lab final terms Flashcards
(109 cards)
1
Q
RA: Atlanto-Occipital
A
• Vertical translation of odontoid > pseudo-
basilar invagination
2
Q
RA: Atlantoaxial
A
- Whittled odontoid
- ADI synovitis
- Bursitis between dens and transverse ligament
- Note the whittled odontoid
3
Q
RA
A
• Anterolisthesis of numerous segments
– Step ladder/door step appearance= multi level anterolisthesis
-erosions
-ADI
4
Q
OA
A
- sclerosis
- enlarged facets
- anterolisthesis usually one level if present
5
Q
RA in SI
A
- Mild loss of joint space
- Iliac erosions
- Sclerosis (minimal or absent)
- Usually unilateral but if bilateral is asymmetric
- Ankylosis very rare
6
Q
Early AS
A
• Onset: 15-35 (avg 26-27) • Bilateral, symmetric • Pseudo-widening of joint • Rosary bead erosions • Sclerosis ( will always be more prominent on iliac side) - sacral ligaments protect sacrum • Best seen on sacral tilt film • Easy to overlook early changes
7
Q
Intermediate AS
A
• Sclerosis begins to obliterate the joint space
8
Q
Chronic AS
A
- Star sign: Bridging ossification of upper SI joint
- Ghost sign: Obliterated joint space
- Bilateral symmetric
9
Q
Romanus lesions:
A
- AS in spine
- focal destruction and erosion of body rim at annulus enthesis
10
Q
Shiny corner sign
A
- AS
• Most often superior anterior VB from healed
erosion
• Increased trabeculation
• Healing erosion causes transient reactive sclerosis
11
Q
Marginal syndesmophytes
A
associated with AS
12
Q
Non-marginal syndesmophytes
A
PA
13
Q
Anterior body squaring
A
,also associated with
AS
14
Q
Bamboo/ poker spine
A
AS
15
Q
costovertebral and costotransverse fusion
A
AS
16
Q
Dagger Sign
A
- AS
- ossification of supraspinous ligament
- trolley track sign
17
Q
Carrot stick fracture
A
- most common in lower cervical and T/L junction
- epidural hematoma in 20%
- anderson lesion is a complication of this
18
Q
Andersson lesion
A
- -complication of a carrot stick fracture
- fragmentation of VB (rapid loss of adjacent endplates with sclerosis)
- pseudoarthritis
19
Q
Thin anterior ossification, lower SI involved
A
AS
20
Q
Thick (disc and mid body) no lower SI, may have upper SI
A
DISH
21
Q
Psoriatic Arthritis
A
- non-marginal syndesmophyte
- T11-L3 MC site
- can cause upper cervical instability (as in RA)
22
Q
PA in SI joint
A
- 30-50% of patients
- Usually bilaeral asymmetric but can be unilateral
- erosions with mild sclerosis
- typically does not proceed to fusion
23
Q
Infectious spondylodiscitis
A
- most often caused by staph aureus (90%)
- prior urinary tract infections
- 40-60 y/0 MC
24
Q
SI infection
A
- unilateral loss of joint space with sclerosis
- rare0 seen in IV drug users
25
Butterfly fragment
-complete comminuted fracture with a triangular cortical fragment that is isolated
26
Spiral fracture
torsion coupled with axial compression and angulation, creates a spiral fracture. in contrast to the blunt-ended oblique fracture, the ends of a spiral fracture are pointed like an in well pen
27
Transverse fracture
-Can occur in healthy bone but frequently seen in diseased bone so always look closely for underlying pathology (ie. Banana-like transverse pathologic fracture associated w/ Paget’s)
28
Chip/corner fracture
-corner of phalanx or long tubular bone
29
Greenstick/ hickory stick fracture
- primarily in infants and children under the age of 10
- tension on convex side... produces a transverse fracture
- important to look for growth plate
30
Buckling/ Torus fracture
- usually seen on an oblique view
- most often seen in metaphysis
- bulging of the cortex caused by compression forces
31
impaction fracture
- subtle radiopaque white line is seen in the region of the impaction
- 2 subtypes:
- depressed-inward bulging of an articular surface (tibial plateau and frontal bone)
- compression - decreased size caused by trabecular telescoping of a vertebral body or the calcaneus
32
Infarction (FX)
-a form of impaction with only a minor break in the cortex
33
Compression fracture
-don't miss the AAA!
-Look for:
>wedge shaped body
>step defect
>ZOC
>hyperflexion injury
>body heigh loss will not come back
34
what is the term for the posterior displacement of the VB?
