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Lab Review 1 Flashcards

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1
Q

What is the diagnosis?
Which radiographic line is abnormal?

A

SCFE
Klein line

type 1 Salter-Harris fracture

line should intersect a portion of lateral capital epiphysis

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2
Q

Patient is a 10-year-old male. He is overweight and complains of pain in the left hip. He presents with a limp.
What is the diagnosis?

A

SCFE

type 1 Salter-Harris fracture

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3
Q

13-year-old male presents with wrist pain.
What is the diagnosis?

A

Gymnast fracture

type 1 Salter-Harris fracture at distal radius

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4
Q

What is the diagnosis?

A

Type 1 Salter-Harris fracture

fracture through physis

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5
Q

What is the diagnosis?

A

Type 2 Salter-Harris fracture

fracture through physis and portion of metaphysis

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6
Q

What is the diagnosis?

A

Type 3 Salter-Harris fracture

fracture through epiphysis extending to edge of physis (5th MCP)

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7
Q

What is the diagnosis?

A

Type 4 Salter-Harris fracture

fracture through epiphysis, across physis, through metaphysis

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8
Q

What is the diagnosis and mechanism?
Is this stable or unstable?

A

Jefferson fracture due to axial compression
Unstable (emergency transport)

presents with postive Rust sign

note widened paraodontoid space with offset of lateral atlantoaxial alignment

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9
Q

What is the diagnosis and mechanism?
Is this stable or unstable?

A

Jefferson fracture due to axial compression
Unstable (emergency transport)

DDx posterior arch fracture

note fractured posterior and anterior arches of C1

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10
Q

What is the mechanism of posterior arch fracture?
Is this stable or unstable?

A

Hyperextension e.g. whiplash
Stable

DDx partial posterior arch agenesis

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11
Q

What is the diagnosis and mechanism of injury?
Is this stable or unstable?

A

Hangman fracture
Unstable (emergency transport)

bilateral fracture of C2 pedicles

leads to traumatic spondylolisthesis

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12
Q

What is the diagnosis?
Is this stable or unstable?

A

Teardrop fracture at C2
Unstable (emergency transport)

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13
Q

20-year-old male presents with neck pain after a hyperextension injury. This is his x-ray.
Which ligaments are ruptured?

A

ALL ruptured

only ALL

teardrop fracture at C2

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14
Q

20-year-old male presents with neck pain after a hyperextension injury. This is his x-ray.
What neurologic injury is of concern?

A

Central cord syndrome: loss of motion and sensation in the upper extremities

due to extension

teardrop fracture at C2

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15
Q

What is the diagnosis?
Is this stable or unstable?

A

Teardrop fractures C4 and C5
Unstable (emergency transport)

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16
Q

16-year-old male dove into shallow water forcing his neck into flexion. This is his x-ray.
Which ligaments are ruptured?

A

Complete posterior ligamentous rupture

worse than extension

teardrop fractures C4 and C5

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17
Q

16-year-old male dove into shallow water forcing his neck into flexion. This is his x-ray.
What neurologic injury is of concern?

A

Anterior cord syndrome: complete motor paralysis, loss of pain and temperature sensations

due to flexion

teardrop freactures C4 and C5

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18
Q

70-year-old male presents with midcervical tenderness 2 weeks after a fall.
What is the diagnosis and mechanism?
Is this stable or unstable?

A

Type 2 odontoid fracture due to hyperextension
Unstable (emergency transport)

most common odontoid fracture

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19
Q

70-year-old male presents with midcervical tenderness 2 weeks after a fall.
What are your concerns for neurologic injury?

A

Guillotine effect: C1 translates forward, posterior elements hit spinal cord

type 2 odontoid fracture

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20
Q

What is the diagnosis and mechanisms of injury?
Is this stable or unstable?

A

Clay shoveler fracture due to flexion avulsion or direct impact
Stable

C4 and C7

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21
Q

What is the diagnosis and mechanisms of injury?
Is this stable or unstable?

