Trauma Flashcards
(29 cards)
Stress fracture sites … what inciting activities
Metatarsal shaft
sesamoids
Calcaneus
Tibia and fibula shaft
patella
femoral neck and shaft
pelvis (pubic rami)
Pars interarticularis
Ribs
Hook of hamate
Common fractures of the foot
A) Freiberg’s infarction
B) Tuft toe injury
C) 5th metatarsal fractures (name 3) and a variant
Diaphyseal shaft, metaphyseal-diaphyseal junction and avulsion of the base ( peroneus brevis tendon)
A) Avascular necrosis of the 2nd MTT head (stressful young female in high heels)
B) first MTP fracture and sesamoid fracture (beware of bipartate sesamoid variant)
C) 5th MT Shaft fracture (tx surgical)
Jones (reduced blood supply, tx variable)
5MT base avulsion (conserative (boot)
apophysis variant
A) Avascular necrosis of the 2nd MTT head (stressful young female in high heels)
B) first MTP fracture and sesamoid fracture (beware of bipartate sesamoid variant)
C) 5th MT Shaft fracture (tx surgical)
Jones (reduced blood supply, tx variable)
5MT base avulsion (conserative (boot)
apophysis variant
Common fractures of the foot
A) Freiberg’s infarction
B) Tuft toe injury
C) 5th metatarsal fractures (name 3) and a variant
Diaphyseal shaft, metaphyseal-diaphyseal junction and avulsion of the base ( peroneus brevis tendon)
Common fractures of the foot
A) Freiberg’s infarction
B) Tuft toe injury
C) 5th metatarsal fractures (name 3) and a variant
Diaphyseal shaft, metaphyseal-diaphyseal junction and avulsion of the base ( peroneus brevis tendon)
A) Avascular necrosis of the 2nd MTT head (stressful young female in high heels)
B) first MTP fracture and sesamoid fracture (beware of bipartate sesamoid variant)
C) 5th MT Shaft fracture (tx surgical)
Jones (reduced blood supply, tx variable)
5MT base avulsion (conserative (boot)
apophysis variant
Lisfranc Fracture-Dislocation
Classification
- Tarsometatarsal (TMT) fracture-dislocation
- AP radiographs: Malalignment of metatarsal (MT) relative to cuneiforms
- Radiographs showed only 62% of MT and 49% of tarsal fractures shown by CT in 1 study
Staging, Grading, & Classification
- Homolateral: Displacement of all MTs laterally
- Divergent: 1st MT displaced medially and 2nd-5th MTs displaced laterally
- Partial: Dislocation not involving all TMT joints
- Isolated: Dislocation of single TMT joint
- Longitudinal: Medial displacement of 1st MT and TMT from remainder of Lisfranc joint
Injury is difficult to fully assess on MR since small fracture fragments are poorly seen.
