Ch 19

Question 1

What is the Salter Harris Type I

Answer 1

Fracture through the epiphyseal plate

Question 2

Type II Salter Harris Fracture

Answer 2

Fracture through the epiphyseal plate and metaphysis (most common)

Question 3

Pediatric fracture in which fracture line is through the epiphyseal plate and epiphysis

Answer 3

Type III Salter Harris

Question 4

Fracture line through the epiphysis, epiphyseal growth plate and metaphysis

Answer 4

Salter Harris IV Type

Question 5

Salter Harris Type V fracture

Answer 5

Compression fracture through epiphysis to the growth plate

Question 6

What is the difference in Salter Harris Type VI, VII, and VIII

Answer 6

VI: injury to perichondral structures
VII: Isolated injury to epiphyseal plate (not to be confused with Type I of fracture through)
VIII: Isolated injury to the metaphysis

Similarity- all very rare

Question 7

Nightstick fracture

Answer 7

Ulna shaft fracture with no injury to radius or IM

Question 8

Essex Lopresti fracture

Answer 8

Dislocation of the radius, disruption of the interroseus membrane, and DRUJ dislocation

Question 9

Monteggia Fracture

Answer 9

Fracture is the proximal 1/3rd ulna with radial head dislocation; classified by radial head dislocation

Question 10

Galeazzi Fracture

Answer 10

Reverse monteggia, fracture of the distal middle or 3rd of radius with dislocation of DRUJ

Question 11

Terrible Triad

Answer 11

Radial head fracture, coronoid process fracture, and proximal ulna dislocation

Question 12

Lines of Gilula

Answer 12

Curves drawn on PA projection reflecting carpal arcs at proximal border of proximal carpal row. And proximal border of distal row : disruption implies carpal fracture or intercarpal ligament disruption

Question 13

Radial Step off

Answer 13

Alteration of distal surface of radius seen as step off rather than gradual slope away from radial styloid; allows for lunate to shift proximally and disrupts the proximal Gilula line

Question 14

Radial inclination

Answer 14

Aka Ulnar tilt, lateral to medial angle of the distal radius; distal radius slopes proximally lateral to medial with normal range 15-25 which allows wrist greater ulnar deviation than radial; decreased radial inclination limits wrist ulnar deviation

Question 15

Ulna variance

Answer 15

Relative length of distal ulna compared to distal radius; normal 0-1mm, more than 2.5mm is positive ulnar variance, if proximal to distal radius by 2.5mm then negative ulnar variance; TFCC can accommodate 1-2mm but greater leads to strain or compression of disc

Question 16

Scaphoid ring sign

Answer 16

Aka signet ring sign; visualization with radial deviation in image as scaphoid distal pole rotates volarly and superimposes on the body of the scaphoid with increased density; may represent scapholunate ligament disruption or no injury as well

Question 17

PA view ulnar deviation

Answer 17

Shows scaphoid fracture best as distal pole rotates dorsally to neutral showing full axial length and rules out SL dissociation

Question 18

PA image in radial deviation

Answer 18

Visualization of lunate, triquetrum, hamate, and pisiform

Question 19

Stress view

Answer 19

Clenched fist; increased SL space with force from gripping indicating dynamic instability; widening of DRUJ due to laxity of TFCC

Question 20

Static instability

Answer 20

Increased SL space on static PA compared to other side vs clenched fist view for dynamic instability

Question 21

Oblique views can show unobstructed view of what?

Answer 21

Trapezium, trapezio-trapezoid joint, Bennet fracture, 1st/2nd intermetacarpal joints

Question 22

Triquetral fractures are often associated with what?

Answer 22

Ligamentous avulsion injury in which there is a fragment of bone on dorsal hand

Question 23

Carpal instability patterns are best shown in what kind of image?

Answer 23

Lateral wrist view

Question 24

Why is the proximal carpal row most unstable?

Answer 24

This intercalated segment lacks muscle and tendon insertions; note in normal view lunate is centered over the distal radius and capitate is centered over the lunate creating C’s

Question 25

What is a DISI deformity?

Answer 25

Dorsal intercalated segmental instability; the disruption in the SL ligament causes the lunate to follow the triquetral which extends or causing a dorsal tilt of the lunate or lunate concavity rotated dorsally

Question 26

What is a VISI deformity?

Answer 26

Due to disruption/laxity in LT ligament, the lunate then follows the flexion or volar tilt of the scaphoid; the lunate concavity is then rotated volarly; SL angle would be greater than 30 degrees for this

Question 27

What all can causes DISI deformity?

Answer 27

SL ligament tear or laxity, distal radius fracture malunion or scaphoid fracture

Question 28

What is a peri lunate dislocation?

Answer 28

The lunate is centered over the radius but the capitate is not centered at the lunate concavity

Question 29

What is a lunate dislocation?

Answer 29

The capitate is centered over the radius but the lunate is not

Question 30

Typically metacarpal fractures are associated with what apex compared to proximal phalanges?

Answer 30

Metacarpals are typically apex dorsal or flexed but proximal phalanges they are typically apex volar or extended; middle are unpredictable- base typically dorsal but neck volar

Question 31

What injury can occur with a PIP joint dorsal dislocation?

Answer 31

Usually caused when digit is in extension and then causes a volar plate injury or avulsion fracture

Question 32

What are dorsal lip fractures?

Answer 32

Volar fracture dislocation of PIP joint at base of middle phalanx with less than 1mm displacement treated with orthotic as in with boutonnière deformity; greater than 1mm displacement or Volar subluxation of PIP requires a surgery

Question 33

What are Pilon fractures?

Answer 33

Uncommon; intra-articular fracture of PIP joint : communition, central depression, and splay sagittally and coronally or joint surface

Question 34

What is the Brewerton ball catcher’s view?

Answer 34

Helpful to assess metacarpal heads, MCPs at 65 degree flexion, beam is projected at 15 degrees

Question 35

What is the difference between a Bennett’s fracture and Rolando’s fracture?

Answer 35

Bennett’s fracture is transverse fracture of base of 1st metacarpal vs Rolando is comminuted usually in a T or Y at base of 1st metacarpal and is intra-articular unlike the non articular Bennett’s (best seen in oblique view of PA view)

Question 36

How is Trapeziometacarpal arthritis viewed?

Answer 36

4 ways- PA, oblique, and Robert’s view (pronated A/P)

Question 37

What is the Eaton classification system?

Answer 37

Or Modified typically used for diagnosis and treatment indications of trapeziometacarpal arthritis criticized as not always lined up with X-RAY

Question 38

What is stage I of Eaton staging?

Answer 38

Normal articular surfaces or possible widening due to effusion

Question 40

Stage II of Eaton

Answer 40

Joint space narrowing, less than 1/3 joint subluxation, medial osteophytes less than 2mm

Question 41

Stage III of Eaton

Answer 41

Marked joint space narrowing, subluxation greater than 30%, medial osteophytes greater or at 2mm, sclerosis and cystic changes

Question 42

Stage IV of Eaton

Answer 42

CMC arthrosis and STT arthrosis; pantrapezial

Question 43

What is pantrapezial?

Answer 43

“Pantrapezial” is a medical term that refers to something involving the entire trapezium bone or the trapeziometacarpal (TMC) joint, often in the context of arthritis. Breakdown: • “Pan-” means “all” or “entire.” • “Trapezial” refers to the trapezium, one of the small bones in the wrist, located at the base of the thumb.