Pelvis + Spine

Question 1

what are the common sites of apophyseal avulsions

Answer 1

ischial tuberosity, ASIS, AIIS, iliac crest

Question 2

apophyseal avulsion is most commonly due to __

Answer 2

repeated / sudden muscle contraction

Question 3

what apophysis is first seen on radiographs when patient is 13 - 15 years old

Answer 3

AIIS, ASIS, iliac crest, ischial tuberosity

Question 4

what apophysis is first seen on radiographs when patient is 11 - 12 years old

Answer 4

lesser trochanter of femur

Question 5

what apophysis is first seen on radiographs when patient is 2 - 3 years old

Answer 5

greater trochanter of femur

Question 6

when does AIIS fuse to the skeleton

Answer 6

16 - 18 years old

Question 7

when does ASIS fuse to the skeleton

Answer 7

21 - 25 yrs

Question 8

when does ischial tuberosity fuse to the skeleton

Answer 8

20 - 25 yrs

Question 9

when does iliac crest fuse to the skeleton

Answer 9

21 - 25 yrs

Question 10

when does lesser trochanter of femur fuse to the skeleton

Answer 10

16 - 17 yrs

Question 11

when does greater trochanter of femur fuse to the skeleton

Answer 11

16 - 17 yrs

Question 12

what are the differences in male & female pelvis

Answer 12

male
- narrower & less flared
- oval / heart pelvic inlet shape
- pubic arch angle < 90 degrees

female
- broader
- round pelvic inlet
- pubic arch angle > 90 degrees

Question 13

what is shenton’s line

Answer 13

line that runs anatomically along medial edge of femoral neck & inferior edge of superior pubic ramus

Question 14

what does an interrupted shenton’s line mean

Answer 14

femoral neck # in adults

developmental dysplasia of hip in children

Question 15

what is Os acetabuli

Answer 15

small bone ossicle at superior margin of acetabular rim which is unfused ossified center / impingement effect from longstanding injury

Question 16

when evaluating SI joint, what should be done

Answer 16

check widths to be equal on both sides and inferior margin of iliac bones line up with inferior aspect of sacral part of joints on both sides

Question 17

when evaluating SP, what should be done

Answer 17

widening should not exceed 5mm and superior margin must be at same level

Question 18

what does a widened SP mean

Answer 18

diastasis

Question 19

what are the 3 lines of the lateral cervical spine

Answer 19

anterior vertebral line, posterior vertebral line, spinolaminar line

Question 20

anterior vertebral line runs along __

Answer 20

anterior surfaces of vertebral bodies

Question 21

posterior vertebral line runs along __

Answer 21

posterior surfaces of vertebral bodies

Question 22

spinolaminar line runs along ___

Answer 22

anterior edge of spinous process at junction of spinous process & laminae

Question 23

what does a disruption in sacral foramina mean

Answer 23

sacral # which might be obscured by rotation or overlying bowel shadows

Question 24

what happens if there is a tiny step in cortical edge of pelvic rings

Answer 24

passes into acetabulum, obturator ring and inferior pubic ramus

Question 25

what is the normal atlantodental interval

Answer 25

adults < 3mm child < 5mm

Question 26

what does a disrupted anterior and posterior ring of Harris Ring mean

Answer 26

base of peg # / C2 body #

Question 27

what pre-vertebral soft tissue signs are indicative of hemorrhage

Answer 27

C1-4 > 7mm C5-7 > 22mm

Question 28

when evaluating AP Peg view, what should be done

Answer 28

check normal alignment of lateral margins of C1 and adjacent lateral margins of C2 equal spaces on each side of peg any # lines across base of peg

Question 29

when evaluating AP spine view, what should be done

Answer 29

spinous process in the midline and smooth lines across lateral masses of vertebra

Question 30

what does a loss of vertebral height indicate

Answer 30

compression #

Question 31

what happens when there is disruption to 3 denis spinal columns

Answer 31

wedging which causes loss of normal concavity of posterior aspects of vertebral body