Weightbearing XR and CT :D
Define:
Ecchymosis
Ecchymosis: discoloration of the skin resulting from bleeding underneath,
Avascular necrosis of the navicular
Adult and children (eponymy)
Adult - Mueller-Weiss disease (Adult female>M)
Children - Kohler disease (B>G)
Bankart fracture:
Barton fracture:
Bennett fracture:
Bosworth fracture:
Chance fracture:
Charcot joint:
Chopart fracture:
Colles fracture:
Cotton fracture:
Dupuytren fracture:
Duverney fracture:
Essex-Lopresti fracture:
Freiberg infraction:
Galeazzi fracture:
Gosselin fracture:
Goyrand fracture:
Harris fracture (see Salter-Harris fractures)
Hill-Sachs fracture:
Holdsworth fracture:
Hutchinson fracture:
Jefferson fracture:
Jones fracture:
Kienböck disease:
Lauge-Hansen classification:
Le Fort facial fractures:
Le Fort ankle fractures:
Lisfranc fracture:
Maisonneuve fracture:
Malgaigne fracture:
Monteggia fracture:
Osgood-Schlatter disease:
Pelligrini-Stieda lesion:
Piedmont fracture:
Pilon fracture:
Pott fracture:
Pouteau fracture:
reverse Barton fracture:
Robert Jones fracture: see Jones fracture
Rolando fracture:
Salter-Harris classification:
Schatzker classification
Segond fracture:
Shepherd fracture:
Smith fracture:
Stieda fracture:
Tillaux fracture:
Weber classification:
Bankart fracture: glenoid
Barton fracture: wrist
Bennett fracture: thumb
Bosworth fracture: ankle
Chance fracture: vertebral
Charcot joint: foot
Chopart fracture: foot
Colles fracture: wrist
Cotton fracture: ankle
Dupuytren fracture: ankle
Duverney fracture: pelvic
Essex-Lopresti fracture: elbow
Freiberg infraction: foot
Galeazzi fracture: forearm
Gosselin fracture: ankle
Goyrand fracture: French term for a Smith fracture
Harris fracture (see Salter-Harris fractures)
Hill-Sachs fracture: shoulder
Holdsworth fracture: vertebral
Hutchinson fracture: wrist
Jefferson fracture: vertebral
Jones fracture: foot
Kienböck disease: hand
Lauge-Hansen classification: ankle
Le Fort facial fractures: facial
Le Fort ankle fractures: ankle
Lisfranc fracture: foot
Maisonneuve fracture: ankle
Malgaigne fracture: pelvis
Monteggia fracture: forearm
Osgood-Schlatter disease: knee
Pelligrini-Stieda lesion: knee
Piedmont fracture: another name for the Galeazzi fracture
Pilon fracture: tibia
Pott fracture: ankle
Pouteau fracture: French name for a Colles fracture
reverse Barton fracture: type III Smith fracture
Robert Jones fracture: see Jones fracture
Rolando fracture: thumb
Salter-Harris classification: growth plate
Schatzker classification: knee
Segond fracture: knee
Shepherd fracture: foot
Smith fracture: wrist
Stieda fracture: can mean Pellegrini-Stieda disease or acute fracture of Stieda process
Tillaux fracture: ankle
Weber classification: ankle
Bankart fracture:
Barton fracture:
Bennett fracture:
Bosworth fracture:
Chance fracture:
Charcot joint:
Chopart fracture:
Colles fracture:
Cotton fracture:
Dupuytren fracture:
Duverney fracture:
Essex-Lopresti fracture:
Freiberg infraction:
Galeazzi fracture:
Gosselin fracture:
Goyrand fracture: F
Harris fracture (see Salter-Harris fractures)
Hill-Sachs fracture:
Holdsworth fracture:
Hutchinson fracture:
Jefferson fracture:
Jones fracture:
Kienböck disease:
Lauge-Hansen classification:
Le Fort facial fractures:
Le Fort ankle fractures:
Lisfranc fracture:
Maisonneuve fracture:
Malgaigne fracture:
Monteggia fracture:
Osgood-Schlatter disease:
Pelligrini-Stieda lesion:
Piedmont fracture:
Pilon fracture:
Pott fracture:
Pouteau fracture: French name for a xxx fracture
reverse Barton fracture:
Rolando fracture:
Salter-Harris classification:
Schatzker classification:
Segond fracture:
Shepherd fracture:
Smith fracture:
Stieda fracture:
Tillaux fracture:
Weber classification:
Bankart fracture: glenoid
Barton fracture: wrist
Bennett fracture: thumb
Bosworth fracture: ankle
Chance fracture: vertebral
Charcot joint: foot
Chopart fracture: foot
Colles fracture: wrist
Cotton fracture: ankle
Dupuytren fracture: ankle
Duverney fracture: pelvic
Essex-Lopresti fracture: elbow
Freiberg infraction: foot
Galeazzi fracture: forearm
Gosselin fracture: ankle
Goyrand fracture: French term for a Smith fracture
Harris fracture (see Salter-Harris fractures)
Hill-Sachs fracture: shoulder
Holdsworth fracture: vertebral
Hutchinson fracture: wrist
Jefferson fracture: vertebral
Jones fracture: foot
Kienböck disease: hand
Lauge-Hansen classification: ankle
Le Fort facial fractures: facial
Le Fort ankle fractures: ankle
Lisfranc fracture: foot
Maisonneuve fracture: ankle
Malgaigne fracture: pelvis
Monteggia fracture: forearm
Osgood-Schlatter disease: knee
Pelligrini-Stieda lesion: knee
Piedmont fracture: another name for the Galeazzi fracture
Pilon fracture: tibia
Pott fracture: ankle
Pouteau fracture: French name for a Colles fracture
reverse Barton fracture: type III Smith fracture
Robert Jones fracture: see Jones fracture
Rolando fracture: thumb
Salter-Harris classification: growth plate
Schatzker classification: knee
Segond fracture: knee
Shepherd fracture: foot
Smith fracture: wrist
Stieda fracture: can mean Pellegrini-Stieda disease or acute fracture of Stieda process
Tillaux fracture: ankle
Weber classification: ankle
Chopart fracture dislocation
Chopart joint
- formed by the talonavicular and calcaneocuboid joints
- Chopart fracture dislocation - caused by high impact trauma.
