C15: Notes Flashcards
the displacement of a bone that is no longer in contact with its normal articulation
dislocation
a serious injury or shock to the body, often requiring modifications that may include variations in positioning, minimal movement of the body part, and so on
trauma
as with fractures, dislocations should be imaged
in two planes, 90 degrees to each other to demonstrate the degree of displacement
a traumatic partial dislocation of the radial head of a child
nursemaid elbow (or jerked elbow)
what causes a nursemaid elbow?
a hard pull on the hand and wrist of a child by an adult
a forced wrenching or twisting of a joint resulting in a partial rupture or tearing of supporting ligaments, without dislocation
sprain
what may result from a sprain?
severe damage to associated blood vessels, tendons, ligaments, and/or nerves
what frequently accompanies a severe sprain?
severe swelling and discoloration caused by hemorrhage of ruptured blood vessels
a bruise type of injury with a possible avulsion fracture
contusion
a disruption of bone caused by mechanical forces applied either directly to the bone or transmitted along the shaft of the bone
fracture (fx)
a fracture is aligned if
the long axes of the bone remain parallel to each other
apposition describes
how the fragmented ends of the bone make contact with each other
how many types of apposition are there?
three
what are the three types of apposition?
anatomic apposition, lack of apposition (distraction), Bayonet apposition
anatomic alignment of ends of fractured bone fragments, wherin the ends of the fragments make end-to-end contact
anatomic apposition
partial dislocation
subluxation
the ends of fragments are aligned but pulled apart and are not making contact with each other
lack of apposition (distraction)
the fracture fragments overlap and the shafts make contact, but not at the fracture ends
Bayonet apposition
loss of alignment of the fracture
angulation
the direction of the angulation is termed what
apex
the apex is opposite in relation to
the distal part of the fracture fragments
the direction or angle of the apex of the fracture, such as a medial or lateral apex, wherein the point or apex of the fracture points medially or laterally
apex angulation
the distal fragment ends are angled toward the midline of the body and the apex is pointed away from the midline
varus deformity
the distal fragment ends are angled away from the midline and the apex is pointed toward the midline
valgus deformity
a fracture in which the bone does not break through the skin
simple (closed) fracture
a fracture in which a portion of the bone (usually the fragmented end) protrudes through the skin
compound (open) fracture
fracture does not transverse through the entire bone (not broken into two pieces)
incomplete (partial) fracture
buckle of the cortex (outer portion of the bone) is characterized by localized expansion or torus of the cortex, possibly with little or no displacement, and no complete break in the cortex
torus fx (buckle fx)
fracture is on one side only; the cortex on one side of the bone is broken and the other side is bent; when the bone straightens, a faint fracture line in the cortex may be seen on one side of the bone, and a slight bulging or wrinkle-like defect is seen on the opposite side
greenstick fx (hickory or willow stick fx)
fracture is complete and includes the cross-section of bone (broken into two pieces)
complete fracture
fracture is transverse at a near right angle to the long axis of the bone
transverse fx
fracture passes through bone at an oblique angle
oblique fx
fracture where the bone has been twisted apart and the fracture spirals around the long axis
spiral fx
fracture where the bone is splintered or crushed at the site of impact, resulting in two or more fragments
comminuted fracture
a type of double fracture in which two fracture lines isolate a distinct segment of bone; the bone is broken into three pieces, with the middle fragment fractured at both ends
segmental fx
a comminuted fracture with two fragments on each side of a main, wedge-shaped separate fragment; it has some resemblance to the wings of a butterfly
butterfly fx
a comminuted fracture in which the bone is splintered into thin sharp fragments
splintered fx
one fracture is firmly driven into the other
impacted fracture
where do impacted fractures most commonly occur?
at distal or proximal ends of the femur, humerus, or radius
an intra-articular fracture of the distal radius often associated with dislocation or subluxation of the radiocarpal joint
Barton fracture
fracture of the distal phalanx caused by a ball striking the end of an extended finger; the distal interphalangeal (DIP) joint is partially flexed, and an avulsion fracture is frequently present at the posterior base of the distal phalanx
baseball (Mallet) fracture
longitudinal fracture which occurs at the base of the first metacarpal with the fracture line entering the carpometacarpal joint, generally includes a posterior dislocation or subluxation
Bennett fracture
fracture that usually involves the distal fifth metacarpal, with an apex posterior angulation best demonstrated on the lateral view
boxer fracture
what fracture results from punching someone or something
boxer fracture
fracture of the wrist in which the distal radius is fractured with the distal fragment displaced posteriorly
Colles fracture
what fracture may result from a forward fall on an outstretched arm?
Colles fracture
a fracture of the wrist with the distal fragment of the radius displaced anteriorly rather than posteriorly
Smith (reverse Colles) fracture
what fracture commonly results from a backward fall on an outstretched arm
Smith (reverse Colles) fracture
fracture that occurs through the pedicles of the axis (C2), with or without displacement of C2 or C3
hangman fracture
an intra-articular fracture of the radial styloid process
Hutchinson (Chauffeur) fracture
fracture of the proximal half of the ulna, along with dislocation of the radial head
Monteggia fracture
a complete fracture of the distal fibula with major injury to the ankle joint, including ligament damage and frequent fracture of the distal tibia or medial malleolus
Pott’s fracture
fracture results from severe stress to a tendon or ligament in a joint region; a fragment of bone is separated or pulled away by the attached tendon or ligament
avulsion fracture
result from a direct blow to the orbit and/or maxilla and zygoma, create fractures to the orbital floor and lateral orbital margins
blowout and/or tripod fracture
fracture involving an isolated bone fragment (is not caused by tendon or ligament stress)
chip fractures
vertebral fracture caused by compression-type injury; the vertebral body collapses or is compressed
compression fracture
what fracture is most evident radiographically by a decreased vertical dimension of the anterior vertebral body
compression fracture
fracture of the skull where a fragment is depressed; appearance is similar to a Ping-Pong ball that has been pressed in by the finger
depressed fracture (or ping-pong fracture)
a fracture through the epiphyseal plate, the point of union of the epiphysis and shaft of a bone
epiphyseal fracture
what fracture is one of the most easily fractured sites in long bones of children?
