Clin D III > Lecture 7- Ortho > Flashcards

Lecture 7- Ortho Flashcards

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1
Q

first line for bones?

A

Xray

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2
Q

when to use CT

A
  • bone detail: extent and severity of fracture
  • fracture fragment evaluation
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3
Q

when to use MRI?

A
  • occult (hidden) fracture evaluation
  • tumor eval
  • soft tissue injuries (ligaments, meniscus, rotator cuff)
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4
Q

Describe use of bone scans

A
  • involves IV injection of radioactive tracer that accumulates in bone that is undergoing rapid turnover/growth
  • imaging of choice for detecting skeletal metastases
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5
Q

describe use of US in ortho

A

newer applications- include evaluating superficial structures (tendons), guiding injections, screening long bone fractures

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6
Q

Xray Views

oblique

A
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7
Q

Xray Views

IR/ER AP

A
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8
Q

Xray Views

Stressed

A
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9
Q

Xray Views

WB or NWB

A
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10
Q

Xray Views

Flexion/Extension

A
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11
Q

Xray Views

comparison views

A
  • esp use in kids
  • compare R & L respectively
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12
Q

Xray Views

scaphoid

A
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13
Q

Xray Views

scapular Y

A
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14
Q

Xray Views

odontoid

A
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15
Q

Xray Views

tunnel

A
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16
Q

Xray Views

sunrise

A
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17
Q

Xray Views

syndesmosis/mortise

A
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18
Q

Xray Views

swimmers

A
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19
Q

how to systematically read xray

A
  • adequacy
  • alignment
  • bones (sometimes nutrient vessels look like fractures)
  • cartilage (is there space where cartilage would be? can’t actually see cartilage)
  • soft tissue
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20
Q

how to view xray

A
  1. look at each bone (smooth contours, lucencies/opacities)
  2. look at each joint
  3. look at soft tissue
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21
Q

what color usually are fracture lines?

A

lucent (black)

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22
Q

Shoulder

tips for shoulder view

A
  • don’t forget to view clavicle (separate image)
  • need to know view to read image
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23
Q

Shoulder

Grashey vs AP

A
  • Grashey: glenohumeral joint, humeral tuberous
  • AP: better for acromialclavicular joint, some parts of humerus
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24
Q

Humeral View

when to order? what should be visible for good image?

