Imaging-Fractures Flashcards Preview

MSK II > Imaging-Fractures > Flashcards

Flashcards in Imaging-Fractures Deck (29)
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1
Q

What are the areas of bone indicated?

A

Physis, medulla and cortex

2
Q

How many views are necessary for radiological diagnosis?

A

2 othogonal (perpendicular) views. You can’t see a fracture unless the x-ray beam is tangential to the fracture.

3
Q

Why is it important to get a view of distal and proximal structures of a deltoid ligament rupture as seen below?

A

The force needed to break the ligament is also transmitted up the interosseous membrane. Notice the fracture that concurrently occurred in the top of the fibula.

4
Q

What is soft tissue swelling typically related to in a child? In an adult?

A

Child = bone injury (weakest part of their bodies). Adult = ligament or tendon injury

5
Q

What is dislocated in this patient?

A

Lunate. It should be lined up parallel with the capitate and the scaphoid.

6
Q

What are important things to look for when trying to find fractures in radiographs?

A

Breaks in the cortex, abnormal densities (dislocations), soft tissue swelling and hemarthrosis.

7
Q

What is the sail sign in the elbow?

A

The anterior fat pad that surrounds the joint capsule of the elbow gets pushed out due to joint effusion. Joint effusion can hint towards a fracture because a fracture can cause blood to fill the joint space.

8
Q

What fracture is common in a FOOSH injury in children and elderly? Adults? Really young children?

A

Colles fracture (distal radius). scaphoid. Distal humerus fracture.

9
Q

An elderly woman falls on an outstretched hand. Radiographs are shown below. What is your diagnosis?

A

Colles fracture (distal radius)

10
Q

What bone could you examine better for a fracture if you have the patient ulnar deviate?

A

Scaphoid

11
Q

What lingo do you use when describing a fracture to an orthopedic surgeon?

A

*

12
Q

When might you have to treat this patient with antibiotics?

A

If it is a tuft fracture (the nailbed is not in tact and it is an open fracture)

13
Q

Where is this humeral head displaced?

A

Anteriorly, this is the most common direction for dislocations because ligaments are weak there.

14
Q

What type of fracture is this?

A

Transverse. It is transverse to the bone.

15
Q

What type of fracture is this?

A

Oblique. The fracture is oblique to the bone.

16
Q

What type of fracture is this?

A

Spiral fracture. It goes 360 degrees around the bone.

17
Q

How would you describe the angulation of this femoral fracture?

A

The apex of angulation is medial or the apex of the distal fragment is lateral.

18
Q

How would you describe the displacement of this radial fracture?

A

The distal fragment is displaced laterally half the bone width.

19
Q

How can you tell if a fracture has rotated?

A

Look for changes in density around the cortex of the fracture.

20
Q

Which of these breaks is more common?

A

The over-ride. Muscle often pulls the broken bone back so they over-ride each other. Distraction is much less common.

21
Q

What modality is more sensitive in diagnosing stress fractures?

A

Bone scan (bottom picture) or MRI (top picture)

22
Q

What do you see here?

A

A little stress fracture. Note the little line of sclerosis that breaks the lines of trebeculae that go in the weight bearing direction.

23
Q

A hurdler comes to see you with this condition. What is your diagnosis?

A

An avulsion fracture of the ischial tuberosity from the hamstrings pulling on it.

24
Q

What makes your wheels start spinning when you see this? What additional view do you need to do to confirm you diagnosis?

A

There is a lot soft tissue swelling beneath the patella so you start thinking about joint effusion. Doing a cross-table lateral view will allow you to see elevation of fat caused by fat leaking out of the marrow of a broken bone.

25
Q

What fractures are unique to children?

A

Torus/buckle (notice the “bent” cortex), greenstick (notice only one side of the cortex broke) and physeal (through the growth plate)

26
Q

What is the weakest part of the bone in a child?

A

Physis. Growth plate fractures are the most common fractures in children and are worse the younger the child is.

27
Q

How does fracture healing appear on a radiograph?

A

Soft tissue swelling => subperiosteal bone formation and soft callus (1-2 weeks) => indistinct fracture line (2-3 weeks) => hard callus => remodeling

28
Q

When are fractures really urgent to get reduced?

A

When you don’t feel distal pulses because of neuromuscular injury.

29
Q

What do you assume of the borders of the fracture line are sclerotic?

A

Nonunion of a fracture.