Trauma Radiology Flashcards

Question

Discuss the presentation and management of C-spine Dislocation

Answer 1

Mechanism: trauma with perching facet joint prevent relocation, associated spinal cord injury X-ray: loss of spinal alignment Treatment: surgical fixation

Answer 2

Fracture is unstable if 2 or more columns involved in injury Anterior column: between anterior longitudinal ligament and midline of vertebrae Middle column: between midline vertebrae and posterior longitudinal ligament Posterior column: between posterior longitudinal ligament and supraspinous ligament

Answer 3

Mechanism: hyperflexion injury X-ray: loss of anterior vertebral height on lateral x-ray Treatment: - non-operative: analgesia, activity limitation, bracing - operative: spinal compression or spinal instability

Answer 4

Mechanism: axial compression, associated SCI X-ray: fracture in anterior and middle columns Treatment: PSIF for compression or instability of spine

Answer 5

Mechanism: flexion injury of spine, associated intra-abdominal injury X-ray: fracture in anterior and posterior column Treatment: Risser table with hyperextension of thoracolumbar junction, PSIF

Answer 6

Mechanism: fracture following normal axial loading of the spine X-ray: wedge compression or biconcave fracture Management: analgesia, vertebroplasty if extreme kyphosis

Answer 7

Spondylolysis: hyperextension injury causing fracture through pars interarticularis Spondylolisthesis: fracture of pars interarticularis and anterior displacement of vertebrae relative to the one below (anterolisthesis) or above (retrolisthesis) it Management: - non-operative: activity modification, rest, analgesia, physical therapy - operative: PSIF if severe compression or unstable

Answer 8

Mechanism: fall X-ray: disruption of obturator foremen, fracture in superior and/or inferior pubic rami Management: - non-operative: analgesia, bedrest, mobilization - operative: unstable

Answer 9

Mechanism: force to knee or side of hip X-ray: disruption of pelvic rim extending into acetabulum, disruption of iliopectineal line in anterior column fracture, disruption of ilioischial line in posterior column fracture Treatment: ORIF

Answer 10

Mechanism: high force injury to pelvis resulting in separation of pelvis at pubic symphysis and SI joint X-ray: widening at pubic symphysis and/or SI joint Treatment: surgery

Answer 11

Demographics: Most often occurs in pediatrics due to tendons being stronger than bone. Mechanism: extreme extension of hip, eccentric loading of the muscle X-ray: avulsion of bone at ASIS or AIIS. Usually well corticated due to prolonged time it had been there. Treatment: - non-operative: rest, ice, rehabilitation, crutches - operative: fixation if distant from bone

Answer 12

Mechanism: fall, stress fracture, osteoporotic fracture X-ray: disruption of arcuate lines of sacrum Treatment: - non-operative: rest, limited weight bearing - operative: unstable

Answer 13

AP: distal tibiofibular overlap >6mm, equal horizontal and medial distance between Talar dome and tibial plafond and talus and medial malleolus of 3mm Lateral: Fibula projects over posterior 1/3 of tibia Mortise: distal tibiofibular overlap >1mm, distance between talus and lateral malleolus of <3-6mm, fibular fossa clearly visible

Answer 14

Sulcus sign of the knee is an impaction fracture of the anteroinferior portion of the lateral femoral condyle Best sign on lateral x-ray. MRI can see bone marrow edema of the femoral condyle and posterior tibial plateau ACL rupture

Answer 15

Mechanism: extreme radial deviation/abduction of the thumb resulting in tearing of the UCL. X-ray: fracture at the proximal and ulnar portion of the proximal first phalanx. May see bone fragment Treatment: require MR or ultrasound to determine if the UCL is stuck within the adductor aponeurosis (Stener lesion), as will require surgery Differential: Gamekeepers thumb is laxity of the ligament resulting in instability of the joint

