Acute Radiology Flashcards by Katie alder

Fracture Terminology

- Open/Closed

• Open/Closed : Communication with skin

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Fracture Terminology

- Simple/Comm

• Simple/Comm. : Fragments 2 or more

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Fracture Terminology

- Complete vs Incomplete

• Complete/Incomplete: all cortex disrupted

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Fracture Terminology: Displacement

Apposition and alignment defined in relation to
distal fragments:

Displacement (e.g., medial lateral, posterior,
anterior)

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Fracture Terminology:

Angulation

Apposition and alignment defined in relation to
distal fragments:

Angulation (e.g., medial, lateral, posterior,
anterior)

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Fracture Terminology:

Overriding

Apposition and alignment defined in relation to

distal fragments: overlap of fragments

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Fracture Terminology:

Distracted

Apposition and alignment defined in relation to

distal fragments: separated fragments

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Fracture Terminology: Green Stick Fracture

Break of one cortical margin

Only with intact periosteum due to tension on soft growing bone

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Fracture Terminology: Torus Fracture

Buckling of cortex due to compression

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Fracture Terminology: Pathologic Fracture

Fracture at site of preexisting osseous abnormality

Cause: tumor,osteoporosis, infection,metabolic disorder

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Fracture Terminology: (Fatigue) Stress Fracture

Fractures produced as a result of repetitive prolonged muscular action on a bone that has not accommodated itself to such actions, activity-related pain abating with rest

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(Fatigue) Stress Fracture Features on XR

X-Ray:
• 15% sensitive in early fractures, increasing to 50% on follow-up)
• Subtle blurring of trabecula margins
• Sclerotic band (due to trabecular compression usually perpendicular cortex)

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Fracture Terminology: Salter Harris

Epiphyseal plate Injury

Types:
I) S: Slipped
II) A: Above
III) L: Lower
IV) T: Through
V) R: Rimmed

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Salter Harris Types:

Slip through physis+ extending
through metaphysis separating a triangular fragment (“corner sign”)

Type II: 75% (most common)
• Location: distal radius (33-50%), distal tibia, fibula, phalanges
• Prognosis: good, may result in minimal shortening

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Salter Harris Types:

Line of fracture: vertically/ obliquely through epiphysis to periphery of physis

Type III: 8%
• Intra-articular fracture
• Location: distal tibia,distal phalanx.
• Types III & IV are more prone to chronic disability

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Salter Harris Types:

Fracture involves metaphysis+
physis+ epiphysis

Type IV: 10%
• Prognosis: guarded (may result in deformity)
• Types III & IV are more prone to chronic disability

Salter Harris Types:

Crushing injury often associated with: fracture
of adjacent shaft

Type V: 1%
• Crushing injury with injury to
vascular supply
• Location: distal femur, proximal tibia
• No intermediate radiographic finding
• Type V associated with growth disturbances and has a poor functional prognosis

Fracture Terminology: Bennett Fracture

Mechanism: forced abduction of thumb
• Intra-articular fracture dislocation of base of 1st
metacarpal
• A small fragment of 1st metacarpal continues to articulate with trapezium

Fracture Terminology: Boxer’s Fracture

Fracture of the MCP neck (most commonlv 5th MCP)

with volar angulation and often external rotation of the distal fragment

Fractures: Most common carpal fracture

Scaphoid Fracture

Most common fracture of carpus (90%)

Mechanism: Fall on outstretched hand in young adults.

Locations:
Waist 70%
Proximal pole 20%
Distal pole, 10%

Fracture Terminology: Mallet Finger

Baseball (mallet) finger
• Dorsal Avulsion of extensor mechanism
• DIP flexion with or without avulsion fragment

Fracture Terminology: Barton’s Fracture

Intra-articular fracture of the volar or dorsal margin of the distal radius.
The carpus usually follows the distal fragment.
Unstable fracture requiring open reduction and internal fixation and/or external fixation.

Fracture Terminology: Chauffer Fracture

Triangular fracture of radial styloid process.

Fracture Terminology: Colle’s Fracture

Extra-articular fracture (in contradistinction to Barton’s fracture)
Distal radius is dorsally displaced/angulated
Ulnar styloid fracture 50%
Foreshortening of radius

Complications of Colle’s Fracture

Median, ulnar nerve injury, OA

Fracture Terminology: Galeazzi Fracture

Fracture of ulnar shaft+ dislocation of radial head • Radial shaft fracture (most commonly) at junction of distal to middle third with dorsal angulation • Dislocation of distal radio-ulnar joint • Ulnar plus variance ( radial shortening) implies complete disruption of interosseous membrane (instability of radio-ulnar joint)

Fracture Terminology: Monteggia Fracture

Mechanism: direct blow to the forearm Anteriorly angulated proximal ulnar fracture with Anterior dislocation of radial head Reverse Monteggia: Radial head displaced posteriorly, Dorsally angulated proximal ulnar fracture

Fracture Terminology: Fat Pad Sign

• Displacement of anterior fat pad indicative of elbow fracture • Posterior fat pad Indicating elbow joint effusion with (supracondylar/lateral condylar / proximal ulnar or radial fractures)

Fracture Terminology: Elbow Lines

Alignment: A) Radio-Capitellar Line B) Anterior Humeral Line.

Treatment Radial Head Fracture

* No displacement: splint, cast * More than 3 mm displacement on lateral view: open reduction and internal fixation * Comminuted: exicision of radial head

Radiographic Features of Radial Head Fracture

* Positive fat pad sign * Fracture line may be difficult to see on * standard projections.

Radiographic Features of Humeral Head Fracture

• Fracture lines according to Neer classification • Pseudosubluxation: inferior displacement of humeral head due to hemarthrosis

Site of clavicle fractures

* Lateral third: 15% * Middle third: 80% * Medial third: 5%

Dislocation vs subluxation

Dislocation: separation of articular surface of glenoid fossa and humeral head that will not reduce spontaneously. Subluxation: transient incomplete separation that reduces spontaneously

Shoulder Dislocation is divided into two large categories:

* TUBS (Traumatic unidirectional Bankart requires surgery) | * AMBRI ( A traumatic multidirectional bilateral recurrent instability)

Anterior Shoulder Dislocation: Radiographic findings

• Humeral head lies inferior and medial to glenoid Two lesions can occur as humeral head strikes the glenoid: • Hill-Sachs lesion (posterior-superior and lateral) of humeral head, (best seen on Ap view with internal rotation) • Bankart lesion (antero-inferior) of glenoid (may require CT)

Posterior Shoulder Dislocation: Radiographic findings

* Humeral head lies superior to glenoid * Trough sign: compression fracture of the anterior humeral surface * Posterior displacement is best seen on the axillary view. * Light bulb sign: a circular appearance of the humeral head, arm fixed in internal rotation. * Rim sign (66%) = distance between medial border of humeral head+anterior glenoid rim >6 mm

General indicators of cervical spine fracture instability

* more than one vertebral column involvement * increased or reduced intervertebral disc space height * increased interspinous distance * facet joint widening * vertebral compression greater than 25%

cervical spine fractures: 4 major mechanisms

* Flexion * Extension * Rotational and shearing, each associated with certain fracture patterns