Upper Limb Trauma Imaging

Question 1

what views are taken of the cervical spine?

Answer 1

AP
lateral
odontoid peg

Question 2

what views are taken of the scaphoid?

Answer 2

AP
lateral
2 obliques

Question 3

what type of fracture is known as a boxers fracture?

Answer 3

angulation

Question 4

all fractures look almost the same, true or false?

Answer 4

false
many different appearances and types of fractures
can be depend on mechanism of injury

Question 5

what is an avulsion fracture?

Answer 5

fracture where a tendon or ligament pulls of a piece of bone

Question 6

what can mimic an acute avulsion fracture?

Answer 6

sesamoid bones
accessory ossification centres in children
old non-united fractures
- all have a completely corticated contour

Question 7

what aspects of the upper limb can be used to assess bony alignment?

Answer 7

acromioclavicular
glenohumeral
elbow
- radio-capitellar
- humero-capitellar
lateral wrist - between radius, lunate and capitate (should sit on top of each other)

Question 8

what can cause a displacement of the ulna?

Answer 8

supracondylar fracture

Question 9

what does the lunate look like?

Answer 9

cashew nut

Question 10

where can fat density be seen on a normal x ray and what does this look like?

Answer 10

usually sits in front of the elbow

looks darker

Question 11

what does a posterior fat density pad at the elbow indicate?

Answer 11

effusion

Question 12

how do childrens bones differ to adult?

Answer 12

more soft so bend and bow rather than snap or splinter dracture

Question 13

common types of fracture in children?

Answer 13

buckle fracture

greenstick fracture

Question 14

what can happen to ligaments in children?

Answer 14

ligaments or tendons can avulse their soft bony attachments

they pull the bone out of alignment

Question 15

what is the weakest part of developing bone?

Answer 15

growth plate so prone to injury

- can be complicated by growth deformity

Question 16

where is the epiphysis in normal bones and what can displace this?

Answer 16

centred on the metaphysis

can be displaced by fracture

Question 17

what can physes be confused with?

Answer 17

fractures

Question 18

what must be kept in mind with young children if injury doesn’t match history?

Answer 18

non-accidental injury

Question 19

what is a salter harris fracture?

Answer 19

fracture involving epiphyseal growth plate

usually in children

Question 20

what is a bony ring?

Answer 20

many bones from rings to help share the transmission of force and increase strength

• spinal canal
• pelvis
• forearm and lower leg

Question 21

what is the significance of bony rings in terms of fracture?

Answer 21

difficult to fracture a ring in only one place
(imagine trying to break a polo mint in only one place)
therefore if you see one injury in a bony ring there is likely to be another so must look for it

Question 22

what foreign materials can be seen on X ray?

Answer 22

metal and glass
(not wood and plastic)
must be more dense than the soft tissue

Question 23

what can cause large fracture from a trivial njury?

Answer 23

skeletal weakening

- focal or whole skeleton

Question 24

likely fracture to occur in elderly osteoporotic lady if falling on outstretched hand?

Answer 24

colles fracture

Question 25

how many carpal bones should there be?

Answer 25

8

Question 26

what fracture would occur from falling on an outstretched hand in a young child?

Answer 26

buckle fracture

Question 27

what fracture would occur from an outstretched hand in adult man?

Answer 27

scaphoid

Question 28

post menopausal woman falling on outstretched hand?

Answer 28

surgical neck of humerus fracture

Question 29

which shoulder dislocation is more difficult to see?

Answer 29

posterior

obtain oblique view as well to see properly

Question 30

what indicates a supracondylar fracture?

Answer 30

humero-capitellar malalignment

Question 31

why is a scaphoid fracture difficult?

Answer 31

can be very difficult to see (almost invisible)

risk to blood supply - can cause avascular necrosis and eventually lead to secondary OA

Question 32

what is a bennets fracture?

Answer 32

involves articular surface of the first metacarpal base