- Asso. with calcaneus, cuboid and navicular bone fractures
Calcaneal fracture
- Most commonly fractured tarsal bone
- lovers fracture > asso. with L-spine, traumatic aortic injury, renal vascular pedicle avulsion
- Plain film signs - boehler’s angle <20 (norm 20-40*)
- Two classifications ( Essex lopresti) divides sparing of the subtalar joint (25%) and subtalar joint (75%)
- SANDERS Classification (number of comminuted fragments on coronal CT
More info
Potential fracture locations for the Sanders classification: Nonarticular fractures are common but are not evaluated as part of this classification. Fracture line A enters the subtalar joint in the lateral aspect of the posterior facet. Fracture line B enters the subtalar joint at the central portion of the posterior facet. Fracture line C enters the subtalar joint at the lateral portion of the posterior facet, or through the medial facet (sustentaculum tali).
Sanders Type II A: The intraarticular fracture line extends through the lateral portion of the posterior articular facet of the subtalar joint.
Sanders Type II B: The intraarticular fracture line extends through the central portion of the posterior articular facet of the subtalar joint.
Sanders Type II C: The intraarticular fracture line extends through the medial portion of the posterior articular facet of the subtalar joint or through the medial facet (sustentaculum tali).
Sanders Type III AB: Two intraarticular fracture lines, three intraarticular fracture fragments. One of the intraarticular fracture lines extends through the lateral portion of the posterior articular facet of the subtalar joint and the other extends through the central portion of the posterior articular facet.
Sanders Type III AC: Two intraarticular fracture lines, three intraarticular fracture fragments. One of the intraarticular fracture lines extends through the lateral portion of the posterior articular facet of the subtalar joint and the other extends through the medial portion of the posterior articular facet or through the medial facet.
Sanders Type III BC: Two intraarticular fracture lines, three intraarticular fracture fragments. One of the intraarticular fracture lines extends through the central portion of the posterior articular facet of the subtalar joint and the other extends through the medial portion of the posterior articular facet or through the medial facet.
Sanders Type IV: Three intraarticular fracture lines, with at least three intraarticular fracture fragments (may be more comminuted).
