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bone path Q7 > bone path midterm 2nd half > Flashcards

bone path midterm 2nd half Flashcards

1
Q

Sacral dyslplasia/ agenesis is associtaed with what?

A

scoliosis, myelomeningocele, hip dislocation, foot deformity and has a strong association with maternal diabetes.

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2
Q

Iliac apophysis is aka? What is iliac apophysis?

A

Risser’s sign. And is an indicator of skeletal maturity.

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3
Q

Where will the iliac apophysis grow from and fuse to?

A

From Lateral ASIS to medial PSIS and will fuse to ilium.

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4
Q

What are the grades of rissers sign like?

A

1+= 25%. 2+= 50%. 3+= 75%. 4+= 100% and 5+= fused.

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5
Q

What age will fusion of the iliac apophysis take place at?

A

16 in boys and 14 in girls.

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6
Q

The pattern of iliac apophysis parallels what?

A

The formation and progression of scoliosis.

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7
Q

What is the triradiate cartilage?

A

Area of synchondrosis between ilium, ischium, and pubis.

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8
Q

What will the triradiate cartilage look like in pediatrics?

A

Normally will be seen as a radiolucency at the acetabulum.

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9
Q

What is the ischial apophysis?

A

Secondary growth center at ischium and is normal to seen in pediatric patients.

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10
Q

What is the paraglenoid sulci and it is aka?

A

notched out area at the inferior aspect of the ilium adjacent to the SI joint and it is the insertion point of the SI ligament and is aka preauricular sulci.

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11
Q

When is the paraglenoid sulci aka preauricular sulci seen?

A

Common in female pelvis but rarely seen in males.

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12
Q

What is the name of the Y or V shaped lucent grooves seen with sclerotic margins in the iliac?

A

Iliac nutrient grooves.

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13
Q

Phleboliths are radiopacities with lecent centers that are located where?

A

Pelvic veins.

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14
Q

Sacrotuberous ligament ossification is often seen when?

A

In diffuse idiopathic skeletal hyperostosis and flourosis.

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15
Q

What is Os acetabuli?

A

An accessor ossicle located adjacent to the superior-lateral aspect of the acetabulum.

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16
Q

How can you differentiate an Os acetabuli from a fracture?

A

Os acetabuli will have rounded and corticated appearances.

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17
Q

What is synostosis?

A

union of two or more separate bones to form a single bone

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18
Q

What is ring epiphyses?

A

unossified cartilage at the inferior and superior anterior vertebral body marigns and this is normal for people under 15 years.

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19
Q

What is the most common chest wall anomaly?

A

Pectus excavatum.

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20
Q

Pectus excavatum is aka?

A

Funnel chest.

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21
Q

What is pectus excavatum aka funnel chest?

A

midline depression of the sternum.

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22
Q

What is pectus carinatum?

A

An anterior displacement of the sternum and is aka pigeon breast.

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23
Q

Pectus carinatum is associated with what?

A

Marquio’s disease.

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24
Q

What is the name of a 1st and 2nd rib synostosis?

A

Serb’s anomaly.

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25
Q

What is the rhomboid fossa?

A

This represents the attachment of the rhomboid ligament to the first rib.

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26
Q

How do you position the patient for a AP Pelvis film?

A

Internally rotate femurs 15 degrees.

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27
Q

How is the femoral angle measured and what is normal?

A

Draw one line parallel to the midaxis of the femoral shaft and one line parallel to the midaxis of the femoral neck and meausre angle inside and normal is 120-130 degrees.

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28
Q

What is femoral herniation pit? Aka?

A

round lucency (seen around femoral neck) that represents reaction to irregular capsule and/or iliopsoas irritation. AKA pitt’s pit.

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29
Q

What is the clinical significance of femoral herniation pit aka pitts pit?

A

usually asymptomatic.

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30
Q

What is seen at the head of the femur that may look like an anomaly?

A

Foveas capitus centralis and this is a notch along the axial aspect due to the round ligament.

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31
Q

What is putti’s triad?

A

3 things that make up the findings for acetabular dysplasia / congenital hip dislocation. 1. absent/small proximal femoral epiphysis. 2. Lateral femoral displacement. 3. steep acetabular roof.

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32
Q

When will acetabular dysplasia/ congenital hip dislocation be diagnosed?

A

Seen in infancy and done by Ultra sound in first 3 months or x-ray after first 3 months.

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33
Q

What are 2 orthopedic tests that can be done fro acetabular dysplasia/ congenital hip dislocation?

A

ortoloni’s and Barlow’s tests.

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34
Q

What is a bipartite patella?

A

Failure of complete ossification of the patella results in an isolated segment or segments (tripartite and multipartite if over 3).

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35
Q

Where are bipartite patellas most commonly seen at (where is the fragment)?

