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Flashcards in LE Deck (57):
1

Knee AP View

Pt supine with knee fully extended and leg in neutral
Beam directed vertically 5-7 degrees slightly cephalic
Limitation: superimposed patella

2

Knee Lateral View

Pt lays on involved side with 25-30 degrees of knee flexion
Beam directed at medial knee joint 5-7 degrees cephalad
Best for patella femoral relationship

3

Relationship of patellar ligament length (PL) to patella length (L)

PL=L +/- 20%

4

Tunnel (Notch) View (Knee)

Pt prone with knee flexed to 40 degrees
Beam projected caudally at 40 degrees from vertical
Demonstrates posterior aspect of femoral condyles, intercondylar notch, intercondylar eminence, medial and lateral tibial spine

5

Potential increased risk of ACL tear

Females have more of an 'A' intercondylar notch while males have more of an 'H' notch

6

Sunrise View (Knee)

Pt. prone with knee flexed 115 degrees
Beam directed at patella 15 degrees cephalad
Demonstrates femoropatellar joint compartment well

7

What is the purpose of deep knee flexion with sunrise view?

to depress the patella deeply within the intercondylar fossa

8

Disadvantages of Sunrise View

Articular surfaces of femoropatellar joint not well viewed
Subtle subluxations may not be detected
Position tolerance

9

Axial (Merchant) View (Knee)

Pt supine with knee flexed 45 degrees
Beam directed caudally through patella at 60 degrees from vertical
Demonstrates Articular facets of the patella and femur, sulcus and congruence angle

10

Congruence angle

Normal: -6 degrees
Greater than 16 degrees associated with patellofemoral disorders
Bisect sulcus angle, draw 2nd line from lowest point of articular ridge of patella to deepest point of sulcus

11

Sulcus Angle

Normal: 138 degrees
Formed by lines extending from deepest point of intercondylar sulcus to the top of the femoral condyles

12

AP Demonstration (Knee)

Medial and lateral joint compartments
Varus and valgus deformities
Fx of femoral condyles, tibial plateus, tibial spines, proximal fibula,
Osteochondral fx
Osteochondral dissecans (late stage)
Spntaneous osteonecrosis
Pellegrinini-Stieda lesion

13

FBI Sign

Fat Blood Interface aka Lipohemarthrosis: Blood and bone marrow fat enter the joint creating layering on radiograph
Indicates: Intraarticular Fx

14

Sinding-Larsen-Johansson Disease

Fragmentation of lower pole of the patella and significant soft tissue swelling associated with calcification and ossifications of the patellar ligament

15

Osgood-Schlatter Disease

Avulsed tibial tuberosity
Soft tissue swelling
Tx: activity modification lower impact and counterforce braces, will heal itself with maturation and time

16

Osteochondral Fx

Shearing/ rotary forces applied to the articular surface of the femur result in detachment fragment of articular cartilage

17

Types of meniscus tears

Peripheral detachment
Peripheral Tear
Cleavage Tear
Simple Vertical Tear
Bucket-Handle Tear
Oblique Tear

18

Ankle AP View

Pt supine with foot in neutral
Beam directed vertically at midpoint between malleoli
Identifies distal tibia and fibula
Fibular Malleolus Longer than Tibial Malleolus

19

Ankle AP View Limitations

Overlap of distal fibula and lateral tibia obstructs view of tibiofibular syndesmosis

20

Mortise View (Ankle)

10 degrees of IR of the ankle eliminates overlap of medial distal fibula for better view of syndesmotic space

21

Ankle Lateral View

Pt lays on involved side
Beam directed vertically to the medial malleolus
Demonstrates anterior aspect of the distal tibia and posterior lip (3rd malleolus) and Fx oriented in the coronal plane

22

What imaging modality will demonstrate meniscal injury

MRI?

23

Ottawa Knee Rules

Age 55+
Tenderness at head of fibula or isolated tenderness of patella
Inability to flex knee to 90 degrees
Inability to weight bear 4 steps
ARE valid under the age of 18
Sensitivity: 98-100%
Specificity: Low

24

Segond Fx and what is typically injured with it

Article

25

Internal Oblique View (Ankle)

Pt in supine with leg and foot in 35 degrees of IR. Neutral PF/DF (90 degrees to leg).
Beam Directed at lateral malleolus
Demonstrates: Medial and lateral malleoli
Tibial Plafond
*Dome of the Talus
Tibiotalar joint
Tibiofibular syndesmosis

26

Inversion Stress View (Ankle)

Pt in supine with foot fixed in device. Pressure plate is positoned 2 cm above ankle joint and applies varus stress adducting the heel
Degree of talar tilt is measures by tibial plafond and dome of the talus. (bilateral comparison)
Normal is 20 degrees

27

Anterior-Draw Stress (Ankle)

Pt on involved side with foot in device. Pressure plate positioned anteriorly 2 cm above ankle and applies posterior stress to shin with heel fixed.
Measure separation btwn Talus and Distal Tibia
0-5 mm Normal
5-10 mm Normal/Abnormal
>10 Abnormal

28

Foot AP View (Dorsoplantar)

Pt in supine with knee flexed and foot flat on film.
Beam directed vertically to the base of the *first metatarsal bone
Demonstrates metatarsal bones and phalanges
1st metatarsal angle

29

1st Metatarsal Angle

Quantifies the amount of metatarsus primus varus associated with hallux valgus
Normal angle 5-10 degrees

30

Foot Lateral View

Pt on involved side
Beam directed vertically to midtarsus
Demonstrates: Bursal projection
Posterior, Medial, Anterior Tuberosities
Anterosuperior spine of calcaneous
Posterior facet of subtalar joint
Sustenaculum tali
Talonavicular
Calcaneocuboid
Boehler Angle
Calcaneal pitch