A

Clay shoveler fracture at C6 due to flexion alvulsion or direct impact
Stable

heals non-union due to traps and levators at supraspinous ligament

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22
Q

What radiographic sign is present in this image?
What is the differential diagnosis?

A

Double spinous sign at C6
Clay shoveler fracture if history of trauma
Nuchal bone if no trauma

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23
Q

What radiographic sign is seen in this image?
What is the diagnosis?

A

Bow tie sign
Unilateral facet dislocation C6/C7

note <49% anterolisthesis

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24
Q

What is the diagnosis and mechanism of injury?
Is this stable or unstable?

A

Unilateral facet dislocation C6/C7 due to flexion with rotation (towards side of dislocation)
Stable until reduced (treat as unstable)

note <49% anterolisthesis and bow tie sign

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25
Neurologic deficit is found in ___% of patients with this injury.
25% | unilateral facet dislocation C6/C7
26
What radiographic sign is seen in this image? What is the diagnosis?
Bow tie sign Unilateral facet dislocation C6/C7 ## Footnote note <49% anterolisthesis
27
Which ligaments are ruptured by this injury? What is the appropriate treatment for this patient?
Rupture of interspinous and facet capsular ligaments (unstable) Halo reduction then surgical fusion (neurosurgical consult) | unilateral facet dislocation C6/C7
28
75-year-old female presents with numbness in both arms after a fall. What is the diagnosis and mechanism of injury? What percent of patients with this injury have neurologic deficit?
Bilateral facet dislocation at C6/C7 due to hyperflexion 75% have neurologic deficit | note >50% anterolisthesis and NO bow tie sign
29
75-year-old female presents with numbness in both arms after a fall. Which damaged structures contribute to instability of this injury?
* Interspinous ligament * Ligamentum flavum * Facet capsules * PLL * 50% have disc herniation | bilateral facet dislocation C6/C7
30
What finding on this x-ray suggests bilateral facet dislocation?
Widened interspinous space | C6/C7
31
What is the diagnosis and mechanism of injury? Is this stable or unstable?
T12 compression fracture (wedge-shaped) due to axial compression and flexion Stable
32
What is the diagnosis? Is the injury likely new or old?
L3 compression fracture (wedge-shaped) Acute fracture: zone of impaction and step defect present
33
What is the diagnosis and mechanism of injury? Is this stable or unstable?
L1 burst fracture due to axial compression with flexion Unstable (involves 2-3 columns) (emergency transport) ## Footnote note retropulsion of middle column body fragments and focal widening of interpedicle distance
34
Neurologic injury occurs in up to ___% of those who sustain this injury.
50% | L1 burst fracture
35
An adult is x-rayed after a motor vehicle accident. What is the necessary follow-up imaging for this patient?
CT for osseous fragments MRI for cord/nerve root damage | L1 burst fracture
36
What radiographic sign is seen in this x-ray? Given this is a traumatic injury, what is the diagnosis and mechanism?
Empty vertebra sign T12 Chance fracture due to flexion and distraction over a fulcrum | horizontal splitting of posterior elements
37
Is this injury stable or unstable? What are the associated injuries with this trauma?
Unstable Damage to **spleen**, pancreas, aorta, viscera due to abdominal trauma | T12 Chance fracture
38
What is the diagnosis and mechanism of injury? Is this stable or unstable?
Duverney fracture (eft iliac wing) due to direct force from lateral direction Stable fracture (ring not disrupted) ## Footnote can be simple or comminuted
39
What is the diagnosis and mechanism of injury?
Duverney fracture due to direct force from lateral direction | can be simple or comminuted ## Footnote stable fracture
40
25-year-old male was in a MVA and his left leg appears shorter than his right. This is his radiograph. What is the diagnosis and mechanism of injury? Is this stable or unstable?
Malgaigne fracture due to vertical sheer force on pelvis Unstable (ring disruption)
41
