Closing cases Flashcards
(27 cards)
Pagets
1) Osteosarcoma- 1%
2) High output cardiac failure
3) Insufficiency fractures ( banana)
4) Extramedullary haematopoiesis
Enchondroma
1) Malignancy- 1% if solitary
2) Malignant transformation
- Proximal location
- Endosteal scalloping >2/3
- Fracture
- Pain
- Increased lucency
- Increased activity on successive scans
- soft tissue mass
3) F/U as per orthopaedic oncologist
PF dislocation relocation
1) Medial patellar facet
2) Lateral femoral condyle
3) Tear of Medial PF retinaculum
Causes
- IS of > 1.3
- Shallow trochlear ( <3mm)
- TTG >20mm
Workup
- CT PF tracking to work up dynamic relationship btwn patella and femur
Lunate dislocation
- Triangular configuration of the lunate with bony overlap
- Suggest malalignment of the carpus
- No fractures to suggest greater arc injury
- scaphoid position is normal
- > Isolated volar dislocation of lunate
- > Would like to look at lateral to confirm
HPOA
- Bilateral symmetric periosteal reaction
- In a patient with lower limb plain-> HPOA
-> If the patient is still in department , I would request a CXR
=> DD- bronchogenic mass, empyema, pleural fibroma
HPOA
- Bilateral symmetric periosteal reaction
- In a patient with lower limb plain-> HPOA
-> If the patient is still in department , I would request a CXR
=> DD- bronchogenic mass, empyema, pleural fibroma
Management
- Staging CT
- Proceed to biopsy
Calcaneal fracture ( axial load)
- Compressed Intra-articular fracture that involves the sub-talar facet of calcaneus
- loss of bohlers angle ( normally 20-40 deg)
- > Collapse of the calcaneus
- Suspect that the patient has had an axial load injury
- > Similar fracture on other side
- > Axial load injury of lumbar
Parsonage turner
- Oedematous/ increased signal in supra and infra
- Atrophy of muscle body
- Tendon is spared
- sparing of the other muscles
==> These appearances are in keeping with DENERVATION
-Supplied by the suprascapular nerve ( branch of the thyrocervical trunk)
- looking for compressive lesion in Suprascapular notch i.e. paralabral cyst from labral tear
- Could be more proximal lesion in brachial plexus
= In the absence of these lesions, the appearances are in keeping with parsonage turner syndrome
Popliteal lesion
- Rounded lesion
- Next to popliteal vein
- Look for FAT SIGN on T1
DD
- nerve sheath tumour ( TIBIAL)
- popliteal artery aneurysm
- Dessicated ganglion
Artery-> Black due to fast flow
Nerves-> tibial and common peroneal ( divides into superficial and deep peroneal)
Arthritis
Contiguous destruction of joints
–»>INFECTION
Marked erosive arthropathy
1) Symmetrical
2) Bone density
3) Bone mineralisation
4) Triangular fibrocartillage
5) PROXIMAL vs DISTAL
6) Erosions
- Central
- Marginal
- Juxta-articular
DD====> There is a differential for this film
- Rheumatoid or atypical rheumatoid
- Gout
- Psoriasis
Diagnosis
- Rheumatoid criteria ( Rh factor, symmetric arthropathy)
- Psoriasis ( HLAB26, extensor surfaces)
-
Rectus femoris avulsion
- Indirect–> Superior acetabulum
- Direct–> AIIS
KICKING the ball and missed the ball
Transitional anatomy at lumbosacral junction with bilateral pseudoarthrosis
- > Sacralisation of L5 body
- > Sacralisation of S1
Expansile lesion in trochanter
- Are bone ends!!
DD:
- ABC
- GCT
- Clear cell
- GCT with secondary ABC
- if soft tissue –> No touch lesion and referral to sarcoma MDT
Scapholunate dissociation
- Widening of scapholunate interval
- Rotatory subluxation of scaphoid with ‘ring sign’
- Lateral radiograph DISI deformity of lunate
? triquetral fracture
If not fixed , get OA and then!!
–> SLACC wrist
Talocalcaneal coalition
-dorsal beaking of the talar head
- C-sign
- ball-and-socket ankle
mortise
- asymmetry of the inferior talar necks
-widening of the lateral talar process
- nonvisualization of the subtalar joint medial facet
- close approximation between the talus and calcaneus
Width of articulation < 10mm
Calcaneonavicular
- elongation of the anterior facet of the calcaneus ( anteater )
- The 45-degree medial oblique view is the best diagnostic radiographic projection to demonstrate this type of coalition
Stress fracture
FRACTURE
- dorsal cortex
- Central bone
- Vertically oriented on sagittal radiograph
Perilunate
AP
- Empty lunate
- Overlap of gilula’s archs
LATERAL
- Alignment btwn lunate and radius is unchanged
- distal carpal row is dislocated dorsally
Madelung deformity
- > growth arrest of ulnar side of distal radius
- > +ve ulnar variance ( should have neutral ulnar variance)
complications
- > causes ulnar carpal impaction ( cysts)
- > predispose to TFCC injury ( recommend MRI)
MRI
- Think elongated TFCC and there is no tear
- looking for features of ulnar carpal impaction
DD
- Turners
- Mucopolysaccharoidoses
-
Axillary view ( sub-acromial impingement)
1) Decreased of the sub-acromial joint space
2) Causes of impingement
- Type 2/3 acromion
- Spur
- laterally or anteriorly sloping acromion
- thickened coracoacromial ligament
- Ask for axillary view
–> Look at GH joint space
WORK UP
1) USS
Super scan differential diagnosis
1) Hyperparathyroidism
2) Renal osteodystrophy
3) Osteomalacia
4) Mets- Prostate, breast
Vertebral plana
MELT
1) Mets, Myeloma
2) EG
3) LCH
4) Trauma
Soft tissue calcification
- tumoral calcinosis ( Normal BIOCHEMISTRY)
- Myositis ossificans
- Dystrophic calcifi cation – scleroderma, dermatomyositis (tends to be sheetlike).
- Tumours – synovial sarcoma, chondrosarcoma, 0steosarcoma, synovial osteochondromatosis.
- Chronic renal failure
- Calcium pyrophosphate dihydrate deposition disease (CPPD).
- Hypercalcaemia – hyperparathyroidism, hypervitaminosis D, milk alkali
syndrome, sarcoidosis. - Hyperuricaemia – severe tophaceous gout.
Sclerotic bone mets
Which bone metastases can be sclerotic?
- Prostate
- Breast
- Any adenocarcinoma
- Carcinoid
- Bladder
- (Lymphoma)
