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Radiology 3 > Musculoskeletal 3 > Flashcards

Musculoskeletal 3 Flashcards

1
Q

lumbar spine

A

Plain films - AP, lateral – standard

Special views: lumbrosacral spot, oblique

Approach – ABC’S (alignment, bones, cartilage, soft tissue)

  • Spinous process alignment (AP)
  • Intrapedicular distance (AP)
  • Transverse processes (AP)
  • Vertebral body width (AP)
  • Vertebral body height, width, cortex (Lateral)
  • Posterior vertebral line (Lateral)
  • Disc spaces (Lateral)
  • Soft tissue (Both)
  • Free stuff (Both)
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2
Q

Bohler’s angle - calcaneus

A
  • A=Superior surface of posterior tuberosity, subtalar articulation
  • B=Superior tip of subtalar articular surface and anterior process
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3
Q

patellar tendon rupture

A

-Cannot extend lower leg at knee
-High-riding patella
Effusion
-Mechanism: sudden muscle contraction (direction change) or direct blow

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4
Q

the pelvis

A

-Single AP view is common
-Judet views - supine, hip 45d -acetabulum
-Inlet - 40d caudad - pelvic ring
-Outlet-40d cephal - sacroiliac
-CT has largely replaced
special views if fx suspected

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5
Q

Alignment: the mortise

A

-The mortise is critical!
-When describing ankle fractures,
always comment on the mortise.
-Is it intact? Wide? Narrow? Where?
-Determines ligamentous disruption and overall stability of the ankle.

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6
Q

hip dislocations

A
  • 90% are posterior
  • Femoral head lateral, superior to the acetabulum
  • Lower extremity internally rotated and shortened
  • Axial force along flexed hip and knee
  • Sciatic nerve injury 10%
  • Anterior Dislocation → External rotation, Shortened, Femoral head is inferior, medial
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7
Q

Spondylolysis

A
  • Bony defect of the pars interarticularis
  • Non-displaced fracture
  • L4-L5, L5-S1
  • Repetitive stresses, congenital, kids
  • Fracture results in a “collar” around neck of the “Scotty Dog”
  • Lateral oblique view
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8
Q

Burst fracture

A
  • Axial load - jump, fall
  • Comminuted, entire vertebral body, both anterior and middle columns
  • Post vertebral line disruption
  • Inter-pedicle space disruption
  • Unstable=post column fx
  • Fx fragment may have “retropulsion” into spinal canal and compress cord
  • CT, MRI if neuro deficit
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9
Q

thoracic spine

A
  • AP, lateral standard views
  • T1 – T12: all have ribs
  • L1: transverse process
  • Fractures less common (rib cage support)
  • Most: compression fx’s
  • Significant mechanism

-Fracture/dislocation: 60-70% spinal cord, injury - all get MRI

  • CT for fracture
  • MRI for spinal cord
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10
Q

talus fracture

A

Uncommon – but serious

High force mechanism

Fracture/dislocation common

High risk AVN, malunion

ORIF

CT all talus fx’s

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11
Q

Femoral shaft fractures

A
  • High Energy/Force
  • Pathologic fx?
  • Displacement due to muscle contraction
  • OR reduction, hardware common
  • High risk of bleeding (femoral artery)
  • High risk compartment syndrome
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12
Q

chance fracture

A
  • “Seatbelt fx” - hyperflexion, force
  • Thoracolumbar junction
  • Horizontal fx thru body, post arch, SP
  • Ligamentous injury
  • May have retropusion of fragments
  • Unstable
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13
Q

slipped capital femoral epiphysis

A 
SCFE
-Capital femoral epiphysis
slips - posterior/lateral
-10-15yo obese boys: hip/knee pain
-Salter-Harris Type I injury
-Risk for AVN
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14
Q

tibial plateau - compression fx

A

Can be subtle! Easy to miss!