What is the diagnosis and mechanism of injury? Is this stable or unstable?
Malgaigne fracture due to vertical shearing force on pelvis Unstable (ring disruption) ## Footnote inferior and superior pubic rami are fractured, iliac wing is fractured, and SI is widened, all ipsilateral
42
What is the diagnosis and mechanism of injury? Is this stable or unstable?
Acetabular blowout fracture due to side impact to trochanter Unstable (multiple bones broken)
43
Which radiographic line is disrupted by the dislocation of the femoral head in this radiograph?
Kohler's line | acetabular blowout fracture
44
What is the diagnosis and mechanism of injury? Is this stable or unstable?
Dashboard fracture due to flexion with abduction Stable but associated with posterior hip dislocation
45
What is the diagnosis and mechanism of injury? Is this stable or unstable?
Bucket handle fracture due to vertical shearing forces on pelvis Unstable ## Footnote inferior and superior rami are fractured ipsilaterally posterior elements are fractured contralaterally to those
46
90-year-old female has lower back and hip pain after falling on her buttocks. What is the diagnosis? Is this stable or unstable?
Straddle fracture Unstable (most common unstable pelvic fracture) ## Footnote bilateral vertical fractures through superior and inferior pubic rami
47
This is the most common form of unstable pelvic fracture. What are the complications that occur in 20% of patients with this injury?
* Bladder rupture * Urethral tear | straddle fracture
48
What is the diagnosis and mechanism of injury? Is this stable or unstable?
Sprung pelvis due to AP compression Unstable ## Footnote pubic diastasis and diastasis of one or both SI joints
49
What is the diagnosis and mechanism of injury? What is a strongly associated risk to keep in mind for this patient?
Sprung pelvis due to AP compression Strong association with pelvic organ injury ## Footnote diastasis of symphysis pubic and diastasis of left SI joint
50
15-year-old male experiences acute trauma during a football game. What is the diagnosis and mechanism of injury?
Left ASIS avulsion fracture due to acute stress from sartorius
51
What is the diagnosis and mechanism of injury?
Right AIIS avulsion fracture due to stress from rectus femoris
52
14-year-old male soccer player reports chronic thigh pain that suddenly got worse when he stepped into a hole. What is the diagnosis and mechanism of injury?
Left ischial tuberosity avulsion fracture due to stress from hamstring ## Footnote note hazy callous around fragment may develop into Reider's bone
53
What is the diagnosis? What is the appropriate treatment for this injury?
Intertrochanteric fracture Surgical management: hip compression screws, intramedullary rods | extracapsular ## Footnote AVN and non-union are uncommon
54
What is the diagnosis? What is the appropriate treatment for this injury?
Subcapital fracture Total hip arthroplasty | intracaspular ## Footnote note disruption of cortex and zone of impaction
55
This injury leaves the patient at risk of avascular necrosis from disruption of which arteries?
Lateral and/or medial femoral circumflex arteries | subcapital fracture ## Footnote most common site for proximal femoral fracture
56
What is the diagnosis and mechanism of injury?
Bumper/fender fracture due to valgus mechanism (force to lateral knee) | depressed lateral tibial plateau ## Footnote MCL asks as a hinge
57
What is the diagnosis and mechanism of injury?
Segond fracture due to avulsion of anterolateral ligament, usually with avulsion of ITB insertion ## Footnote lateral tibial plateau
58
What are the injuries associated with the bony trauma in this radiograph? What referral is necessary for this patient?
Associated with ACL tear and meniscal tear Refer to orthopedist | Segond fracture ## Footnote LCL typically intact
59
What is the diagnosis? What follow up imaging is necessary?
OCD/osteochondral fracture MRI arthrogram with contrast needed ## Footnote commonly in children and adolescents
60
What is the diagnosis? Is this stable or unstable?
Bimalleolar fracture Unstable
61
What is the diagnosis and mechanism of injury?
Maisonneuve fracture due to inversion-external rotation at ankle ## Footnote ankle injury with proximal fibular fracture
