5: Radiology - X-rays and upper limb

Question 1

What needs to be obtained from a trauma patient before examining an X-ray of their injury?

Answer 1

History and examination info:

Patient age

Mechanism of injury

Site of pain / deformity

Question 2

Is one view sufficient to diagnose a fracture?

Answer 2

No

Fracture may be invisible in one view, plus bone alignment may be obscured

Question 3

How many views are usually enough to diagnose a bone fracture?

Answer 3

Two views

Question 4

Which X-ray views should be used to diagnose a C spine injury?

Answer 4

AP (i.e THE OTHER ONE)

Lateral

Odontoid peg

Question 5

Which bone fracture of the hand requires four different X-ray views to adequately diagnose?

Answer 5

Scaphoid fracture

Question 6

Fractures can appear on X-ray as darker areas crossing bone - what are they called?

Answer 6

Lucencies

Question 7

What does comminution mean?

Answer 7

Fragmentation of bone

Question 8

What, found around joints, may swell following a fracture?

Answer 8

Soft tissue

Can be seen on X-ray

Question 9

Fractures may present on X-ray as ___ of bone.

Answer 9

angulations

Question 10

What term, describing movement of bone away from its original position, may indicate a fracture has occured?

Answer 10

Displacement

Question 11

What term describes the crushing-together of bones which may have resulted in a fracture?

Answer 11

Impaction

Question 12

What term describes the ripping away of cortical bone from the rest of the bone, often resulting in fracture?

Answer 12

Avulsion

Question 13

Which bones, embedded tendons in the knee and hand, are often mistaken for avulsion fractures?

Answer 13

Patella

Sesamoid bones

Question 14

What can mimic an avulsion fracture?

Answer 14

Sesamoids / patella

Past non-united fractures

Question 15

Bone ___, as in the spine, can indicate whether a fracture has occurred.

Answer 15

alignment

Question 16

What is the posterior fat pad sign?

What does it indicate?

What kind of X-ray abnormality is it?

Answer 16

Presence of displaced fat pad posterior to distal humerus

Elbow effusion

Soft tissue abnormality

Question 17

What is an important indicator of elbow trauma on X-ray?

Answer 17

Posterior fat pad sign

Question 18

What type of fractures do the bones of children sustain?

Why?

Answer 18

Buckle fractures, bowing, incomplete fractures

Because their bones are softer so they tend not to snap

Question 19

What may avulse from bones in children’s fractures?

Answer 19

Ligaments

Question 20

What is a physiological lucency found at the epiphysis of childrens’ bones?

Answer 20

Epiphyseal growth plate

Question 21

What, in children, may be mistaken for fractures?

Answer 21

Epiphyseal growth plates

Question 22

In relation to epiphyseal growth plates, what is a Salter-Harris fracture?

Answer 22

Displacement of epiphysis from metaphysis due to fracture

Question 23

In terms of children’s fractures, what does NAI stand for?

Answer 23

Non-accidental injury

i.e child abuse

Question 24

It’s important not to ___ ___ after identifying an X-ray abnormality.

Answer 24

switch off

as there is often more than one

Question 25

If a bony ring is injured, how many fractures would you expect to find?

Answer 25

More than one

Question 26

Why does foreign material like glass and metal show up on X-ray?

Answer 26

Differing density from bone and soft tissue

Question 27

What foreign materials are often invisible on X-ray?

Answer 27

Plastic

Wood

Question 28

What is a pathological fracture?

Answer 28

Fracture resulting from normal stress on WEAKENED skeleton

Question 29

Pathological fractures are ___ to the mechanism of injury.

Answer 29

disproportionate

Question 30

What are some causes of skeletal weakening leading to pathological fracture?

Answer 30

Metastatic deposits in bone

Osteoporosis

Question 31

What shoulder instability is difficult to spot on X-ray?

What view can be used to see it?

Answer 31

Posterior dislocation

Oblique X-ray