  • Usually lateral plateau
  • Increase in trabecular density – sclerotic
  • Tibia lateral to femur
  • Direct blow “fender fx”
  • Osteoporosis - minor mechanism
  • Effusion, can’t walk
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15
Q

tibial pilon/plafond fracture

A

Fx of the Tibial Plafond

Comminuted Intraarticular Impacted

Vertical load - Jumpers

Unstable - Get CT scan

Plafond = “ceiling”. Fx of the “ceiling” of the ankle joint

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16
Q

Spondylolisthesis

A
  • Anterior slippage of the vertebral column relative to the vertebral body below it
  • True: Fracture of pars interarticularis with displacement
  • Pseudo: no pars interarticularis fx
  • Usually a result of bilateral spondylolysis
  • Most commonly occurs at the L3/4, 4/5 or L5-S1 level
  • Results in spinal stenosis
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17
Q

osgood-schlatter disease

A
  • Micro-avulsion at insertion of patellar tendon at apophysis (cartilaginous tissue for tendon insertion)
  • 10-12yo - when tibial tubercle ossifies
  • Family hx same
  • Pain, inflammation
  • Rest, good prognosis
  • Can also occur at calcaneus, navicular (foot)
18
Q

pelvis fractures: stable

A
  • 2/3 of all pelvis fx’s
  • Avulsions common in athletes
  • Isolated ischium, pubic ramus - fall, osteoporosis
  • Sacral - fall, direct blow
  • Illiac wing – blunt, MVA: Duverney’s
19
Q

ankle xrays - the approach

A
  • AABC’S (ABC = Adequacy, Alignment, Bones/Periosteum, Cartilage (joint space), Soft Tissue)
  • Tibia, fibula, talus
  • Malleoli - check medial, lat, posterior
  • Mortise: ligament disruption - check width, symmetry
  • Soft tissues
  • Ottawa Ankle Rules
  • Many Fx Classifications -Weber common
  • Ligaments are key!
20
Q

Bohler’s and Gissane: calcaneus

A
  • Decreased/Increased Bohler’s or Gissane’s Angle?
  • Suspect fx
  • Bohler’s commonly decreased
  • Gissane’s commonly increased
21
Q

tibial plateau

A
  • Bumper, dashboard - auto vs. ped, MVA
  • Axial load, valgus force - jumpers
  • High risk of ligamentous injury
  • Order CT scan
  • Most require ORIF
22
Q

true spondyloisthesis

A

-spinous process step-off above subluxed vertebral body w/ PI defect

23
Q

greenstick/torus fx’s

A

-Incomplete break in
cortex = greenstick fx
-Buckle, buldge, impaction along cortex = torus fx
-Common in kids: soft bones; radius/ulna

24
Q

hip fractures - proximal femur

A
  • 250k/yr in US
  • 20% mortality in elderly
  • Trauma, osteoporosis, steroids
  • Location and displacement: key
  • Displaced neck, subcapital fx’s: High risk AVN femoral head, Garden Classification)
  • ORIF: pins to total arthroplasty
  • CT, MRI for fx’s, MRI occult fx’s
25
Q

hip hardware

A
  1. Screws – stabilize, realign hip and preserve anatomic angle. Non-displaced and incomplete fx’s with little risk for AVN
  2. Dynamic hip screw – stabilize, realign hip and preserve anatomic angle. Fx’s with little risk of AVN
  3. Hemiarthroplasty – proximal femur preserved, femoral head/neck replaced, cup inserted into acetabulum. Used if high risk AVN
  4. Total hip arthroplasty – replace entire proximal femur, add cup for acetabulum. Widely displaced, high risk AVN, poor quality native bone
26
Q

Pediatric wrist is special

A

Capitate/hamate
first to osssify

Spiral order

Roughly 1 carpal per year age up to age 7

Radial head epiphysis >age 3

Pisiform ~ age 12 – the last one

27
Q

Trimalleolar fracture

A
  • All 3 malleoli fx’d, including posterior
  • (AKA: malleolus tertius)
  • Unstable fracture
  • Follow the cortical lines of both the tibia and fibula on lateral
28
Q

calcaneus fracture

A
  • Jumpers, axial load or fall from height
  • Most common tarsal bone fracture
  • Axial view calcaneus
  • Decreased Bohler’s Angle, increased Gissane Angle
  • Can be subtle! CT all
  • Compression fx of lumbar spine common w/ these fx’s – axial load transfer. Get plain films L-spine too
29
Q

Wedge compression fracture

A
  • Hyperflexion, fall
  • Osteoporosis, pathologic
  • Loss of height anterior vertebral body only (anterior column)
  • Posterior body height and post vertebral line intact
  • > % loss height = >severity
  • Common - 1 in 4 >75yrs
  • CT to r/o Burst fx
30
Q

Salter-Harris Classification

A

Type I:

  • Fx through epiphyseal plate, w/ or w/o displacementof the epiphysis.
  • Difficult to detect w/o displacement

Type II:

  • Fx through epiphyseal plate and metaphysis
  • Most common type; up to 75%

Type III:
-Fx through epiphyseal plate and epiphysis

Type IV:
-Fx through epiphyseal plate, epiphysis and metaphysis

Type V:

  • Impaction fx involving all/part of the epiphyseal plate
  • Most serious growth consequences
  • Note: epiphyseal plate is also called the physis or growth plate
  • It is the radiolucent area/space between the epiphysis and metaphysis
31
Q

Base of 5th metatarsal

A

Jones Fx

  • Base 5th MT shaft at least 1.5cm from styloid
  • Direct blow, repeated activity, stress
  • High incidence non-union - Cast, ORIF

Pseudo-jones Fx (avulsion fx @ tuberosity)

  • Common - “Dancer’s Fx”
  • Avulsion peroneus brevis tendon (aka: fibularis longus)
  • Fracture at styloid of 5th MT
  • Walking cast
32
Q

Pediatric elbow ossification

A

When do the bones first appear on xray?

CRITOE

  • Capitellum 1yr (1-8mo)
  • Radial head 3yr (3-6yr)
  • Internal (medial) epicondyle 5yr (3-7yr)
  • Trochlea 7yr (7-10yr)
  • Olecranon 9yr (8-10yr)
  • External (lateral) epicondyle 11yr (11-12y)
33
Q

legg-calve-perthes dz

A

LCP
-Avascular necrosis of
femoral head, epiphysis
-Flat, irregular, sclerotic

-Boys: 4:1 predominant
-Age 4-9 most common
-LCP is idiopathic
-”growing pains”
-Limp, hip pain, often
knee pain

34
Q

Salter-Harris fracture classification

A

Growth plate fx’s
in children

Can affect growth,
bony development

Higher number =
worse prognosis

I-V for us
I-IX for pediatric
orthopedists

35
Q

Maisonneuve fracture

A 
Spiral fx proximal
fibula with: 
-Wide medial mortise
-Medial malleolar fx
-Tibiofibular joint
widening (syndesmosis disruption)
-With or without distal 
fibula fx (classic)

Check proximal
leg tenderness
in all ankle injuries!

36
Q

Pediatric considerations

A
  • Growth Plates
  • Salter-Harris Classification
  • Wrist ossification order
  • Elbow ossification order - CRITOE
  • Osgood-Schlatter
  • Legg-Calve-Perthes
  • Slipped Capital Femoral -Epiphysis
  • Ossification = when bones actually form or when you can see them on xray
  • Metaphasysis is the active part next to the growth plate
37
Q

pseudospondylolisthesis

A

-step off below subluxation, PI intact

38
Q

Bimalleolar fracture

A
  • Lateral and medial malleoli fractures. Posterior malleolus intact.
  • Unstable fracture with mortise (ligamentous) disruption
39
Q

patellar dislocation

A
  • Often clinically evident, may self reduce
  • Majority are lateral
  • Xray for patella fx post-reduction
  • 30% w/ ligamentous, meniscus injury
40
Q

Pelvis fractures: unstable

A
  • Unstable = pelvic ring is disrupted in 2 or > places
  • Diastasis = separation – SI joints or pubic symphysis
  • High-risk injury - hemorrhage, pelvic organ injury
  • The ring of the pelvis is fractured in 2 or more places – that alone makes it unstable
  • High risk for hemorrhage! You can lose up to 2 liters of blood!
41
Q

degenerative joint disease - spondylosis

A
  • DJD, Osteoarthritis = Spondylosis
  • Cortical sclerosis, disc space narrowing, spurs
  • Ankylosing Spondylitis (bamboo spine)
42
Q

Lisfranc fracture/dislocation

A
  • Midfoot slide.
  • Check: 1st, 2nd MT alignment w/ 1st and 2nd cuneiform:
  • Check: 5th MT alignment w/ cuboid:
  • Check: fx at proximal 2nd MT:
  • Check: MT/cuboid spacing on AP/oblique
  • Unstable
  • ORIF
  • Often the mechanism is extreme dorsiflexion at MTP joints – tip-toe position.
  • Actual Lisfranc ligament is between first cuneiform and medial base of the second metatarsal bone

Radiology 3 (3 decks)

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