- retropulsion
| - burst fracture
35
Salter-Harris Type I
* Pure epiphyseal separation that may widen growth plate
* Look for ST swelling on comparison x-ray
* M/C under 5 y/o secondary to birth trauma
36
Salter- Harris II
- through physis and portion of metaphysis
- Thurston-Holland Sign = corner sign
- eriosteum remains intact on the side of the metaphyseal fracture
- M/C: 10-16 y/o
- Distal radius (50%), tibia, fibula, femur, ulna
37
Salter-Harris III
- Through physis and epiphysis
- MC 10-15 y/o
- Medial/ lateral distal tibia, proximal tibia, distal femur
38
Salter- Harris IV
- trace the fracture, it discretely goes through metaphysis and epiphysis
- MC lateral condyle of humerus <10 y/o
- tibia >10 y/o
39
Pseudo-fracture
- caused by softening
- bone weakened by tumor, osteoporosis, infection, metabolic processes
- absence of trauma, pain aids in Dx
- Looser's zones, Umbau zonen, Milkman's syndrome
40
Stress/ fatigue fracture
-Repetitive stress that cause micro fractures,
that as they heal, will show up as endosteal
and or periosteal callus
41
Non union
- failure to complete osseous fusion because of: distraction, inadequate immobilization, infection, impaired circulation
- midclavicle
- ulna
- tibia
42
bone bruise
- ONLY SEEN ON MRI
| - represents microfracture
43
Jefferson/ burst FX
- MOI: forceful blow from vertex
- rust sign: patient holding neck with hands, creating brace
- most are bilateral
- lateral masses of C1 are lateral to body of C2 on APOM
- Use CT to confirm for kids because atlas ring prepuberty is larger than C2
44
Rust sign
patient holding neck with hands, creating brace
45
C1 posterior arch fracture
- caused by hyperextension
| - compression between condyles of occiput and posterior arch of axis
46
Hangman's Fracture
- AKA traumatic spyndylolisthesis aka hangee's fracture
- MC at C2
- hyperextension with chin being jerked back
- fracture through pedicle body junction
- anterior displacement of C2 on C3
47
Teardrop fracture
- caused by hyperextension or hyperflexion
- ALL pulls vertebral body, causing avulsion
- Associated with acute cervical cord syndrome
- Loss of anterior column, lateral spinothalamic tract
- injury to IVD, posterior ligaments
- associated with acute cervical cord syndrome
- upper extremity involvement more often than lower
48
Mach effect
-know types of dens fractures and which heal better and why
49
Type II Dens Fracture
-often doesn't fuse because there is poor blood supply where dens meets body
50
Angular variant
- completely normal to have dens come up and go posterior
| - know it's not a fracture because there is no disruption of the cortex
51
Compression Fracture
- wedge from compression of one vertebra between the 2 adjacent ones
- hyperflexion
- intact ivd, ALL, posterior ligamentous structures
- if ant. body measures >/= than 3mm less than post.=>wedge
- retropharyngeal space may be increased
52
step defect
part of a compression fracture
53
burst fracture
- vertical compression to head propelling nucleus pulposus thru endplate into the body
- CT is best modality
- Widening of interpedicular distance
54
Acute cervical cord syndrome
- associated with a teardrop fracture
| - compelte motor paralysis and loss of anterior column sensations of pain and temp
55
Articular pillar fracture
- do pillar and bone window CT
- C4-C7 MC
- Hyperextension with lateral flexion
56
Clay shoveler's fracture
- aka root puller's fracture
- aculsion of SP by trapezius or rhomboid minor
- MC C7
- FX proximal or middle spinous-displaced inferior
57
double spinous process sign
associated with clay shoveler's fracture
58
atlantoccipital dislocation
- rare usually fatal injury (usually a pedestrian)
- hyperextension and distraction (usually ant)
- prevalent in pediatric patients (survive 3x's than adults)
59
Rotary subluxation C1
- CT definitive method
- frontal view: C1 lateral mass wider and closer to C2 on side of anterior rotation
- torticollis in acute patient
- "cock ribbon" head hold-lateral flexion, head rotated to opposite side and slight flexion
60
pillar dislocation
- bilateral interfacetal dislocation (BID)
- severe hyperflexion injury (soft tissue finding)
- Naked facet sign- absence of one articular surface of a single facet joint
- corners prevent from self reduction - chip fracture may occur
- tear of supraspinous, interspinous, ligament flavum, joint capsule, posterior longitudinal ligament, disc, anterior longitudinal ligament
61
Unilateral interfacetal dislocation
