Radiology 2

Question 1

4 forms of fractures

Answer 1

strain
stress
pathological
incomplete

Question 2

what do we do with new fractures?

Answer 2

orthopedic referral- we don’t adjust new fractures

Question 3

what do you do with cervical spine fractures?

Answer 3

CT- defines fracture extent and comminution
MRI will assess neuro impact
potentially neurologically unstable fractures (collar, stabilize, 911)

Question 4

jefferson burst fracture

Answer 4

axial compression compresses C1 between and occiput and C2

Question 5

hangman’s fracture

Answer 5

hyperextension leading to fracture at pedicles or posterior

AKA type IV spondylo

Question 6

Type II dens fracture

Answer 6

fracture through base of dens

Question 7

type III dens fracture

Answer 7

fracture into body of C2

Question 8

teardrop fracture

Answer 8

usually hyperextension (avulsion), could be hyperflexion (impaction)-Rust sign

Question 9

unilateral facet dislocation

Answer 9

perched facet
one facet goes fully in front of the facet below; the other facet stays behind the facet below, but is elevated toward the top of the facet

Question 10

compression fracture of cervical spine

Answer 10

usually wedge-shaped, but subtle in cervical spine

Question 11

bilateral facet dislocation

Answer 11

aren’t ambulatory most of the time (so don’t pick it!)

Question 12

what do you do with thoracic spine fracture

Answer 12

CT will define fracture extent and comminution; MRI will asses neuro impact

Question 13

compression fracture of thoracic spine

Answer 13

usually wedge shaped with high impact trauma; often concave with osteoporosis
if height is reduced by >30%, may be comminuted with pedicle widening (do CT)

Question 14

how do you know the thoracic spine fracture is old or new?

Answer 14

look for step defect and/or line of trabecular impaction/condensation
new is under 3 months of age
compare with prior films
MRI evaluates presence of marrow edema in new fracture

Question 15

how do you evaluate lumbar spine fractures?

Answer 15

CT will define the fracture extent and comminution

MRI will assess neurological impact

Question 16

compression fracture of lumbar spine

Answer 16

same discussion as with thoracic compression fractures

Question 17

pars defect

Answer 17

most common at L5, but any level possible

stress fracture in teen years

Question 18

type I AC tear

Answer 18

no radiographic evidence

Question 19

type II AC tear

Answer 19

AC rupture + coracoclavicular= elevation of the distal clavicle within acomion

Question 20

type III AC tear

Answer 20

AC rupture + coracoclavicular rupture= complete elevation of distal clavicle

Question 21

humeral dislocation

Answer 21

> 90% anterior and inferior

complications of Bankart and Hill-Sach’s fracture

Question 22

elbow injuries

Answer 22

may be difficult to see, so evaluate secondary indicators of fat pad elevation

Question 23

torus/buckle fracture

Answer 23

buckling of periosteum, painful but uncomplicated

Question 24

greenstick fracture

Answer 24

bend, but not full fracture

Question 25

colles fracture and smith fracture

Answer 25

both distal radius fractures, different angulation

Question 26

scaphoid fracture

Answer 26

usually at waist, risk of being occult, non-union, AVN (MRI finds them)

Question 27

lunate dislocation

Answer 27

pie, widening (dissassociation) of scapholunate space

Question 28

boxer fracture:

Answer 28

distal metacarpal head fracture with risk of healing with angulation

Question 29

gamekeeper thumb

Answer 29

avulsion of ulnar collateral ligament at first proximal phalanx base

Question 30

bennett fracture

Answer 30

fracture of first metacarpal base

Question 31

ankle fractures

Answer 31

usually avulsions of the lateral malleolar tips

Question 32

osteochondritis dessicans

Answer 32

focal AVN, most commonly at knee and talar dome; MRI finds it

Question 33

SCFE

Answer 33

salter harris fracture, usually young, overweight males | crutch the patient, get them off weight-bearing, and refer to orthopedic urgently

Question 34

salter harris fractures

Answer 34

``` mnemonic (SALTR or ME ME) type I: slipped (epiphysis off physis) type II: above (metaphysis and physis) type III: lower (epiphysis and physis) type IV: through (epiphysis, physis and metaphysis) type V: rammed (mashed the physis) ```

Question 35

fracture management

Answer 35

refer to orthopedist/neurologist CT to evaluate for comminution MRI to evaluate marrow signal and neurological compromise lab studies for pathology (CBC, DXA, MRI) stabilize the region is it old or new? re-radiograph for long bone healing/callus do NOT THRUST until it's healed

Question 36

avascular necrosis

Answer 36

``` AKA osteonecrosis childhood femoral head AVN (legg-calve-perthes) adult femoral head AVN (chandler's) lunate (keinbock's) scaphoid (preisser's) metatarsal head (freiberg's) ```

Question 37

causes of AVN

Answer 37

``` most common (STARS) steroids, trauma, alcohol, radiation, sickle cell anemia, idiopathic, clotting, pregnancy, renal disease ```

Question 38

AVN

Answer 38

marrow death, so MRI is best to evaluate and can find it within 24 hours of onset

Question 39

management of AVN

Answer 39

take patient off weight bearing and refer to orthopedist urgently

Question 40

myositis ossificans

Answer 40

heterotopic bone formation biceps and quads 6 months to develop