A

Superolateral quadrant of the patella.

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36
Q

What causes bipartite patellas?

A

Unknown but chronic trauma during ossification is thought likely NOT DUE TO TRAUMA.

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37
Q

Will bipartite patellas be uni or bi lateral?

A

40-80% of the time they are bilateral.

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38
Q

What is a normal notch seen on the lateral femoral condyle?

A

Popliteal tendon groove.

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39
Q

Name the accessory ossicles of the foot?

A

Os trigonum, Os tibial externum, os supranavicular, OS peroneum.

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40
Q

Which accessory ossicle of the foot is most common and which one is injured the most?

A

Both are Os trigonum.

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41
Q

Where will Os trigonum be seen at?

A

Posterior aspect of the talus.

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42
Q

What will advanced imaging show for os trigonum?

A

If symptomatic can show focal uptake on bone scan and signs of edema in soft tissues.

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43
Q

Where is Os tibiale externum seen at?

A

Medial to the navicular.

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44
Q

How many sub types of Os tibiale externum are there and which one is most common?

A

3 subtypes and type II is most common and is triangular with a flat surface abutting the navicular.

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45
Q

Where is the Os supranavicular seen at?

A

Adjacent to the navicular.

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46
Q

Where is the Os peroneum seen at?

A

Near the cuboid.

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47
Q

What is tarsal coalition?

A

a congenital condition of fibrous, cartilaginous, or bony union of 2 or more tarsal bones.

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48
Q

What tarsal bone is always invovled in tarsal coalition and what other bones will it be joined to?

A

Calcaneous will always be part of it and it will connect to either navicular (most common) or talus.

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49
Q

What causes tarsal coalition?

A

congenital- failure of mesenchymal segmentation during early embyronic development or aquired- as a result of infection, trauma, inflammatory arthritis, or surgery.

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50
Q

What is the clinical significance of tarsal coalition?

A

Many cases remain asymptomatic throughout life minor trauma can trigger pain.

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51
Q

Tarsal coalition is probably the ________ diagnosis clinically.

A

missed.

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52
Q

What is a loss of the subtalar joint called?

A

Talocalcaneal synostosis.

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53
Q

What is the name a normal lucency in the distal fibula?

A

Fibular fossa.

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54
Q

What is a well-circumscribed radiolucency present in the calcaneus that is normal and what causes it?

A

Calcaneal pseudocyst and it is caused by the orientation of the calcaneal trabeulae.

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55
Q

What is a normal radiolucency that is seen in the greater tuberosity of the humerus called?

A

Humeral pseudocyst.

56
Q

What is the lucency normaly seen in the clavicle?

A

The conoid ligament insertion.

57
Q

What will the name be of the timor like appearance of bone that is just the attachment site of the biceps tendon?

A

Radial tuberosity.

58
Q

What is VATER syndrome?

A

a syndrome of congenital anomalies that is often seen when multiple congenital anomalies are present.

59
Q

What is negative ulnar variance?

A

When the ulna is proximal to the perpendicular line (A shortening of the ulna).

60
Q

What 2 things are associated with negative ulnar variance?

A

Kiennbock’s disease, and post traumatic scapholunate disslocation.

61
Q

What is Kienbock’s disease?

A

Sclerosis, collapse, and fragmentation of the lunate.

62
Q

Negative ulnar variance is implicated in what?

A

avascular necrosis of the lunate.

63
Q

What bones are connected in carpal coalition?

A

Mainly the Lunate and triquetrum, but can be others.

64
Q

What is the most common developmental anomaly of the hand?

A

Syndactyly.

65
Q

What is syndactyly?

A

Fusion of skin between digits or fusion of osseous phalanges of adjacent digits.

66
Q

What is polydactyly?

A

Extra digits.

67
Q

Polydactyly is most common amoung who?

A

Blacks.

68
Q

What is a sponyloysis?

A

AN interruption of the pars which may be either uni or bi lateral.

69
Q

What is spondylolisthesis?

A

Displacement of a vertebral body in relation to the segment below it and is traditionally an anterior displacement.

70
Q

What are the different ways to grade spondylolisthesis’s?

A
  1. Divide sacral base into four areas using 3 lines. Then grades will be 1-5. 5 is when there is a spondyloptosis. 2. Measure displacement then divide by length of the sacral promontory and multiply by 100 and this gives you a percentage. 3. You can just give millimeters of displacement.
71
Q

What is the best way to identify a spondylolisthesis?

A

Compare posterior vertebral body line (george’s Line). Could also use Ulmanns line which is a perpendicular line to the sacral base formthe anterior sacral promontory and if this line intersects through the anteriorinferior margin on L5 then an anterolisthesis should be suspected.

72
Q

What line is better at identifying spondylolisthesis George or Ulmanns?

A

Ulmanns is more accurate.