Calcaneal fracture classification
Classification
- Extra-articular (25%)
- avulsion injury of anterior process by bifurcate ligament
- sustentaculum tali
- calcaneal tuberosity (Achilles tendon avulsion)
- Intra-articular (75%)
- Essex-Lopresti classification
- the primary fracture line runs obliquely through the posterior facet forming two fragments
- the secondary fracture line runs in one of two planesthe axial plane beneath the facet exiting posteriorly in tongue-type fractures
- when the superolateral fragment and posterior facet remain attached to the tuberosity posteriorly
- behind the posterior facet in joint depression fractures
Sanders classification
based on the number of articular fragments seen on the coronal CT image at the widest point of the posterior facet
Classification of Osteohcondral Fractures
Definitions
- Osteochondral injury: Injury extending across articular cartilage to involve underlying bone
- Osteochondral lesion (OCL): Acute or chronic osteochondral injury
- Osteochondritis dissecans (OCD): Chronic osteochondral injury
Imaging
- Osteochondral injuries well-described in talar dome but also occur elsewhere in foot
- Subtalar joint, talonavicular joint, calcaneocuboid joint, metatarsophalangeal (MTP) joints
- See abnormalities of articular cartilage, subchondral bone plate, and underlying medullary bone
- Bone marrow edema involving subchondral bone is nonspecific
- Raises suspicion for possible osteochondral lesion
- May also reflect bone bruise or osteoarthritis
- Isolated cartilage injury
- Cartilage defect: Fills with contrast
- Margins of defect are sharply angled in acute injury, rounded in chronic injury
- Osteochondral injury
- Bowl-shaped, low signal intensity fracture line beneath articular surface
- Subchondral bone marrow edema
- Overlying cartilage injury may be visible, or cartilage may normalize
- Osteochondral or chondral lesion unstable by MR arthrogram criteria when fluid extends beneath fragment
Top Differential Diagnoses
- Osteoarthritis
- Stress fracture
- Avascular necrosis
Pathology
- Subtalar joint: Inversion injury
- MTP joints: Hyperdorsiflexion, axial impact or abduction injury
Presentation
Most common signs/symptoms
- Persistent pain after conservative management of injury
- Other signs/symptoms
- Clicking or catching sensation in joint
Natural History & Prognosis
- Osteochondral injuries tend to lead to osteoarthritis
- Osteochondral injuries of 1st MTP implicated as cause of hallux rigidus
Treatment
- Excision of loose fragment & microfracture
- Arthrodesis for severe injury
Classification of osteochondral injuries of the talus by Anderson et al.
Stage I is identified only by MRI scanning, which demonstrates trabecular compression of subchondral bone; stage II lesions have incomplete separation of the osteochondral fragment from the talus. If a subchondral cyst also is present, the lesion is designated stage IIa. Stage III lesions occur when the fragment is no longer attached to the talus but is undisplaced. Stage IV indicates both complete detachment and displacement. (From Alexander IF, Chrichton KI, Grattan-Smith Y, et al. Osteochondral fractures of the dome of the talus. J Bone Joint Surg Am. 1989;71:1143, with permission.)
Stage I: Subchondral trabecular compression fracture (not seen radiographically)
Stage II: Incomplete separation of an osteochondral fragment
Stage III: The osteochondral fragment is unattached but undisplaced
Stage IV: A displaced osteochondral fragment
Talus fracture
- Divided anatomically into (lateral process, posterior process, head, body and neck fractures
- Hawkins classification
- neck # may disrupt blood supply to the talus > osteonecrosis
- Hawkins sign (lucent band on subchrondral region on frontal ankle XR in 6-8wks. > increased reabsorption from active hyperaemia = intact blood flow. Abscence of the sign would indicate avascular necrosis
- Osteochondral lesion - cresenting lucency on XR.
Radiographics sign of talocalcaneal coalition
& Caclcaneonaviular coalition
C sign (talocalcaneal coalitions (middle subtalar facet)
Caclcaneonaviular coalition (fusion between anterior and process) anteater sign on lateral view
Weber classification of the ankle.
A
B
C
Weber A
- Distal fibular fracture with intact syndesmosis
Weber B
- Proximal transsyndesmotic fracture - usually assocaitated with partial syndesmotic rupture
Weber C
- high fibular fracture above hte level of the syndesmosis with totoal syndesmotic rupture and mortose instability
Syndesmosis is a fibrous ligamentous complex that connects the distal tib and fib, where the distal fibular fits into a groove in the distal tiia (formed by the anterior and posterior tibiofoibular ligaments. The interosseous membrane connects the length of the tibia and fibular superior to the syndesmosis.
