Abnormal extremity Flashcards
effusion
escape of fluid into a cavity
sprain
injury to a joint ligament or capsule
strain
injury to a muslce or tendon
pathologic fracture
a fracture through abnormally fragile bones
fatigue or stress fracture
an incomplete fracture due to repetative stress
DJD
degenerative joint disease
dislocation
disruption of normal articulation
osteomyelitis
bone infection
seven signs of fracture
- increase lucency
- opacity (hematoma)
- contour disruption
- masses
- hematoma or swelling
- unexplained fragments despite absnese of obvious fracture
- callus formation
what is OLDACID used for?
to describe fractures
define OLDACID
Open vs closed
Location
Degree
Articular extension
Communition/pattern
Intrinsic bone quality
Displacement/angulation/rotation
open vs closed facture
open fractures break through the skin or body cavity
close fractures have intact skin
how should location of a fracture be described
giving the bone involved and the location on the bone
how is the degree of a fracture described
either as complete or incomplete
complete vs incomplete fracature
a complete fracture disrupts both cortices
an incomplete fracture just disrupts one
what is another name for an incomplete fracture
what population do you normally see these in?
why?
greenstick fracture
in children
because their bones have not hardened yet
what is the articular extension of a fracture
if the fracture extends into the joint
what are two ways to describe articular extension of a fracture
intra-articular
extra-articular
describe the articular extension of this fracture
extra-articular, displaced
describe the articular extension of this fracture
intra-articular, displaced
describe the articular extension of this fracture
intra-articular, non-displaced
describe the articular extension of this fracture
extra-articulat non displaced
which are more complicated, intra or extra articular fractures
intra, because the joint surface is damaged
14 ways to describe the pattern of a fracture
- simple
- transverse
- oblique
- spiral
- linear/longitudinal
- comminuted
- segmental
- compression
- impacted
- torus
- distraction
- avulsion
- stress
- pathologic
simple fracture
a closed fracture with two ends but no fragmentation and little tissue damage
describe the pattern of this fracture
simple fracture
describe the pattern of this fracture
transverse
is this a complete or incomplete fracture
incomplete
transverse fracture
fracture occuring on a horizonal plane
oblique fracture
fracture breaks at an angle
describe the pattern of this fracture
oblique
describe the fractute of this bone
O closed
L distal 1/3 of the tibia
D complete
A extra-articular
C oblique
I no abnormalities
D no displacement
spiral fracture
a helical fracture that appears S shaped on Xray, usually from a twisting motion or injury
describe the pattern of this fracture
spiral
completely describe this fracture
O closed
L midshaft of the humerus
D complete
A extra articular
C spiral
I no abnormalities
D slightly displace
completely describe this fracture
O closed
L midshaft of the femur
D complete
A extra-articular
C spiral
I no abnormalities
D severly displaced, 20deg displacement lateral apex
linear fracture
fracture line that runs parallel to the long axis of a bone with no displacement
describe the pattern of this fracture
linear
comminuted fracture
a fracture with more than two fragments
describe the pattern of this fracture
comminuted
completely describe this fracture
O closed
L proximal 1/3 of the humerus
D complete
A no articular extension
C mildly comminuted
I no abnormalities
D mildly displaced, 10deg angulation medial apex
what are three general descriptors of comminution
- non-comminuted
- mildy comminuted
- severely comminuted
segmental fracture
fractute which separates large bone fragments from the body of the fractured bone
describe this fracture pattern
segmental
describe this fracture pattern
butterfly
compression fracture
collapsed vertebrae
impacted fracture
shortening of the bone with no loss of alignment
describe the fracture pattern
impacted
what is a torus fracture?
what age group are they common in
compression fracture of a long bone that causes the cortex to buckle
pediatrics
completely describe this fracture
O closed
L distal 1/3 of the radius
D complete
A no articular extension
C torus
I no abnormalites
D no displacement
what is a distracted fracture?
what can caused this
a fracture where bone length is increased due
muscle tension on the fractured ends of a bone pulling in opposite directions
avulsion fracture
when a small chunk of bone attached to a tendon or ligament is tore off the main bone
completely describe this fracture
O closed
L proximal head of the 1st phalanx
D incomplete
A intra-articular, displaced
C non-comminuted
I no abnormalities
D slightly displaced
two types of stress fractures
fatigue and insufficiency
what is the difference between fatigue and insufficiency stress fractures
fatigue fractures are caused by abnormal stress on a normal bone
insufficiency fractures are due to normal stress placed on an abnormal bone
pathologic fracture
fracture that occurs due a weakened area of bone
osteopenia
decreased bone density that often results in pathological fracture
when is osteopenia visable on x ray
not until there has been a 50% loss
what disease process is present here
osteopenia
how is displacement descibed
the displacement of the distal fragment in relation to the proximal
5 categories of displacement
- dislocation
- angulation
- rotation
- translation
- shortening
what category of dislocation is this
dislocation
how is rotational displacement described
by the amount of rotation in the distal fragement relative to the proximal
translation
sideways movement of the fracture
how is translation described
by the percent of movement relative to the diameter of the bone
how is shortening displacement described?