73
Q

What are the 6 categories of spondylolisthesis?

A

Type I- Dysplastic= congenital abnormality. Type II- Isthmic= direct alteration to the pars. Type III- Degenerative= secondary to degenerative arthrosis of the zygaphyseal joints. Type IV- Traumatic= secondary to fracture of areas other than pars. Type V- Pathologic= bone disease. Type VI- Iatrogenic= surgical interventions gone bad.

74
Q

What are the different subtypes of Type II spondylolisthesis?

A

A- caused by biomechnical stress believed to be stess fractures. B- Elongation of the pars without separation due to healing of a pars fracture. C- acute (as in just happened not repetitive trauma or stress fractures) pars fractures and is rare.

75
Q

What is a common type I spondylolisthesis?

A

Congenital malformation of the upper sacrum and or the neural arch of the L5 vertebra and is non-spondylolytic.

76
Q

What type of spondylolisthesis is most common?

A

Type II.

77
Q

What causes a type II spondylolisthesis and what is it aka?

A

caused by repetitive trauma, stress fractures of the pars and is not a congenital condition. AKA spondylolysis spondlylolisthesis.

78
Q

What is the role of genetics with type II spondylolisthesis?

A

Certain genetic factors may predispose an individual to the defect, but the defect is aquired.

79
Q

What is seen 13 times more in people with pars defects?

A

Spina bifida occulta.

80
Q

90% of all spondylolysis spondylolisthesis are found where?

A

L5.

81
Q

What is the most commonly proposed cause of Type II spondylolisthesis?

A

Stress fractures.

82
Q

What type of posture can be associated with type II spondylolisthesis?

A

Hyperextension.

83
Q

Since spondylolysis spondylolisthesis are only found in humans (besides one gorilla) what is the causal factors?

A

Upright posture with repetitive hyperextension.

84
Q

Why will pars stress fractures (type II) not heal like other stress fractures?

A

people are not immobilized at the time of spondylolysis and this results in non-union of the stress fracture.

85
Q

What is the correlation between the degree of anterior displacment and the severity of subjective symptoms?

A

There is no correlation.

86
Q

What % of people with radiologic signs of sponylolisthesis never develop symptoms?

A

50%.

87
Q

Will there be pain that is specifically related to spondyloysis and/or spondylolisthesis?

A

No spondylolysis with or without spondylolisthesis does not cause pain in most patients.

88
Q

what typically happens to the cnetral canal with isthmic spondylolisthesis?

A

It actually increases with isthmic spondyloisthesis.

89
Q

What are the clinical findings with a grade 1 type II spondylolisthesis?

A

minimal to absence of any physical findings and may reveal an audible click and step-off defects may be felt.

90
Q

What are the clinical findings with a grade 2-4 type II spondylolisthesis?

A

Postural changes, accentuated lumbar lordosis, gait patter (pelvic waddle, phalen-dickson sign, short stride and stiff-legged), neurological evaluation is usually unremarkable.

91
Q

What is the gold standard to identify Type II spondylolisthesis?

A

Single-photon emission computed tomography (SPECT). A specialized bone scan.

92
Q

Why will SPECT be so good at identifying Type II spondylolisthesis?

A

Spondylolysis will have a higher metabolic rate at the defect and this is picked up with SPECT.

93
Q

How helpful will bone scans and MRI be at identifying Type II spondylolisthesis?

A

Bone scan- good just not as many angles and may fail to reveal spondylysis in as many as 53% of cases. MRI- good at identifying bone marrow edema with active spondlyosis of area around pars.

94
Q

When is an inverted napoleon’s hat seen?

A

With a grade 2 or greater type II spondyolisthesis of L5 when the TP is superimposed over the sacral base and ala.

95
Q

When are sclerotic (pathological hardening or thickening) pedicle signs seen?

A

usually associated with unilateral defects, but can be seen with bilateral defects particularly when healing is occurring.

96
Q

What is a common finding seen with L5 spondylolisthesis?

A

L4 retrolisthesis.

97
Q

50% of retrolistheses at L4 will have what?

A

A symptomatic L4-5 derangement.

98
Q

What is the most reliable view that depicts spondylolysis?

A

Oblique.

99
Q

What is it called when the sacrum grows more bone to support an anterolisthesis?

A

Buttress phenomenon.

100
Q

What is the importance of the buttress phenomenon?

A

It will be a better prognosis and probably be stable.

101
Q

What are the different parts of the scotty dog (eye, nose, ear, foreleg, neck, body)?

A

Eye-pedicle, Nose- TP, Ear- SAP, Foreleg- IAP, Neck- pars, body- lamina.

102
Q

What is needed to radiographically consider a spondylolisthesis unstable?

A

Progressive anterolisthesis, high grade slop (>25), sacral doming with trapezoid L5 vertebral body, larger slip angles and excessive mobility on dynamic stress radiography.