Answer 16

- Type 1: Lateral split fracture - Type 2: Lateral split-depressed fracture - Type 3: Lateral pure depression fracture - Type 4: Medial plateau fracture - Type 5: Bicondylar fracture - Type 6: Metaphyseal-diaphysis always disassoaciation

Answer 17

- Type 1: Incomplete valgus impacted - Type 2: complete fracture nondisplaced - Type 3: Complete, partially displaced - Type 4: Complete, fully displaced

Answer 18

``` Parts: - Greater tuberosity - Lesser tuberosity - Articular surface - Shaft Classification: - 1 part: cuff and collar - 2 part: closed reduction and cuff/collar and PT. ORIF for displaced fractures or GT involvement - 3/4 part: ORIF ```

Answer 19

- Type 1: nondisplaced - Type 2: subtalar dislocation - Type 3: subtalar and tibiotalar dislocation - Type 4: subtalar, tibiotalar and talonavicular dislocation Management: - All require emergent reduction in ED and then ORIF due to risk of AVN from distal to proximal blood supply , unless type 1

Answer 20

Distal 1/3 radius shaft fracture and associated DRUJ injury Mechanism: - FOOSH Presentation: - ROM testing for forearm instability - DRUJ stress testing leading to wrist of midline forearm pain X-Ray - DRUJ instability: ulnar styloid fracture, widening of joint on AP view, dorsal or velar displacement, radial shortening >5mm Management: - ORIF with stabilization of DRUJ

Answer 21

``` Proximal 1/3 ulna fracture with associated radial head dislocation - most common in children Mechanism: - loss of ROM at elbow - radial deviation of hand with wrist extension - weakness of thumb and MCP extension Management: - closed reduction and casting in kids - ORIF if displaced or in adults ```

Answer 22

Elbow dislocation, radial head or neck fracture, coronoid fracture Mechanism: - FOOSH with valgus, axial and posterolateral rotatory forces Presentation: - varus, valgus instability X-ray: - line drawn through Center of radial neck should always intersect Center of capitellum Treatment: - initial reduction of elbow but will require ORIF

Answer 23

Mechanism: - anterior most common from hyperextension and associated with PCL and intimal tear of popliteal artery - posterior due to axial load on flexed knee and has highest rate of complete tear of popliteal artery - lateral from varus or valgus force and associated with ACL/PCL injury and peroneal nerve injury Presentation: - 50% spontaneously reduce - more than 3 ligaments have been disrupted/unstable - ABI >0.9 than serial exams, <0..9 require duplex ultrasound or CT angiography - if pulses not present do immediate reduction and re-examine Treatment: - Ortho emergency so require immediate reduction and possible vascular consult - open reduction

Answer 24

<1 Month - macrophage and hematoma surrounding site 1 Month - osteoclast remove sharp edges with callus formation within hematoma 1-3 Months - bone formation within callus and associated bridging fragments 6-12 Months - cortical gap bridged by bone 1-2 years - remodelling in order to achieve proper architecture

Answer 25

Pathophysiology - increased pressure lead to decreased venous and lymphatic drainage -> exceed capillary perfusion pressure stopping blood supply -> nerve anoxia to ischemia to necrosis Presentation - early have pain with active contraction and passive stretch along with tense compartment - 5 P's: pain out of proportion, paresthesia, pallor, paralysis, pulselessness Management - remove constrictive dressings and raise limb - urgent fasciotomy

Answer 26

``` Source - remove foreign body from wound - irrigate copiously - cover wound with sterile dressing - reduce and splint fracture Prevent Infection - tetanus - Gustillo 1 get Ancef for 3 days, Gustillo 2 get Ancef plus Gentamicin for 3 days and Gustillo 3 get grade II plus penicillin if in soil Surgery - OR irrigation within 6-8 hrs ```

Answer 27

Presentation - unstable knee with ACL/PCL and MCL all being torn - assessment of nerve and vascular status Management - urgent reduction and reassess neuromuscular status - knee immobilization for 6-8 weeks

Trauma Radiology Flashcards

(51 cards)