joint repair and imaging

Question 1

chronic shoulder pathologies:
- rotator cuff tear
- recurrent dislocation
- osteoarthritis

Acute:
- acute dislocation or rotator cuff tear
- proximal humeral fracture

Question 2

any joint should have 2 views imaged AS STANDARD

Question 3

what are the 2 standard views for shoulder

Answer 3

AP
lateral scapular (Y) VIEW

Question 4

what is a axial shoulder good for seeing

Answer 4

dislocation, humeral head

Question 5

what projection is good for viewing glenoid rim and identifying fractures, dislocation and humeral head pathology

Answer 5

garth’s projection / modified trauma axial / AP axial oblique

(know what it looks like_

Question 6

what acronym can be used to identify osteoarthritis (know what osteoarthritis looks like)

Answer 6

Loss of joint space
Osteophytes
Subchondral sclerosis
Subcondral cysts

(subcondral = bone beneath cartilage)

osteophyte (bone limb around joint)

Question 7

what direction does anterior / posterior shoulder dislocation go, majority happen in which direction

Answer 7

anterior dislocation = humeral head, goes down and in (towards ribs)

posterior dislocation = humeral head goes up and out

95% are anterior dislocations

Question 8

why’s anterior dislocation more common in shoulder

Answer 8

the muscular and ligamentous support anterior to the humeral head is much less robust than the substantial muscular and bony support afforded posteriorly by the rotator cuff and scapula

Question 9

what is hill Sachs lesion

Answer 9

Hill-Sachs defects are a posterolateral humeral head depression fracture, resulting from the impaction with the anterior glenoid rim.

Question 10

what a bankart lesion

Answer 10

A Bankart lesion (glenoid labrum tear) is an injury to the cartilage in your shoulder joint. I

• characteristic of anterior dislocation / tends to happen along with the hill Sachs lesion

Question 11

what is a zanca view of the shoulder

Answer 11

AP view directed to the AC joint (exaggerates view of AC joint)

Question 12

what is a serendipity view of shoulder and whats it used for

Answer 12

a radiograph of the clavicles is obtained with 40 degrees of upward/cephalic tilt of the X-ray beam

• identifying sternoclavicular dislocation

Question 13

what does ORIF stand for and what is it

Answer 13

qopen reduction, internal fixation

• a type of surgery used to stabilize and heal a broken bone.

Question 14

what is total shoulder and reverse shoulder arthroplasty/ difference between them

Answer 14

shoulder replacement (with metal and plastic)

total shoulder= prosthetic ball and ‘humerus’ going into joint

reverse shoulder = prosthetic ball in joint and the ‘humerus’ sitting on the ball

Question 15

what line is followed to assess for injury in an AP pelvis xray image

Answer 15

shentons line

Question 16

why is a HBL hip needed

Answer 16

• suspected hip fracture/dislocation
• shows true NOF

Question 17

what is a Clements-nakayama view of the hip, whats it done for

Answer 17

• modified view (no movement of patient)
• for suspected BILATERAL NOF fracture or significant bilateral lower limb injury or hip fracture/dislocation
• ## shows true NOF (cuz camera is angled)

Question 18

whats an inlet/outlet view of pelvis for

Answer 18

inlet = see pelvic ring and associated pathology, posterior displacement of ring and fracture to pubic symphysis

outlet = tangential view of inlet view, suspected cephalic shift of hemipelvis

Question 19

what a judet view of hip and its use

Answer 19

2 part view of acetabulum (each side hip get elevated 45degrees)

• evaluation of superior, medial, lateral and posterior surface of acetabulum

Question 20

what is a flamingo view of hip and why’s it done

Answer 20

3 part standing pelvis view,
1. both feet down
2. each feet off one time and WB on standing foot

• evaluation of suspected pubic symphysis instability

Question 21

what is the pelvic teardrop

Answer 21

radiographic feature seen on pelvic x-rays and results from the end-on projection of a bony ridge running along the floor of the acetabular fossa (cotyloid fossa).

