repetitive hyperextension.
84
Why will pars stress fractures (type II) not heal like other stress fractures?
people are not immobilized at the time of spondylolysis and this results in non-union of the stress fracture.
85
What is the correlation between the degree of anterior displacment and the severity of subjective symptoms?
There is no correlation.
86
What % of people with radiologic signs of sponylolisthesis never develop symptoms?
50%.
87
Will there be pain that is specifically related to spondyloysis and/or spondylolisthesis?
No spondylolysis with or without spondylolisthesis does not cause pain in most patients.
88
what typically happens to the cnetral canal with isthmic spondylolisthesis?
It actually increases with isthmic spondyloisthesis.
89
What are the clinical findings with a grade 1 type II spondylolisthesis?
minimal to absence of any physical findings and may reveal an audible click and step-off defects may be felt.
90
What are the clinical findings with a grade 2-4 type II spondylolisthesis?
Postural changes, accentuated lumbar lordosis, gait patter (pelvic waddle, phalen-dickson sign, short stride and stiff-legged), neurological evaluation is usually unremarkable.
91
What is the gold standard to identify Type II spondylolisthesis?
Single-photon emission computed tomography (SPECT). A specialized bone scan.
92
Why will SPECT be so good at identifying Type II spondylolisthesis?
Spondylolysis will have a higher metabolic rate at the defect and this is picked up with SPECT.
93
How helpful will bone scans and MRI be at identifying Type II spondylolisthesis?
Bone scan- good just not as many angles and may fail to reveal spondylysis in as many as 53% of cases. MRI- good at identifying bone marrow edema with active spondlyosis of area around pars.
94
When is an inverted napoleon's hat seen?
With a grade 2 or greater type II spondyolisthesis of L5 when the TP is superimposed over the sacral base and ala.
95
When are sclerotic (pathological hardening or thickening) pedicle signs seen?
usually associated with unilateral defects, but can be seen with bilateral defects particularly when healing is occurring.
96
What is a common finding seen with L5 spondylolisthesis?
L4 retrolisthesis.
97
50% of retrolistheses at L4 will have what?
A symptomatic L4-5 derangement.
98
What is the most reliable view that depicts spondylolysis?
Oblique.
99
What is it called when the sacrum grows more bone to support an anterolisthesis?
Buttress phenomenon.
100
What is the importance of the buttress phenomenon?
It will be a better prognosis and probably be stable.
101
What are the different parts of the scotty dog (eye, nose, ear, foreleg, neck, body)?
Eye-pedicle, Nose- TP, Ear- SAP, Foreleg- IAP, Neck- pars, body- lamina.
102
What is needed to radiographically consider a spondylolisthesis unstable?
Progressive anterolisthesis, high grade slop (>25), sacral doming with trapezoid L5 vertebral body, larger slip angles and excessive mobility on dynamic stress radiography.
103
If there is a high risk of increasing instability of a spondylolisthesis what type of imaging should be done?
Flexion- extension at 6-12 month intervals especially during adolescent growth periods.
104
What are the 2 peak times for progression of anteriolisthesis?
Prepubertal growth spurts, and onset of disc degeneration.
105
Grade 1 slips generally progress how much?
usually not more than 1% after they occur.
106
Who will have an increased frequency of slip progressino and excessive mobility?
Children with high grade slip greater than or equal to 50%.
107
What is the threshold for indicating the need for surgery with spondlyolisthesis?
There is no consensus.
108
If a patient presents with low back pain from recent trauma and they had a long standing Type II spondylolisthesis how can you tell if this spondylolisthesis has been aggrevated by the recent trauma?
Take flexion- extension films to determine segmental instability and a SPECT can be helpful to determine increased physiologic activity of the subchondral bone at the level of the pars.
109
What will give us the definitive diagnosis of a pars fracture? How about stress fractures?
Axial CT. Stress- SPECT.
110
What is a subtle sign of a pars fracture in an early phase before the emergence of a defect?
Bone marrow edema best demonstrated on a T2 MRI.
111
What is the correlation between bone marrow edema and the presence of back pain?
Closely correlates.
112
What happens to the discs usually in between a type II spondylolisthesis?
Normal hydration preserved height are common in small slips.
113
What happens to the disc usually with a retrolisthesis?
Usually tandem disc pathology; dehydration, loss of height, curcumferential disc bulging and frank herniation.
114
What is the reason pars fractures don’t heal?
Dealyed diagnosis, failure to rest adequetly, inherent biomechanics placing stress at pars, poor blood supply.
115
What % of adult patients with sponylolisthesis show progressive displacment?
2-3%.
116
What age will anterior displacement from spondylolisthesis happen at primarily?
between ages of 5 and 10.
117
Maximum anterior displacement is usually seen within how long after development?
18-24 months which usually takes place before the patient is 10.
118
Will cessation of athletic activity influence the degree of slippage from sponylolisthesis?
No.
119
What are the 4 reasons to have surgery for spondylolisthesis?
unstable or progressive, nerve compression, failed conservative treatment, less than 10 years old with grade 2 or greater and progressive slippage with neurological deficit.
120
What are the 3 f's and what type of spondylolisthesis are they for?
Type III- Female, Fourth lumbar vertebra, forty years or older.
121
What happens to L4 vertebra with a type III spondylolisthesis?
anterior displacement not more than 25% (or grade 1), the majority will only slip 10-15%.
122
How much more common are type III spondylolisthesis in females than males?
6 times.
123
What is the mechanism of displacment for type III spondys?
Combination of zygapophyseal joint arthrosis, disc degeneration and remodeling of the articular process and pars.
124
What should be considered if the patient is presenting with intermittent neurogenic claudication?
Degenerative spondylolisthesis.
125
What causes pain with degenerative spondylolisthesis?
It is usually due to arthritic changes and foraminal compromises.
126
Type IV spondys occur as a result of what?
An acute severe injury that creates a fracture of a portion of the neural arch other than at the pars.
127
What is the a common location for type IV spondys?
C2 and it is known as a hangmans fracture.
128
What is the prognosis for a type IV spondy?
They usually heal when appropriately immobilized.
129
Type V spondys occur how?
Due to generalized or systemic disorders of bone that affects the neural arch of the spine. Metastatic carcinoma, osteopetrosis, pagets disease are some common causes.
130
What is more common uni- or bilateral isthmic spondys?
Bilateral.
131
What type of isthmic spondys have a higher chance of healing?
Unilateral defects.
132
What will the spondylolisthesis be like for unilateral isthmic?
most cases never show anterior slip but if they do slip it is less than 5-10%.
133
How are many cases of unilateral isthmic spondylolisthesis identified?
The contralateral pedicle will be sclerotic (abnormal hardening).
134
What will the facets be like with a unilateral isthmic spondy?
The ipsilateral facet will frequently show facet dysplasia (abnormal development).
135
Where is one of the most common locations for a type I spondy?
C6 is the most common location.
136
What is the prognosis for the type I spondy?
If stable (can be seen on flexion extension views) and has not neurological complications the majority of patients remain asymptomatic.
