Pelvis, LE, UE Anomalies/Variants

Question 1

What are phleboliths?

Answer 1

Acquired normality: calcified venous thrombi within pelvis

Question 2

How do phleboliths form?

Answer 2

Clots organize, fibroblasts arrive and become osteocytes

Question 3

How might you differentiate phleboliths from kidney stones?

Answer 3

Phleboliths are usually below the ischial spine
Kidney stones are usually above

Question 4

What are paraglenoid sulci?

Answer 4

Incidental/normal finding of grooves nect to sacroiliac joints (within pelvic brim)

very common in females

Question 5

DDH

What is Putti’s triad?

Answer 5

• Lateral displacement of the femur
• Small or absent femoral capital epiphysis
• Increased acetabular angulation

Question 6

DDH

How much of the femoral head is usually covered by the acetabulum?

Answer 6

2/3 coverage of femoral head

Question 7

Developmental dysplasia of the hip (DDH) presents a concern for ___ and ___, especially with dislocation.

Answer 7

avascular necrosis and DJD

Question 8

Os acetabulum is usually asymptomatic, but can be associated with ___.

Answer 8

femoroacetabular impingement syndrome (FAI)

Question 9

What is os acetabulum?

Answer 9

Accessory ossicle of the acetabular margin

mostly incidental; often mistaken for a fracture

Question 10

If someone with os acetabulum has FAI, they will experience hip pain with ___ motions.

Answer 10

hip flexion and ab-/ad-duction

Question 11

FAI

What are two possible abnormal shapes of the FA joint that can result in mechanical impingement and pain?

Answer 11

Cam type: oblong protrusion on the femoral neck
Pincer type: deep acetabular socket

both due to overgrowth

different clinical implications

Question 12

Which patients may be more prone to Cam or Pincer type FAI?

Answer 12

Hockey goalies, baseball/softball players

due to wide stance

Question 13

What is the clinical relevance of Pitt’s femoral herniation pits?

Answer 13

Clue to labral problems secondary to FAI

Question 14

How do bi-/tri-/multi-partite patellae occur?

Answer 14

Extra ossification centers never united

Question 15

How might you differentiate a bi-/tri-/multi-partite patella from a fracture?

Answer 15

• 80% of these are bilateral (x-ray the other knee)
• Patella fracture won’t happen at the superolateral margin

Question 16

Bi-/tri-/multi-partite patella is usually an incidental finding.
What type of activity will trigger issues/symptoms of the extra ossification centers?

Answer 16

Heavy squatting

will need to rest or have surgery with a longer recovery

Question 17

What is the term for congenital fusion within the tarsus?

Answer 17

Tarsal coalition

Question 18

What type of fusion occurs with tarsal coalition?

Answer 18

Can be bony or fibrous

Question 19

Symptoms of tarsal coalition are related to ___ or ___.

Answer 19

pes planus or high arch

rigid flat foot or rigid high arch

foot levelers won’t help

Question 20

Tarsal coalition is bilateral in ___% of patients.

Answer 20

about 50%

Question 21

What are the two most common types of tarsal coalition?

Answer 21

• Calcaneonavicular
• Talocalcaneal

Question 22

What radiographic sign describes calcaneonavicular coalition?
What sign describes talocalcaneal coalition?

Answer 22

Calcaneonavicular: Anteater sign
Talocalcaneal: C sign

Question 23

If there is a sesamoid bone found in the medial side of the foot, the likely diagnosis is ___.

Answer 23

Os tibiale externum

Question 24

What is os tibiale externum?

Answer 24

Separate ossicle in tendon on medial side of foot

Question 25

Which bones will border an os trigonium?

Answer 25

* Calcaneus * Talus * Tibia

Question 26

Which repetitive motion most commonly agitates symptoms of os trigonium syndrome?

Answer 26

Planter flexion e.g. sprinters, ballet danacers

Question 27

If a ballet dancer has os trigonium that has become inflamed and symptomatic, what is a possibility that explains this? What would be the appropriate management?

Answer 27

Possible fatigue fracture May need surgical management

Question 28

What is a pseudotumor of the humerus?

Answer 28

**Mach effect** making the greater tuberosity appear as a lytic mass | NOT A DIAGNOSIS

Question 29

X-ray reveals exostosis proximal to the medial epicondyle of the humerus that points toward the elbow joint. What is the diagnosis?

Answer 29

Supracondylar process

Question 30

X-ray reveals exostosis proximal to the medial epicondyle of the humerus that points away from the elbow joint. What is the diagnosis?

Answer 30

Pedunculated osteochondroma

Question 31

A supracondylar process is seen on a patient's humeral radiograph. Given this finding, what other structure may be presently entrapping the median nerve?

Answer 31

Struther ligament | from extra bone to condyle

Question 32

Supracondylar processes on the humerus can present symptoms due to:

Answer 32

* Median neuropathy (ulnar uncommon) * Brachial artery compromise * Fracture

Question 33

What are the concerns associatied with positive ulnar variance?

Answer 33

* Ulnar impingement syndrome * TFCC tear

Question 34

What are the concerns associated with negative ulnar variance?

Answer 34

Lunate avascular necrosis (Keinbock disease) | sclerosis, flattening, and fragmentation

Question 35

What is Keinbock disease?

Answer 35

Lunate avascular necrosis | sclerosis, flattening, and fragmentation ## Footnote presents with negative ulnar variance

Question 36

What is Madelung deformity?

Answer 36

* Short bowed radius with DRUJ dislocation * Failure of medial growth at the distal radial physis * Ulna is relatively long ## Footnote technically not positive ulnar variance

Question 37

What are the two most common types of carpal coalition?

Answer 37

* Lunotriquetral * Capitate-hamate | typically involves just one row

Question 38

What is the clinical significance of carpal coalition that involves/crosses more than one row?

Answer 38

* Biomechanical results * Can indicate dysplasia