103
Q

If there is a high risk of increasing instability of a spondylolisthesis what type of imaging should be done?

A

Flexion- extension at 6-12 month intervals especially during adolescent growth periods.

104
Q

What are the 2 peak times for progression of anteriolisthesis?

A

Prepubertal growth spurts, and onset of disc degeneration.

105
Q

Grade 1 slips generally progress how much?

A

usually not more than 1% after they occur.

106
Q

Who will have an increased frequency of slip progressino and excessive mobility?

A

Children with high grade slip greater than or equal to 50%.

107
Q

What is the threshold for indicating the need for surgery with spondlyolisthesis?

A

There is no consensus.

108
Q

If a patient presents with low back pain from recent trauma and they had a long standing Type II spondylolisthesis how can you tell if this spondylolisthesis has been aggrevated by the recent trauma?

A

Take flexion- extension films to determine segmental instability and a SPECT can be helpful to determine increased physiologic activity of the subchondral bone at the level of the pars.

109
Q

What will give us the definitive diagnosis of a pars fracture? How about stress fractures?

A

Axial CT. Stress- SPECT.

110
Q

What is a subtle sign of a pars fracture in an early phase before the emergence of a defect?

A

Bone marrow edema best demonstrated on a T2 MRI.

111
Q

What is the correlation between bone marrow edema and the presence of back pain?

A

Closely correlates.

112
Q

What happens to the discs usually in between a type II spondylolisthesis?

A

Normal hydration preserved height are common in small slips.

113
Q

What happens to the disc usually with a retrolisthesis?

A

Usually tandem disc pathology; dehydration, loss of height, curcumferential disc bulging and frank herniation.

114
Q

What is the reason pars fractures don’t heal?

A

Dealyed diagnosis, failure to rest adequetly, inherent biomechanics placing stress at pars, poor blood supply.

115
Q

What % of adult patients with sponylolisthesis show progressive displacment?

A

2-3%.

116
Q

What age will anterior displacement from spondylolisthesis happen at primarily?

A

between ages of 5 and 10.

117
Q

Maximum anterior displacement is usually seen within how long after development?

A

18-24 months which usually takes place before the patient is 10.

118
Q

Will cessation of athletic activity influence the degree of slippage from sponylolisthesis?

A

No.

119
Q

What are the 4 reasons to have surgery for spondylolisthesis?

A

unstable or progressive, nerve compression, failed conservative treatment, less than 10 years old with grade 2 or greater and progressive slippage with neurological deficit.

120
Q

What are the 3 f’s and what type of spondylolisthesis are they for?

A

Type III- Female, Fourth lumbar vertebra, forty years or older.

121
Q

What happens to L4 vertebra with a type III spondylolisthesis?

A

anterior displacement not more than 25% (or grade 1), the majority will only slip 10-15%.

122
Q

How much more common are type III spondylolisthesis in females than males?

A

6 times.

123
Q

What is the mechanism of displacment for type III spondys?

A

Combination of zygapophyseal joint arthrosis, disc degeneration and remodeling of the articular process and pars.

124
Q

What should be considered if the patient is presenting with intermittent neurogenic claudication?

A

Degenerative spondylolisthesis.

125
Q

What causes pain with degenerative spondylolisthesis?

A

It is usually due to arthritic changes and foraminal compromises.

126
Q

Type IV spondys occur as a result of what?

A

An acute severe injury that creates a fracture of a portion of the neural arch other than at the pars.

127
Q

What is the a common location for type IV spondys?

A

C2 and it is known as a hangmans fracture.

128
Q

What is the prognosis for a type IV spondy?

A

They usually heal when appropriately immobilized.

129
Q

Type V spondys occur how?

A

Due to generalized or systemic disorders of bone that affects the neural arch of the spine. Metastatic carcinoma, osteopetrosis, pagets disease are some common causes.

130
Q

What is more common uni- or bilateral isthmic spondys?

A

Bilateral.

131
Q

What type of isthmic spondys have a higher chance of healing?

A

Unilateral defects.

132
Q

What will the spondylolisthesis be like for unilateral isthmic?

A

most cases never show anterior slip but if they do slip it is less than 5-10%.

133
Q

How are many cases of unilateral isthmic spondylolisthesis identified?

A

The contralateral pedicle will be sclerotic (abnormal hardening).

134
Q

What will the facets be like with a unilateral isthmic spondy?

A

The ipsilateral facet will frequently show facet dysplasia (abnormal development).

135
Q

Where is one of the most common locations for a type I spondy?

A

C6 is the most common location.

136
Q

What is the prognosis for the type I spondy?

A

If stable (can be seen on flexion extension views) and has not neurological complications the majority of patients remain asymptomatic.

bone path Q7 (3 decks)

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