Imaging

Question 1

One view on imaging is enough for diagnosis - true or false

Answer 1

False
Some fractures may not be visible from certain angles
Need at least 2

Question 2

How many views do you need in X-rays of the cervical spine

Answer 2

3

Question 3

How many views do you need in X-rays of the scaphoid

Answer 3

4

Question 4

How might a fracture appear on X-ray

Answer 4

Lucency crossing bone

Cortical extension - incomplete border

Question 5

What do fractures involving the joint increase your risk of

Answer 5

Malalignment

This goes on to cause faster wear and tear - leads to secondary OA

Question 6

What causes impacted fractures

Answer 6

Axial loading force

Question 7

What is an avulsion fracture

Answer 7

When tendon/ligament is torn off the bone and pulls off a small fragment

Question 8

List common avulsion fracture mimics

Answer 8

sesamoid bones
accessory ossification centres
Old fractures

Question 9

What is the posterior fat pad sign

Answer 9

May appear behind elbow on X-ray

Always abnormal and indicates elbow trauma

Question 10

Why do children get unique bone injuries

Answer 10

Bones are still soft so may bend and bow rather than snapping

Question 11

What is a buckle fracture

Answer 11

Seen in kids

Appears as a bulge in the bone as it is where bone has gone into itself

Question 12

What is the weakest part of developing bone

Answer 12

Growth plate - physis

Prone to injury and growth deformity

Question 13

What is a Salter-Harris fracture

Answer 13

epithesis slips off the metaphysis due to fracture in growth plate

Question 14

When should you suspect non-accidental injury

Answer 14

When injury doesn’t match the story

Leg fractures in babies who can’t walk

Question 15

Why must you be careful with fractures in bony rings

Answer 15

Very unlikely that they will break in just one place so must look for further injury

Question 16

Give examples of bony rings within the body

Answer 16

Spinal canal
Pelvis
Forearm
Lower leg

Question 17

Which foreign bodies will be seen on X-ray

Answer 17

Metal

Glass

Question 18

Which foreign bodies cannot be seen on X-ray

Answer 18

Plastic

Wood

Question 19

What is a pathological fracture

Answer 19

When abnormality seems out of proportion to the mechanism of injury

Question 20

What can cause pathological fractures

Answer 20

malignancy, osteoporosis or other metabolic bone diseases

Question 21

What is the risk with supracondylar fractures

Answer 21

Damage to the brachial artery and surrounding nerves

Question 22

What is the risk with scaphoid fractures

Answer 22

Blood supply can be disrupts making it prone to non-union or AVN

Question 23

What is a Bennett’s fracture

Answer 23

Involves articular surface of 1st metacarpal base

Tendons pull on thumb leading to displacement

Question 24

Lower limb fractures are associated with high morbidity and mortality - true or false

Answer 24

True

Question 25

List common limitations of X-rays

Answer 25

Assessment difficult due to overlapping anatomical structures Some fractures are impossible to view as projections don't show them up or they are undisplaced Don't show soft tissue injury

Question 26

Which imaging techniques would you use to view soft tissue injuries

Answer 26

US = superficial MRI = deep

Question 27

List typical sites of impacted fractures

Answer 27

Femoral neck Tibial plateau Calcaneus

Question 28

What causes a pelvic ring fracture

Answer 28

High energy trauma - RTA or fall from height Osteoporosis - low energy trauma

Question 29

What are the risks of intracapsular femoral fractures

Answer 29

Interferes with blood supply to femoral head | Prone to AVN or non-union

Question 30

What are the 2 types of proximal femoral fractures

Answer 30

Intracapsular | Extracapsular

Question 31

How do you treat extracapsular femoral fractures

Answer 31

Internal fixation using DHS

Question 32

How do you treat intracapsular femoral fractures

Answer 32

Arthroplasty

Question 33

What are the risks of femoral shaft fractures

Answer 33

Blood loss | Fat embolus

Question 34

What usually accompanies significant soft tissue injury to the knee

Answer 34

An effusion in the suprapatellar space

Question 35

What surrounding structure can be damaged by knee dislocations

Answer 35

Ligaments | Blood vessels - popliteal artery

Question 36

What causes tibial plateau fractures

Answer 36

Valgus force - e.g. being hit on the outside of the knee

Question 37

Which injury mechanism is most common in ankle injury

Answer 37

Inversion | Eversion

Question 38

Ankle fractures usually occur in multiples - true or false

Answer 38

True

Question 39

What predisposes you to tendon rupture

Answer 39

Diabetes RA Steroid use