Lower extremity imaging

Question 1

What should you always look at when looking at bone x-rays?

Answer 1

A - adequacy, alignment
B - bones
C - cartilage
S - soft tissues
EVERYTIME

Question 2

What makes your viewing adequate?

Answer 2

minimum of 2 views - AP & lateral, 3 views are even better with an oblique view!

Is the exposure sufficient?

Question 3

What are you looking for in regards to alignment?

Answer 3

anatomic relation of bone axes – fractures/dislocations can alter normal axes

Question 4

What’s a lisfranc injury?

Answer 4

dislocation of the second metatarsal

Question 5

What can soft tissue help recognize?

Answer 5

swelling can speak for an occult fracture that may not be visible

Question 6

What are examples of occult fractures?

Answer 6

• distal radius fracture (pronator quadratus fat pad sign +)
• neck of femur fracture
• radial head fracture (sail sign may be +)
• scaphoid fracture
• supracondylar fracture (loss of alignment)

Question 7

What are the 4 anatomical classes of bones?

Answer 7

long, short, flat, and irregular

Question 8

What are the benefits of splintage?

Answer 8

reducing pain and blood loss, pressure on skin, pressure on adjacent neurovascular structures, and reducing risk of fat embolism and further damage

Question 9

What is: the assessment and reassessment of neurovascular status before and after any manipulation or handling of the fracture?

Answer 9

principles of immobilization

Question 10

Always immobilize joints ____ and ____ the fracture

Answer 10

above and below

Question 11

What type of fracture is simple, noncomplicated, with no skin wounds at or near fracture site?

Answer 11

closed fracture

Question 12

What type of fracture is complicated, with a skin wound, and may be comminuted and dislocated?

Answer 12

open fracture

Question 13

How are long bone fractures described?

Answer 13

reference to direction of fracture

Question 14

What’s a transverse fracture?

Answer 14

fracture passes at right angles to shaft of bone

Question 15

What’s a displaced fracture?

Answer 15

loss of alignment along the long axis

Question 16

What can medial angulation of a displaced fracture also be called?

Answer 16

varus

Question 17

What can lateral angulation of a displaced fracture also be called?

Answer 17

valgus

Question 18

What can a proximal migration of the distal fracture result in?

Answer 18

shortening

Question 19

what type of fracture is when the bone is crushed?

Answer 19

compression

Question 20

What type of fracture is when one end of the extremity is fixed but the rest of the extremity remains in motion?

Answer 20

spiral fracture

Question 21

In who are accidental spiral fractures of the tibia common?

Answer 21

preschool children who fall short distances onto an extended leg “toddler’s fractures”

Question 22

What type of fracture should you suspect abuse?

Answer 22

spiral fractures

Question 23

What type of fracture is urgent in children?

Answer 23

epiphyseal fractures because they are growth plate fractures – it could result in a limb that is crooked or unequal in length

Question 24

Where are growth plates found?

Answer 24

long bones of the body – femur, radius, ulna, metacarpal
most have at least 2 growth plates on ends of the bone

Question 25

What are salter-harris fractures?

Answer 25

fractures around the end of the bone

Question 26

What is a fracture that breaks through the bone at the growth plate separating the end of the bone and disrupting the growth plate?

Answer 26

Type 1 Salter-Harris fracture

Question 27

What is a fracture that break through part of the bone at the growth plate and crack through the bone shaft but not entirely?

Answer 27

Type 2 Salter-Harris fracture -- MC growth plate fracture

Question 28

What is a fracture that crosses through a portion of the growth plate and breaks off a piece of the bone at the end? (90 degree angle)?

Answer 28

Type 3 Salter-Harris fracture - MC in older children

Question 29

What is a fracture that breaks through the bone shaft, the growth plate, AND the end of the bone (diagonal)?

Answer 29

Type IV Salter Harris fracture

Question 30

What is a fracture that occurs due to a crushing injury to the growth plate from a compression force?

Answer 30

Type V Salter Harris fracture

Question 31

What is a fracture that results in more than 2 separate bone components like "butterfly" or "segmental"?

Answer 31

comminuted fractures

Question 32

What type of fracture results from 2 oblique fractures forming a "butterfly" fragment?

Answer 32

butterfly fracture (comminuted)

Question 33

What type of fracture is when segments of bone are separated from both proximal and distal portions of tibial and fibular shafts?

Answer 33

segmental fracture (comminuted)

Question 34

What type of fracture occurs when force results in bending such that the bone doesn't break completely "incomplete break" but still results in a fracture?

Answer 34

greenstick fracture!

Question 35

What type of fracture is common in young children, especially less than 10 years, commonly mid-diaphyseal, affecting forearm and lower leg?

Answer 35

greenstick fracture

Question 36

What type of fracture is at the lower end of the fibula and medial mallelous of tibia and is associated w/ a rolled ankle and eversion of the ankle and tear of the deltoid ligament?

Answer 36

Pott fracture

Question 37

What type of fracture is caused by the radius overriding the rest of the bone causing a dinner fork deformity?

Answer 37

Colle's fracture

Question 38

What type of fracture is a distal radial fragment is tilted into a posterior angulation and may be displaced ventrally (REVERSE COLLE's)?

Answer 38

Smith's Fracture

Question 39

How many views does the elbow usually require?

Answer 39

3 - AP, oblique w/ elbow extended, and lateral with the elbow flexed

Question 40

What fat pads should you be analyzing in the elbow?

Answer 40

anterior and posterior **seeing a posterior fat pad is NEVER normal**

Question 41

What is important to remember about ossification in the elbow?

Answer 41

develops during childhood and can be mistaken for fractures

Question 42

What order does the elbow ossification occur?

Answer 42

CRITOE capitellum - radial head - internal/medial epicondyle - trochlea - olecranon - external/lateral epicondyle

Question 43

When the imaginary line drawn from front of humerus does NOT intersect the middle-anterior 1/3 of the capitellum, what should you suspect?

Answer 43

supracondylar fracture

Question 44

When the imaginary line down the middle of the radius does NOT pass through the middle of the capitellum, what should you suspect?

Answer 44

radial head dislocation

Question 45

What is the sail sign?

Answer 45

elevated anterior fat pad

Question 46

What is the most common metatarsal fractured?

Answer 46

5th metatarsal

Question 47

What is the most important weight-bearing structure in the forefoot?

Answer 47

metatarsals

Question 48

What are the attachments of the 5th metatarsal?

Answer 48

peroneus brevis, tertius, lateral band of plantar fascia

Question 49

How is the fifth metatarsal supplied by arterial branches?

Answer 49

dorsalis pedis, posterior tibial, peroneal arteries nutrient artery from 4th plantar metatarsal artery and inserts into plantar medial diaphysis -- vulnerable to increased nonunion rates due to anatomic location of the bloody supply which results in watershed

Question 50

What is the fifth metatarsal?

Answer 50

pinky toe but below the toe part and in the foot part

Question 51

What type of fracture is at the distal portion of the fibula above the lateral mallelolus w/ associated tear of tibiofibular ligaments and the deltoid ligament and therefore affects BIMALLEOLAR ligaments?

Answer 51

dupuytren fracture

Question 52

This is a reminder

Answer 52

to review xray anatomy!