(know what it looks like on xray)

Question 22

know where the ilioischial and ileopectineal line is on hip xray

Question 23

is the inlet or outlet view of pelvis the TRUE pelvis

Answer 23

outlet

Question 24

recontructive surgery to restore joint motion and function to relieve pain is called?

Answer 24

ATHROPLASTY

Question 25

what is the difference between THR and hemi/half replacement of hip

Answer 25

THR = femur and head replaced hemi = only femoral head replaced

Question 26

which direction of dislocation is most common in hip

Answer 26

posterior

Question 27

what is IM nail surgery for hipsq

Answer 27

intramedullary nail surgery - a metal rod is inserted into the centre of the femur then fixed at both ends with screws

Question 28

know difference between posterior and anterior dislocation of hip on xray

Question 29

posterior hip dislocation is often associated with other fractures whilst anterior dislocation is always isolated, ant displacement of hip can be classified as superior (iliac/pubic) or inferior (obturator), which is most common

Answer 29

inferior

Question 30

superior anterior dislocation of hip can be mistaken for posterior dislocation, what are something to look for that confirm its anterior dislocation

Answer 30

- lesser trochanter more visible due to eternal rotation - femoral head looks larger than other side due to magnification

Question 31

upon physical/clinical examination, what are clear indicators of posterior hip dislocation

Answer 31

a shorter, internally rotated leg

Question 32

knee has 3 parts, medial, lateral, anterior (patella). what is the difference b/w TKR and partial KR

Answer 32

TKR = all 3 compartments of knee replaced partial = 2 or less compartment of knee replaced

Question 33

how long does a TKR last

Answer 33

10-15 yrs

Question 34

know what a unicompartmental implant looks like on knees, what can it be used for?

Answer 34

osteoarthritis

Question 35

what type of imaging would you want pre-op for knees

Answer 35

weight baring xray, CT, MRI (can show cartilage)

Question 36

why do u need a weight baring xray prior to knee replacement surgery

Answer 36

to gather the mechanical and anatomical axis of femur

Question 37

what is the mechanical and anatomical axis of femur

Answer 37

mechanical = parallel/ straight line down shaft of femur anatomical = straight line down from femoral head (to knee)

Question 38

what are post knee op projections wanted

Answer 38

AP, LATERAL, SKYLINE (40-45 flexion to check alignment)

Question 39

what is a broadens view of ankle

Answer 39

projection that accurately 1 examines the large posterior calcaneal facet and the subtalar joint 2.

Question 40

what is a Harris axial view (heel)

Answer 40

penetrated axial projection) is a special radiographic view that is used for assessment of talocalcaneal coalition. -(calcaneum view)

Question 41

what is a saltzmann view

Answer 41

weight-bearing radiographic view that examines the hindfoot alignment as part of a foot and ankle instability investigation. - shoot image facing toes angled 20 edges towards ankle

Question 42

what is a stress view of ankle and why needed

Answer 42

assess the integrity of the syndesmosis and deltoid ligament - radiographer hold ankle still and pulls tilts foot to either side or can do foot hanging off bed and let gravity pull

Question 43

angle of foot rotation for mortise view, why is this view needed

Answer 43

15-20 degrees - trauma - post op - fracture healing - diagnosing OA or osteochondral injury

Question 44

what is external fixation of ankle

Answer 44

external fixation device may be used to keep fractured bones stabilized and in alignment. The device can be adjusted externally to ensure the bones remain in an optimal position during the healing process.

Question 45

note: external fixation is done first to deal with the soft tissue injury over the fracture

Question 46

once soft tissue injury is healed, external fixation is removed and what procedure can be done to hold bones in palce

Answer 46

ORIF + SYNDESMOTIC SCREW

Question 47

What is athrodesis (type of ankle operation)

Answer 47

orthopedic surgery in which two or more bones in a joint are fused to become one larger bone. - relieves pain that meds cant help with (sacrifices rupture of membrane and function)

Question 48

if not arthrodesis, what other surgery on ankle can be done

Answer 48

arthroplasty - replacements due to severe OA - preserves rupture of membrane and function