Question 32

what are the 3 denis spinal columns

Answer 32

anterior column, middle column, posterior column

Question 33

what makes up the anterior column

Answer 33

anterior longitudinal ligament, anterior annulus fibrosus, anterior 2/3 vertebral body

Question 34

what makes up the posterior column

Answer 34

posterior elements (pedicles, facets, lamina, spinous process), posterior ligament (supraspinous + interspinous ligaments)

Question 35

what makes up the middle column

Answer 35

posterior longitudinal ligament, annulus fibrosis, 1/3 vertebral body

Question 36

what does a localized displacement of left paraspinal line mean

Answer 36

paraspinal hematoma from vertebral body #

Question 37

what are stable pelvic injuries

Answer 37

- iliac wing # - sacrum # - superior & inferior pubic ramus # - # of roof of most superior sacral foramen

Question 38

what are unstable pelvic injuries

Answer 38

- lateral compression # with pelvis pushed inward - anterior-posterior compression # - vertical shear # with one half of pelvis shifted upwards

Question 39

what does anterior-posterior compression # result in

Answer 39

ruptured SI joint & SP diastasis

Question 40

what is C2 hangman #

Answer 40

bilateral # through pars interarticularis of C2 vertebra due to hyperextension

Question 41

what does an oblique # through C2 cause

Answer 41

increased AP width of C2 body

Question 42

what are the 2 types of teardrop #

Answer 42

flexion & extension

Question 43

what is the cause of flexion teardrop #

Answer 43

interspinous ligament tear

Question 44

what is the cause of extension teardrop #

Answer 44

disrupted anterior longitudinal ligament

Question 45

what causes unilateral facet joint dislocation

Answer 45

distraction flexion

Question 46

what causes anterior subluxation

Answer 46

flexion-rotation injury

Question 47

what causes clay shoveler #

Answer 47

avulsion # of spinous process due to sudden flexion with contraction of lower neck muscles / direct trauma

Question 48

what is the most common injury of the thoracolumbar region

Answer 48

vertebral compression # in upper lumbar & lower thoracic vertebrae

Question 49

what is seen in flexion compression #

Answer 49

anterior aspect of vertebral body loses height but not posterior aspect

Question 50

what is seen in compression #

Answer 50

vertebral body lost height and pedicles splayed apart

Question 51

what is a burst #

Answer 51

vertical compression # with disrupted anterior & middle column due to fall from height or landing on feet

Question 52

why is transverse # considered minor & mechanically stable

Answer 52

due to lack of neurological compromise

Question 53

what are chance #

Answer 53

flexion-distraction injury

Question 54

where do chance # commonly occur at

Answer 54

upper lumbar/ thoracolumbar junction

Question 55

what happens during chance #s

Answer 55

vertebral body fractured transversely including spinous process, posterosuperior aspect of vertebral body

Question 56

what happens during spondylolisthesis

Answer 56

vertebra displaced over another due to trauma, aging, spondylosis

Question 57

what are the different grading of spondylolisthesis

Answer 57

type I: 25% displacement type II: 25 - 50% " type III: 50 - 75% " type IV: 75 - 100% "

Question 58

spondylosis develops into __

Answer 58

spondylolisthesis

Question 59

what are the risk factors of spondylolysis

Answer 59

male, strenuous sports, genetics

Question 60

what is the cause of spondylosis

Answer 60

OA of spine causing narrowed IV disc spaces and osteophytes

Question 61

risk factors of spondylosis

Answer 61

aging, obesity, genetics, sedentary lifestyle

Question 62

ankylosing spondylitis causes ___

Answer 62

calcification of anterior & posterior longitudinal ligaments & IV discs

Question 63

ankylosing spondylitis results in __

Answer 63

fused / bamboo spine

Question 64

ankylosing spondylitis is common among

Answer 64

20 - 40 yr olds

Question 65

what is a sign of spinal metastasis

Answer 65

winking owl due to pedicle destruction