- flexion-rotation forces
- affects IVF
- jumped facet
- bowtie sign- ant displaced pillar and its former opposing pillar
- tear of every ligament as bilateral except facet capsule on side that did not dislocate
62
Bow tie sign
- Unilateral Interfacetal Dislocation
| - Ant displaced pillar and its former opposing pillar
63
Compression fracture
- wedge shaped vertebra
- ZOC- denotes <2 months since injury,
- CT provides Dx
- step defect
- endplate disruption (superior more common)
- In T/s- mc T11/12
- Axial and flexion injury
- osteoporitic biconcave
- codfish type fracture
- MC fx in lumbar spine
64
Codfish Fx
- Compression fx
- biconcave
- MC fx in Lumbar spine
65
Abdominal Ileus
- AKA paralytic ileus
- Occurs with severe spinal trauma
- coin on edge appearance in small bowel
- excessive amount of small and large bowel gas with slightly distended abdomen
- see individual haustra in large bowel
66
Universal fracture
-Pancake fx
-flattened fx
-vertebral plana
-underlying pathologies
>osteoporosis (95%)
>Mets (4%)
>multiple myeloma (1%)
67
Post. Limbus
- aka post apophyseal ring fx
- CT definitive
- MC in adolescence and young adults
- stiffness, spasm, numbness, weakness, claudication
- MC L4-5, L5-S1
- may be asymptomatic
- TQ! must be differentiated from posterior spur
68
Transverse process fracture
- MC: L2,3
- always unilateral
- check for hematuria or lack of urination
- do obliques to rule out intestinal gas or non unions
- 2nd MC of L/S (compression is #1)
69
Chance aka Lap Belt Fx
- aka: fulcrum Fx- hyperflexion over the anterir abdomen- compression and distraction forces
- horizontal splitting of spinous and neural arch
- Upper L/S
- high incidence visceral damage
- empty vertebra sign
- empty vertebra sign
- horizontal splitting of spinous and neural arch
70
horizontal (transverse) sacral Fx
- does not break ring- stable
- MC S3-4 near lower SI jit
- AP view, lateral, sacral base tilt
- Suicidal Jumper's Fx: affects S1 and S2
71
Vertical sacral fracture
```
• Result from indirect trauma to pelvis
• >50%àpelvic organ damage
• NO EVIDENCE ON LATERAL VIEW
• Sacral foramina are interrupted by fracture
(left side)
• Disrupts ring- unstable
```
72
Duverney’s fracture
• Fracture of iliac wing- stable
• From direct force from lateral direction
• Best seen on oblique view
• Stable- surrounding muscles attach, prevent
separation of fractured fragments
• More common in osteoporosis
73
Malgaine’s fracture!!!!!!
• Complications- rupture of the diaphragm, bowels
• M/C fracture in pelvis (1/3)
• Ipsilateral double vertical fx of sup pubic
ramus and ischiopubic ramus, w/ fx or dislocation of the SI jt
• Unstable- high morbidity and mortality rate
– à rupture of diaphragm and bowel
74
Bucket handle fracture
-sup pubic ramus and ischiopubic juntion on side opposite the oblique forve of impact to the pelvis w/ a Fx or dislocation of the SI jt on side of impact
75
Explosion fracture of acetabulum
- always check acetabulum if a patient has an iliac fracture
- car accident- knees hit dashboard
- contraindication to side posture
76
Avulsion fractures of the ilium
- usually tuberosity or bony process
- tug lesions
- athletes
77
ASIS avulsion fracture
- sartorius
- once healed, ddx= osteochondroma
- treatment- open reduction, internal fixation
- pain relieved by HIP FLEXION
78
AIIS Avulsion Fx
- rectus femoris
- active flexion limited
- Ddx osteochondroma
79
Rider's bone
- healed apophysitis or avulsion (hamstrings)
- frequently bilateral
- leaves wide gap (from hyperemia of apophysis)
- can grow larger than ischium
- reduced hip mobility
- D/Dx: osteochondroma
80
Straddle Fx
- bilateral obturator ring Fx
- most common unstable unjury of pelvis
- good chance to tear urethra or puncture bladder
- double vertical fx involving both sup pubic rami and ischiopubic junctions
81
Sprung pelvis
- aka open book
- separation of pubic symphysis and one SI joint
- Severe visceral damage (rupture of urethra)
82
Subcapital impaction fracture
-look at femoral neck for kids and elderly
83
Lesser trochanter fracture
- comminuted
| - must consider it to be pathologic until you prove it isn't
84
whiplash syndrome causes what radiographic findings
- Divergent spinous sign (increased interspinous space)
- soft tissue swelling in retro esophageal space
- widened ADI
- widened or narrowed IVD
- lucent cleft sign (vacuum phenomenon in extension)
- displaced ring epiphysis
- widened Z jt >2mm
85
Hip dislocation