62
What is the diagnosis and mechanism of injury? Which radiographic line assists in diagnosis?
Don Juan fracture due to jumping from significant height Reduction of Bohler's angle | intra-articular and often comminuted (requiring surgery)
63
What is the diagnosis?
Calcaneal fatigue fracture ## Footnote note: normal Bohler's angle and sclerosing perpendicular to trabeculae
64
What is the diagnosis and mechanism of injury?
Jones/dancer fracture due to inversion and plantar flexion | transverse fracture at the base of fith metatarsal ## Footnote most common bony injury of the foot
65
What is the diagnosis? What is a complication that occurs with this injury?
Aviators fracture Avascular osteonecrosis complication | talar neck fracture (second most commonly fractured tarsal) ## Footnote hematoma also present
66
What is the diagnosis? What is this injury associated with?
Lisfranc injury Associated with neuropathic arthropathy
67
What is the diagnosis and mechanism of injury?
Bankart fracture due to avulsion from triceps | fracture of anterior inferior glenoid rim ## Footnote associated with anterior shoulder dislocation
68
What is the diagnosis and mechanism of injury?
Hill-Sach fracture due to anterior shoulder dislocation
69
What is the diagnosis and mechanism of injury?
Flap fracture associated with anterior dislocation and supraspinatus avulsion | greater tuberosity fracture
70
What is the diagnosis?
Chisel fracture ## Footnote vertical fracture through radial head/neck
71
What is the diagnosis and mechanism of injury? What is the appropriate treatment?
Little leaguer elbow due to avulsion of medial epicondyle Requires surgery
72
49-year-old male sustained this injury while kickboxing. What is the diagnosis?
Nightstick fracture | fracture of ulna due to direct trauma
73
What is the diagnosis?
Monteggia fracture/dislocation | Nightstick (ulnar fracture) and dislocation of radial head
74
What is the diagnosis?
Galeazzi fracture/dislocation ## Footnote fracture of the distal radial shaft and dislocation of distal radioulnar joint
75
What is the diagnosis and mechanism of injury?
Colles fracture due to FOOSH | DDx Smith fracture
76
What is the diagnosis and mechanism of injury?
Smith fracture due to fall on outstretched hand and flexed wrist ## Footnote note anterior angulation
77
What is the diagnosis and mechanism of injury?
Colles fracture due to fall on outstretched hand and extended wrist ## Footnote note dorsal angulation
78
What is the diagnosis?
Hutchinson/Chaeuffeur fracture | fracture of radial styloid process
79
This is the most common carpal to fracture and the most common accult fracture. Which carpal is fractured? What are complications associated with this injury?
Scaphoid Complications of **avascular necrosis**, non-union (SNAC wrist), insability, degeneration
80
This is the second most common carpal to fracture. What is the diagnosis and mechanism of injury?
Fischer fracture due to avulsion of dorsum of triquetrum from radiocarpal ligament in hyperflexion ## Footnote note pooping duck sign
81
What is the diagnosis and mechanism of injury?
Lunate dislocation due to hyperextension | most common carpal dislocation ## Footnote note pie sign
82
What is the diagnosis? What are the radiographic signs present?
Scapholunate dissociation (ligament rupture) Terry Thomas sign (wide S-L joint) and signet ring sign of scaphoid
83
What is the diagnosis?
SLAC wrist
84
What is the diagnosis?
Bar room fracture | 4th or 5th metacarpal
85
What is the diagnosis?
Boxer fracture | 2nd or 3rd metacarpal
86
What is the diagnosis? What is a complication of this injury?
Gamekeeper thumb Stener lesion complication
87
What is the diagnosis and mechanism of injury?
Mallet finger due to avulsion of dorsal distal phalanx from extensor digitorum longus with forceful flexion of DIP
88
What is the diagnosis?
Bennett fracture | non comminuted fracture of first metacarpal base
89
What is the diagnosis?
Rolando fracture | comminuted fracture of first metacarpal base
90
What is the name of this injury? Which structure is involved?
Pellegrini-Stieda lesion Myositis ossificans of medial collateral ligament of knee

Bone & Joint (12 decks)

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