========
more info
Ankle Ligament Introduction
Primary ligaments of ankle include (see below for details)
medial
- Deltoid ligament
- Calcaneonavicular ligament (Spring Ligament)
lateral
- Syndesmosis (includes AITFL, PITFL, TTFL, IOL, ITL)
- Anterior talofibular ligament (ATFL)
- Posterior talofibular ligament (PTFL)
- Calcaneal fibular ligament (CFL)
- Lateral talocalcaneal ligament (LTCL)
Syndesmosis
Function
responsible for integrity of ankle mortise
AnatomySyndesmosis components
- Anterior-inferior tibiofibular ligament (AITFL)
- Posterior-inferior tibiofibular ligament (PITFL)
- deep portion of this ligament sometimes reffered to as the inferior transverse ligament
- Transverse tibiofibular ligament (TTFL)
- Interosseous ligament (IOL)
SHIII lateral tiial epiphyses (typically in adlolesents)
- avulsion of the anterior inferior tibiofibular ligament
- reduction needed if > 2 mm displacement
- results from supination-external rotation injury
- leads to avulsion of anterolateral tibia at the site of attachment of the anterior inferior tibiofibular ligament
- lack of coronal plane fracture in the posterior distal tibial metaphysis distinguishes this fracture from a triplane fracture
Associated conditions
- distal fibular fracture (usually SH I or II)
- ipsilateral tibial shaft fracture
https://www.orthobullets.com/pediatrics/4028/tillaux-fractures
Triplane fracture ? Define
- fracture through distal tibia with a complex SH IV fracture pattern with components in all three planes; may be 2, 3, or 4 part fractures
- vertical epiphyseal fracture
- horizontal physeal fracture
- oblique metaphyseal fracture
- SH VI pattern
mechanism of injury
- lateral triplane fracturesresults from supination-external rotation injury
- similar to tillaux fractures
- medial triplane fractures
- results from adduction injury
Chondral and Osteochondral Injury of the ankle
imaging features
pathology
ddx
Imaging
- Osteochondral injuries well-described in talar dome but also occur elsewhere in foot
- Subtalar joint, talonavicular joint, calcaneocuboid joint, metatarsophalangeal (MTP) joints
- See abnormalities of articular cartilage, subchondral bone plate, and underlying medullary bone
- Bone marrow edema involving subchondral bone is nonspecific
- Raises suspicion for possible osteochondral lesion
- May also reflect bone bruise or osteoarthritis
- Isolated cartilage injury
- Cartilage defect: Fills with contrast
- Margins of defect are sharply angled in acute injury, rounded in chronic injury
- Osteochondral injury
- Bowl-shaped, low signal intensity fracture line beneath articular surface
- Subchondral bone marrow edema
- Overlying cartilage injury may be visible, or cartilage may normalize
- Osteochondral or chondral lesion unstable by MR arthrogram criteria when fluid extends beneath fragment
Top Differential Diagnoses
- Osteoarthritis
- Stress fracture
- Avascular necrosis
- Pathology
- Subtalar joint: Inversion injury
- MTP joints: Hyperdorsiflexion, axial impact or abduction injury
Transient Patellar Dislocation
- Marrow contusions in classic distribution
- Inferomedial patella
- Lateral aspect of lateral femoral condyle (LFC)
- Edema or disruption of medial patellofemoral ligament (MPFL)
- Joint effusion
- Intraarticular bodies (if chondral fracture present)
- Subtle flake of avulsed bone at medial pole of patella due to MPFL disruption
- ===============
- Checklist
- TPD in setting of typical marrow contusion pattern
- Look carefully for chondral injury ± intraarticular bodies
- Describe morphology of trochlear groove and patella
- Describe location of MPFL tear (if possible
Classic constellation of findings after transient patellar dislocation (TPD):
- The medial patellofemoral ligament (MPFL) is torn , there are subchondral marrow contusions in the medial patella and lateral femoral condyle , and chondral injury to the patella .
- Acute events usually demonstrate a large effusion ± intraarticular bodies.