• Most are posterior
• Femoral head are between gluteal muscles
and back of acetabulum
• CONTRAINDICATION: adjusting in side posture
on either side
• DDx: os acetabuli
86
Avulsion Fx of acetabulum
- anytime there is a first time dislocation (other than fingers/toes- must be concerned about a fx)
- image before relocating
87
Posterior dislocation
-no fx, would go ahead and relocate
88
anterior dislocation
-no visible fx - once relocated, STILL a contraindication to side posture for remainder of patient's life
89
bumper/fender fx
- tibial plateau fx from impact of femoral condyles into tibia
- pts are usually >50 yo, common esp in osteoporotic pts
- Fx line is difficult to visualize
- CT valuable
- MRI for soft tissue
- Lateral Tibial plateau
90
Avulsion Fx of anterior tibial spine
-ACL tear--> MRI
-MOI: hyperextension of knee, internal rotation of tibia
>child bicycle fall
91
Segond's fracture
- avulsion at insertion of TFL at lateral tibial condyle
- MRI shows signal intensity
- 75-100% ACL tear
- 70% meniscal tear
92
suprapatellar effusion
- fluid accumulation in suprapatellar pouch
| - looking for a small egg shaped grainy radiodensity
93
lipohemarthrosis
- interarticular fracture
- bone marrow into joint fluid (synovial blood + marrow)
- FBI Sign
- supine lateral knee
94
FBI sign
-Fat (on bottom of xray)
-Blood
-Interface
(lipohemarthrosis)
95
view for patellar dislocation
-sunrise
96
Boot-Top Fracture
• BB fracture- both bones
• From ski boot injuries when boots wouldn’t
auto-release
• Rod in tibia, but they don’t realign fibula
97
Distal Fibula Fx
- lateral malleolus fx
- small sliver of bone Fx at tip of fibula (not in this image)
- AP, Oblique, Lateral
98
Trimalleolar Fx
- 3rd malleolus- post aspect of distal tibia= COTTON'S FRACTURE
- Fx tend to happen with excessive plantar flexion
99
toddler Fx
- anywhere along length of tibia
- spiral fracture that is often a hairline fracture, difficult see
- MOI child gets foot caught in slats of crib
100
Calcaneal compression Fx
- decreased Bohlers angle 28 is lowest it should be
- ALWAYS x-ray thoracolumbar spine as well
- white lines throughout are zones of compaction
101
Talar fracture
• Impact of anterior tibia being forced
downward into talar neck
• AVN of talar neck due to vascularity being compromised
– More anterior the neck fracture, increased
likelihood
– Early formation of a linear lucency beneath the cortex of the dome = intact blood supply
(Hawkin’s sign)
102
Aviator’s Fracture
* Vertical fracture through Talus
| * MOI: automobile injuries- trying to stop
103
Jones/Dancer’s fracture
• Fracture in proximal 5th MT= dancer’s
– Where peroneus brevis tendon inserts àheals without complication
• Middle to distal 5th MT= Jones
• Bone does not have good blood supply > pinned, can still have complication
• Remember- growth plate for apophysis where PB tendon attaches is vertical
104
Bedroom Fracture
* Striking an object with bare foot
| * 1st &/or 5th phalange
105
Lisfranc’s Fx-Dislocation
• Component of Charot’s joint (diabetic foot)
• Tear ligaments of undersurface of foot, 2-4th MT separate from rest of foot
– Foot trapped in stirrup
• Linemen in football
• May be predisposed to secondary OA
106
Clavicle Fracture Non-displaced Clavicle fx
• Occur in 3 separate areas- proximal, middle,
distal 1/3
– Majority in middle 1/3
– Least in proximal
• Nondisplaced- m.c : car accident where shoulder belt fractures clavicle
• Must do AP, 15-20 degree cephalad tilt to get ribs out of way
• Most are non-comminuted, typically align top and bottom with foreshortening
– Stable- wear clavicle support and will heal fine
107
Dista Clavicle Fracture
• Can mimic an A/C joint injury (where
coracoclavicular ligament is stretched/torn)
• Little kids don’t get A/C separations
108
(Post-traumatic) osteolysis of distal clavicle
• Begin to demineralize the end of the bone
• Looking to see that the end of the clavicle is
losing articular surface
– Will be fuzzy
• Repetitive micro trauma- athletes who train with dumbbells
• Control inflammation- ice, nutrition
– Microcrystaline hydoxyappetite- speeds up fractured healing
• Contraindication- hx of stones, blood around area (hematoma) àmyositis ossificans
109
Flap Fracture
```
• Greater tuberosity fx
• Avulsion by the connecting tendons
– Left hand picture- faint lucensy that comes all the way through
• MOI: trauma from fall (unknown how)
• Often only seen on one view
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