A
  • only order if concern for shaft fracture or tumor
  • joint above & below
  • always do IR & ER unless fracture or dislocation
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25
# Elbow Imaging what is soft tissue issue
* pos fat pad sign (sail sign) * dark area displacing the fat pad indicating blood/injury
26
# Elbow Imaging how to get proper AP view
lay arm as flat as possible
27
# Elbow Imaging purpose of the radiocapitellar line?
* helps us know if it is dislocated
28
# Forearm Imaging components
* just changing from pronation to supination does not give 2 proper views of radius/ulna * make sure entire unit moves together * bones should mostly overlap on lat view * must include wrist + elbow
29
# Wrist Imaging components
* does not have to include fingers * does not have to include radius/ulna shaft * too much radius/ulna are sometimes signs of bad images * scaphoid view ordered here
30
# Hand Imaging components
* "ok" sign for lat view * finger tips should be visible * oblique view to look at metacarpals
31
# Hip Imaging components
* AP, frog leg, pelvis most common * cross table lateral possible not common * MAKE SURE TO LOOK AT PUBIC RAMI * bilat hip is different from pelvis
32
# Femur Imaging components
* AP should include knee and hip to be adequate * difficult to accomplish lateral because of lead in groin and overlap of pelvis structures * ok if not perfect, caution w reshooting
33
# Knee Imaging components
* several views possible, based on problem * look at fibula & tibial tubercule * should be WB unless fracture & pt can't stand
34
# Knee Imaging when to use tunnel imaging?
ligament damage
35
# Tib/Fib Imaging Components
* often anlged on film because leg is too long * must include knee _ ankle jointsonly performed for fractures and tumors *
36
# Knee Imaging which views should be wt bearing
Ap, Lat, oblique
37
# Ankle Imaging components
* AP + Lat: arthritis * AP + Lat + Mortise: injuries * mortise "straightens" things out * don't ignore post ankle
38
# Fracture Terminology Simple Closed fracure
2 fracture fragments, skin intact may take 7-10d to be visible on xray
39
# Fracture Terminology compound (open) fracture
2 fracture fragments, skin is penetrated
40
# Fracture Terminology comminuted (complex) fracture
2+ bone fragments
41
# Fracture Terminology transverse
fracure like --- across bone
42
# Fracture Terminology oblique fracture
diagonal fracture ( / )
43
# Fracture Terminology angulation
* to describe direction of fracture * dorsal, radial, ulnar, valgus, varus, lateral, medial
44
# Fracture Terminology displacement
* describe the DISTAL fragment when looking as displacement (proximal part of bone is the "anchor") * can be full displacement or side to side movement of the fragments
45
# Fracture Terminology Distraction vs Overriding
* distraction: fragments have been pulled apart * overriding: overlap of fragments/shortening
46
# Fracture Terminology impaction
fragments have been driven together
47
# Fracture Terminology stress fracture
* opaque on imaging NOT lucent * summation of microfractures caused by unusal or excess stress (athletes) * tibia is common site of stress fx in all ages
48
# Fracture Terminology Pathologic Fractures
* fracture through bone abnormality (benign or malignant leading to bone weakness) * minimal or no trauma
49
# Fracture Terminology Avulsion fracture
* fracture of bony fragment that is produced by the pull of a ligamentous or tendinous attachment
50
# Fracture Terminology describe avulsion fracture of the knee
* Segond fracture * highly associated with ACL tear, get an MRI
51
# Pediatric Fracture Terminology * physis * diaphysis
* physis: grwoth plate, bone formation here, weakest part of bone * diaphysis: shaft
52
# Pediatric Fracture Terminology Salter-Harris Fracture types for physis fractures | SALTER
Type 1: straight across physis Type 2: above physis (meta) Type 3: below physis (epi) Type 4: through everything Type 5: crushed
53
# Pediatric Fracture Terminology greenstick fracture
* incomplete fractures where the bone "bends like a twig" and the cortex cracks
54
# Pediatric Fracture Terminology torus fractures
* buckle fracture, type of incomplete * creates a "bump" without an obvious fracture line * very common- seen w/ falls on outstretched hands (FOOSH)
55
# Fracture Healing Terminology callus formation
fracture line is no longer clean + lucent bony bridging of fracture line
56
# Fracture Healing Terminology nonunion
* causes: infection, inadequate immbolization, inadequate blood supply, inadequate nutrition * non healing fracture
57
# Fracture Healing Terminology rate of fracture healing depends on?
age, type of fracture, nutritional/hormonal status, adequacy of tx
58
# Fracture Healing Terminology malunion
healed in bad positioning
59
# Common Fractures Scaphoid- overview
* 5% have complications (nonunion, osteoarthritis, avascular necrosis) * surgically repair, refer to ortho if you see it
60
# Common Fractures colles fracture overview
* fracture of the distal radius with dorsal angulation of the distral fragment * +/- ulnar styloid fracture * FOOSH (hyperextension injury)
61
# Common Fractures Smith Fracture
* fracture of distal radius with palmar angulation of the distal fragment * fall on back of flexed hand
62
# Common Fractures Radial head fracture
* easily missed- look for pasterior fat fat sign * most common elbow fracture in adults * caused by call on outstretched arm or direct blow to elbow
63
# Common Fractures boxer fracture
* fracture of head of 5th metacarpal * usually result of punching solid object * usually closed * prescribe abx; if they punched someone in mouth give abx
64
# Common Fractures hip fracture risk factors
* old people more common due to brittle bones * risk factors: osteoporosis, age, high energy trauma, pathologies that weaken bone
65
# Common Fractures Hip fracture- what part of bone most common
66
# Fracture Terminology Spiral fracture
* "spiral" break in bone (curling) * caused by rotational forces * common in children (femur), aging females (humerus)
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