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LE Flashcards

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1
Q

Knee AP View

A

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

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2
Q

Knee Lateral View

A

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

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3
Q

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

A

PL=L +/- 20%

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4
Q

Tunnel (Notch) View (Knee)

A

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

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5
Q

Potential increased risk of ACL tear

A

Females have more of an ‘A’ intercondylar notch while males have more of an ‘H’ notch

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6
Q

Sunrise View (Knee)

A

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

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7
Q

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

A

to depress the patella deeply within the intercondylar fossa

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8
Q

Disadvantages of Sunrise View

A

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

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9
Q

Axial (Merchant) View (Knee)

A

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

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10
Q

Congruence angle

A

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

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11
Q

Sulcus Angle

A

Normal: 138 degrees

Formed by lines extending from deepest point of intercondylar sulcus to the top of the femoral condyles

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12
Q

AP Demonstration (Knee)

A 
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
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13
Q

FBI Sign

A

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

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14
Q

Sinding-Larsen-Johansson Disease

A

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

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15
Q

Osgood-Schlatter Disease

A

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

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16
Q

Osteochondral Fx

A

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

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17
Q

Types of meniscus tears

A 
Peripheral detachment
Peripheral Tear
Cleavage Tear
Simple Vertical Tear
Bucket-Handle Tear
Oblique Tear
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18
Q

Ankle AP View

A

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

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19
Q

Ankle AP View Limitations

A

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

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20
Q

Mortise View (Ankle)

A

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

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21
Q

Ankle Lateral View

A

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

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22
Q

What imaging modality will demonstrate meniscal injury

A

MRI?

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23
Q

Ottawa Knee Rules

Study These Flashcards
A 
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
Q

Segond Fx and what is typically injured with it

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

Diagnostic Imaging (3 decks)

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