what is another name
the amount the fracture has collapsed
bayonette apposition
complete describe this fracture
O closed
L distal radius
D complete
A extra-articular, displaced
C transverse
I no abnormalites
D 30 degrees angulation apex volar
what is the Salter-Harris classification used for
to grade pediatric fracture that involve the growth plate
define the SALTR acronym
Seperation through the growth plate
Above the growth plate
Lower or below the growth plate
Through the growth plate above and below
Ram, compression at the growth plate
Salter Harris type one
separation of the growth plate but no fracture of the metaphysis or diaphysis
what Salter-Harris classification is this
type I, separation
what Salter-Harris classification is this
SH type II, fracture through the metaphysis with seperation of the growth plate
Salter-Harris type II
fracture through the metaphysis with separation of the growth plate
what Salter Harris classifiction is this
Type III, epiphyseal fracture with growth plate separation
Salter Harris type III
fracture of the epiphysis with separation of the growth plate
Salter Harris type IV
fracture extends through physis into the epiphysis and metaphysis
what Salter-Harris classification is this
Salter Harris IV, meta/epi/physeal
Salter Harris Type V
ram, compression of the physis
what Salter-Harris classification is this
Type V, ram
completely describe this fracture
O closed
L distal radius
D complete
A non-articular
C distraction
I no abnormalities
D 2cm dorsal dislocation
S Salter Harris I
complete describe this fracture
O closed
L distal femer
D complete
A extra-articular, displaced
C mildy comminuted
I no abnormalities
D 5cm lateral displacement
S SH II
what will malignant tumors look like on xray
aggressive pattern of bone destruction with a wide transition, destruction of bone, and soft tissue masses
what will benign tumors look like on xray
a less aggressive pattern of bone destruction with clear borders and no cortical destruction
what type of metastatic process is at work here
malignant
what type of metastatic process is at work here
benign
what are the three main types of arthritis
- hypertrophic
- erosive
- infectious
three examples of hypertrophic arthritis
- DJD
- Charcot
- Calcium pyrophosphate deposition disease
four types of erosive arthritis
- RA
- Gout
- Psoriatic
- Hemophilia
two types of infectious arthritis
- pyogenic
- tuberculosis
DJD (osteoarthritis)
wearing down of the articular cartilage
where is DJD commonly seen
hips, knees, back, DIP and PIP joints
what is the pathology of DJD
- articular cartilage wears down
- bone on bone action produces inflammation and pain
- osteophytes form in response
subarticular cysts
cysts that form in subarticular bone affected by DJD
four radiographic signs of DJD
- assymetrical joint space narrowing
- periarticular sclerosis
- osteophytes
- subarticular cysts
what type of arthritis is this?
how can you tell?
osteoarthritis
subarticular cysts, periarticular sclerosis, narrowed joint spaces with osteophytes
rheumatoid arthritis
inflammatory process of the synovium
4 signs radiographic signs of RA
- Soft tissue edema
- loss of articular cartilage
- joint subluxation
- no osteophytes
what type of arthritis is displayed here
how can you tell
RA
displaced joints, loss of articular cartilage, no osteophytes/sclerosis/cysts
gout
a metabolic disorder associated with high uric acid and the accumlation of crystals in the joint
how will gout look on a radiograph
large erosions of bone with sclerotic, overhanging hook like margins
can also have no radiographic signs
what disease process is displayed here
how can you tell
gout
soft tissue edema, hook like projections proximal to the joint
what causes septic arthritis
infection causing effusion and swelling of adjacent soft tissue
focal osteopenia
bone degeneration on either side of a septic joint
what will septic arthritis look like on radiograph
soft tissue swelling, periarticular osteopenia, joint space narrowing
what disease process is present here?
what other diagnosis could this be mistaken for
septic joint
metastasis
avascular necrosis
where does it often occur?
bone death caused by poor blood supply to an area of bone
the femoral head unilaterally
four radiographic signs of avascular necrosis
- osteopenia
- sclerosis
- dark cresent
- collapse
what are two common causes of avascular necrosis
fracture and chronic steroid injection
what sign is present on this?
what is it indicative of
bite out lesion
avascular necrosis
what sign is present on this?
what is it indicative of
sclerosis “snow topped moutain”
avascular necrosis
what sign is present on this?
what is it indicative of
femoral collapse
avascular necrosis
avascular necrosis of the humeral head
avascular necrosis of the humeral head
three radiographic signs of osteomyelitis
- lytic lesion
- sequestrum
- perostitis
sequestrum
a devascularized piece of bone that may persist in a lesion
perostitis
inflammation of adjacent periosteum related to osteomyelitis
when would osteomyelitis develop into septic arthritis
when it extends into a joint
T/F osteomyelitis is usually evident on xray by day 1
false, radiographs can be normal for the first 10 days
what is this?
what sign might be present here?
acromioclavicular separation
“piano key sign”
what is this?
how cann you tell
anterior shoulder dislocation
because the humeral head is displaced under the coracoid process
what is this? how can you tell? what sign might be present with this injury?
posterior shoulder dislocation
light bulb sign
the humeral head is under the acromion