- Most injuries are transient and reduce spontaneously upon knee extension.
- Predisposing factors include a congenitally shallow trochlear groove, a Wilberg type III patella (very prominent lateral facet), patella alta, genu valgum, and ligamentous laxity.
Patella fracture imaigng features.
Differential?
Direct trauma. Sudden extension of knee (distraction)
DDx. Bipartate/multipartate patella, have rounded well corticated margins.
Dorsal defect of the patella, normal variant - round lucency at the superior articular aspect of the patella.
Tibial plateau fracture
classification
Spell it.
Schatzker classification
Myxoid degenration verses Meniscal Injury
Definition
Imaging features
Treatment
Myxoid degeneration - increased signal within the meiscus that does no t extend t ot eh meniscal surface. (Not thought to cause symptoms and is not treated.
Meniscal tear - linear band of increased signal that does extend to the articular surface. MRI is >90% sensitive and specific for Dx meniscal tear
==============
Meniscal Injury
- MR findings in meniscus which has not undergone surgery (1 or more present)Linear high signal intensity extending to meniscal surface on 2 or more images
- This can be easier to visualize on MR arthrography than conventional MR
- Change in meniscal contour
- Displaced meniscal fragment
- Parameniscal cyst
- MR findings in postoperative meniscus
- High-signal line may persist in meniscus at site of previous tear
- Without arthrography, meniscal fragment displacement is only reliable sign of recurrent tear
- MR arthrography shows contrast extending into nondisplaced tear
- Top Differential Diagnoses
- Intrameniscal signal
- Vascular or degenerative signal: Usually located centrally in meniscus
- Normal anatomy
- Anterior horn lateral meniscus: Multiple fascicles may mimic tear
- Transverse ligament or meniscofemoral ligament may mimic tear where they join meniscus
- Popliteus tendon adjacent to posterior horn lateral meniscus
- Intrameniscal signal
- Posterior root tears
- Can be easily overlooked; seen best on coronal images
- Meniscal root should lie adjacent to posterior cruciate ligament
Best diagnostic clue
- Contrast material entering meniscus
- Morphology
- Tear usually linear, sometimes creates divot along surface of meniscus
- Longitudinal tear: Vertically oriented, parallel to meniscus periphery
- Radial tear: Vertically oriented, extends from free edge of meniscus toward periphery
- Horizontal tear: Primarily horizontal, exits meniscus at either superior or inferior surface or at free edge
- Complex tear: 2 or more of aforementioned patterns
Pathology:
Degenerative (horizontally oriented) or traumatic (vertically oriented or complex)
Microscopic Features
- Peripheral 1/3 of meniscus is vascularized, potential to heal
- Central portion is avascular, no potential to heal
Treatment
- Unstable or avascular portions (flaps, displaced fragments, radial/”parrot beak” tears) debrided
- Peripheral tears may be sutured
Knee meniscal tear
Types
ABSENT BOWTIE SIGN
GHOST MENISCUS
DOUBLE DELTA SIGN
DOUBLE PCL SIGN
MATCHING CLEFT SIGN
Horizontal; vertical; bucket handle; radial tear (body or horn); meniscal cyst
================
Horizontal/oblique (more degenerative)
Vertical/longitudinal (superior to inferior extension), tear in fixed distance to the edge of the meniscus
Bucket handel tear - Extensive vertical tear ( inner edge of the meniscus gets displaced r flipped over) Commonly the displaced fragment is in the intercondylar notch. ABSENT BOWTIE SIGN
- Anterior displacement > double deltar sign (if fragment flip anteriorly
- Double PCL sign ( if fragment is displaced and flip centrally into the intercondylar notch. (medial meniscus only)
Radial tear - verticle tear perpendicular to the arc of the meniscus (vs. tears that follows the curves as above) Radial tear transects the longitudinal bundles
Radial/ transverse of the meniscal body ( vertical linear tear extending from the free edge to the periphery
Radial tear of the meniscal horn
Ghost meniscal horn