31

Boehler Angle

Relationship of talus and calcaneous
Intersection of line drawn from posterosuperior margin of the calcaneal tuberosity (bursal projection) through the posterior facet of the subtalar joint
Line drawn from the tip of the posterior facet through the superior margin of the anterior process of the calcaneous
Normal 20-40 degrees

32

Calcaneal Pitch

Intersection of line drawn tangentially to inferior surface of the calcaneus and one drawn along the plantar surface of the foot
Normal 20-30 Degrees

33

Foot Oblique View

Pt supine with lateral border of the foot elevated 40-45 degrees
Beam Directed vertically to base of the 3rd metatarsal
Demonstrates Phalanges, Metatarsals, Anterior Subtalar joint
Talonavicular Joint
Naviculocuneiform Joint
Calcaneocuboid Joint

34

Harris-Beath View (foot)

Pt stands on film
Beam directed at 45 degree angle toward midline of heel
Posterior-Tangential View
Demonstrates: Middle facet of subtalar joint
Posterior facet of subtalar joint
Sustentaculum tali
Body of the calcaneous

35

Tangential View (foot)

Pt seated with foot and toes DF with gauze
Beam directed vertiacally to head of the 1st metatarsal
Demonstrates: Metatarsal heads
Sesmoid bones of the 1st metatarsal

36

Pilon Fx

From fall or imact to bottom of foot
Triangular Fx of tibia

37

Unimalleolar Fx

Come on... kinda self explanatory kid

38

Avulsion Fx

Commonly separates base of the 5th metatarsal at attachment of tendon of fibularis brevis due to inversion stress
Some overlap as Jones Fx

39

Jones Fx

Fx of the base of the shaft of the 5th metatarsal

40

Maisonneuve Fx

Commonly occurs at the junction of the middle and distal thirds of the fibula.
Disrupted tibfib syndesmosis and interosseus membrane is torn up to the level of fx.
Tibiotalar joint compartment is widened because of lateral subluxation of the talus

41

Ottawa Ankle Rules

Point tenderness on the medial or lateral malleolus, navicular or base of the 5th
Inability to weight bear immediately and in emergency (4 steps)
Rules ARE valid in under 18

42

Lauge-Hansen

Type A ?
Type B ?
Type C ?

43

If the broken tibia causes anterior compartment syndrome, what motor and sensory loss would you suspect?

Anterior Compartment Syndrome:
Muscles involved are TA, EHL, EDL, and Fib tertius.
Nerves are the deep peroneal nerve and a branch of the common peroneal nerve.

Deep fibular nerve would innervate the sensory portion between the 1st and second toes. Motor function of this nerve you would lose the DF so foot drop would occur as well as great toe extension and digits 2-5 extension.

44

Slipped Capital Femoral Epiphysis

Typically occurs anteriorly with excessive ER?

45

Hip AP View

Patient in supine with both feet in 15 degrees of IR
Beam directed at Midpelvis or Femoral Head
Demonstrates: Iliac, Sacrum, Pubic, Ischium, Femoral Head and Neck, Greater and Lesser Trochanters
Limitations: Acetabulum partially obscured by overlying femoral heads
Not adequate for eval of sacral bone, SI joint or acetabulum

46

Ferguson View (Hip)

Angled AP view
Pt in supine w/ 15 degrees of IR
Beam at 15 degrees cephalic angle at midpelvis
Demonstrates injury to the SI joints and pubic and ischial rami

47

Anterior Oblique (Judet) View (hip)

Patient in supine with involved hip elevated to 45 degrees
Central been vertically at hip
Demonstrates iliopubic column and posterior lip of the acetabulum

48

Posterior Obliqu (Judet) View (hip)

Pt. positioned in supine and the UNaffected hip is elevated to 45 degrees
Beam directed vertically at affected hip
Demonstrates Ilioishial column (posterior) and posterior lip of the acetabulum and the anterior acetabular rim

49

Frog-Lateral View (hip)

Pt in supine with knees flexed, soles of feet together and thighs maximally abducted
Beam directed vertically 10-15 degrees cephalad to just above pubic rami
Selective - beam directed toward affected hip
Demonstrated lateral aspect of the femoral head and both trochanters

50

Groin Lateral View (hip)

Pt in supine with affected extremity extended and opposite leg elevated and abducted (out of way)
Cassette on lateral hip
Beam directed horizontally toward the groin with 20 degree cephalad angle
Demonstrates anterior and posterior aspects of femoral head, and anterior rim of acetabulum to identify displacement of Fxs
Angle of femoral anteversion

51

Normal Femoral anteversion

25-30 Degrees

52

Common sites of Avulsion Fx and muscles attached (Hip)

Iliac crest -abs
Body of pubis and inferior pubic ramus -adductors and gracillis
Ishial Tub - hamstrings
Lesser Troch - iliopsoas
Greater Troch -glut, obterator internus, gemellus, piriformis
AIIS - Rectus Fem
ASIS -Sartorius and TFL

53

Malgaigne Fx

Unstable hemipelvic Fx
Unlateral fx of superior or inferior pubic rami
Disruption of ipsilateral SI
Recognized clinically by shortening of LE

54

Sprung Pelvis

Bilateral Pelvic Dislocation
Disruption of both SI joints
Associated with separation of the pubic symphysis

55

Proximal Femur Fxs

Intracapsular:
Capital - femoral head
Subcapital (common) - proximal femoral neck
Tans or midcervical - distal femoral neck
Basicervical- Distal to the femoral neck
Extracapsular:
Intertrochanteric - through trochanters
Subtrochanteric -proximal femoral shaft

56

Trabeculae of Hip

..See image in slides

57

Vascular supply of proximal femur

Branches of Femoral artery... See image in slides