Lecture 7- Ortho Flashcards
1
Q
first line for bones?
A
Xray
2
Q
when to use CT
A
- bone detail: extent and severity of fracture
- fracture fragment evaluation
3
Q
when to use MRI?
A
- occult (hidden) fracture evaluation
- tumor eval
- soft tissue injuries (ligaments, meniscus, rotator cuff)
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
5
Q
describe use of US in ortho
A
newer applications- include evaluating superficial structures (tendons), guiding injections, screening long bone fractures
6
Q
Xray Views
oblique
A
7
Q
Xray Views
IR/ER AP
A
8
Q
Xray Views
Stressed
A
9
Q
Xray Views
WB or NWB
A
10
Q
Xray Views
Flexion/Extension
A
11
Q
Xray Views
comparison views
A
- esp use in kids
- compare R & L respectively
12
Q
Xray Views
scaphoid
A
13
Q
Xray Views
scapular Y
A
14
Q
Xray Views
odontoid
A
15
Q
Xray Views
tunnel
A
16
Q
Xray Views
sunrise
A
17
Q
Xray Views
syndesmosis/mortise
A
18
Q
Xray Views
swimmers
A
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
20
Q
how to view xray
A
- look at each bone (smooth contours, lucencies/opacities)
- look at each joint
- look at soft tissue
21
Q
what color usually are fracture lines?
A
lucent (black)
22
Q
Shoulder
tips for shoulder view
A
- don’t forget to view clavicle (separate image)
- need to know view to read image
23
Q
Shoulder
Grashey vs AP
A
- Grashey: glenohumeral joint, humeral tuberous
- AP: better for acromialclavicular joint, some parts of humerus
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
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)