epiphyseal fracture
fractures due to disease process within the bone
pathologic fracture
fracture where lines radiate from a central point of injury with a starlike pattern
stellate fracture
where does a stellate fracture usually occur? what is it often caused by?
patella; often caused by knees hitting the dashboard in a motor vehicle accident
a nontraumatic fracture in origin that results from repeated stress on a bone; are frequently difficult to demonstrate radiographically and may be visible only through subsequent callus formation at the fracture site or on a NM bone scan
stress or fatigue fracture
fracture of the ankle joint involves the medial and lateral malleoli as well as the posterior lip of the distal tibia
trimalleolar fracture
comminuted fracture of the distal phalynx may be caused by a crushing blow to the distal finger or thumb
tuft or Burst fracture
fracture fragments are realigned by manipulation and are immobilized by a cast or splint; is a nonsurgical procedure
closed reduction
for severe fractures with significant displacement or fragmentation, a surgical procedure is required; fracture site is exposed and screws, plates, or rods are installed as needed to maintain alignment of the bony fragments until new bone growth can take place
open reduction with internal fixation (ORIF)
anterior cruciate ligament
ACL
stiffening of a joint by operative means
arthrodesis
any disease that affects a joint
arthropathy
creation of an artificial joint to correct ankylosis
arthroplasty
a state of sterility; condition in which living pathogens are absent
asepsis
orthopedic screw designed to enter and fix porous and spongy bone
cancellous screw
large screw used for internal fixation of nondisplaced fractures of proximal femur
cannulated screw
an artificial regulator for cardiac rate and rhythm
cardiac pacemaker
orthopedic wire that tightens around fracture stie to reduce shortening of limb
cerclage wire
the use of radioactive cesium in the treatment of certain malignancies, including prostate cancer
cesium implants
surgical removal of gallbladder
cholecystectomy
procedure in which bone fragments are reduced manually without surgical intervention
closed reduction
narrow orthopedic screw designed to enter and fix cortical bone
cortical screw
closed reduction (cast or traction)
CR
lighted tubular endoscope used for examination of the urinary bladder
cystoscope
dynamic hip screw
DHS
screw and plate combination used to apply forces through the fracture site; used commonly for long bone saft fractures in which stress may be great
dynamic compression plate
electrohydraulic shock waves used to break apart calcifications in the urinary system
ESWL (extracorporeal shock wave lithotripsy)
external fixation
EX-FIX
a special OR table used for hip pinnings and other orthopedic procedures to provide traction to the involved limb and allow fluoroscopy to be performed during the procedure
fracture (orthopedic) table
surgical procedure designed to reduce proximal femoral fractures through the use of various internal fixation devices
hip pinning
high tibial osteotomy
HTO
procedure in which a special external fixator is used to lengthen long bones as treatment for severe fracture or congenital deformity
ilizarov technique
intramedullary nail
IM nail
titanium or other alloy cage filled with bone and inserted between the vertebral bodies to maintain disk space height and permit fusion of the intervertebral joint
interbody bone fusion device
a flexible or rigid device placed within the medullary cavity to reduce a fracture or stabilize a diseased long bone
intramedullary rod
unthreaded (smooth) or threaded metallic wire used to reduce fractures of the wrist (carpals) and individual bones of the hands and feet; also may be used for skeletal traction
Kirchner wire (K-wire)
a surgical procedure performed to alleviate pain caused by neural impingement by removing an aspect of the lamina in the vertebral arch
laminectomy
surgical reopening into one or more laminae of the vertebral arch
laminotomy
use of a special endoscopic device to visualize and assist with surgical removal of the gallbladder
laparoscopic cholecystectomy
crushing of calcification in the renal pelvis, ureter, or urinary bladder by mechanical force or sound waves
lithotripsy
microsurgical procedure performed on the spine to remove bony fragments or disk material that may be causing neural impingement
microdiskectomy
a condition in which body changes or a herniated disk procedures impingement of the spinal nerves that pass through the vertebral arch of the vertebra
neural impingement
reduction of fracture fragments through surgical interventions
open reduction
radiographic procedure performed during surgery to visualize and locate undetected stories or obstructions within the biliary ducts
operative (immediate) cholangiography
open reduction with internal fixation
ORIF
posterior cruciate ligament
PCL
fabricated (artificial) substitute for a diseased or missing anatomic part
prosthesis
to align two bone fragments in the correct position as treatment for a fracture, as applied in orthopedic medicine
reduce
a nonfunctional examination of the urinary system during which contrast medium is introduced directly retrograde (backward, against the flow) into the pelvicalyceal system via catheterization by a urologist during a minor surgical procedure
retrograde urography
flexible and thin orthopedic plate used to fix and connect fractures
semitubular plate
an isolation drape that separates the sterile field from the nonsterile environment; often used to permit the use of C-arm fluoroscopy during a hip pinning procedure
shower curtain
surgical fusion of one vertebra to another, which stabilizes them following laminectomy or as treatment for a degenerative condition or fracture
spinal fusion
condition caused by degenerative changes that result in enlargement of the facet joints, which often leads to impingement of the spinal nerves that pass by them
spinal stenosis
soaking of moisture through a sterile or nonsterile drape, cover, or protective barrier, permitting bacteria to reach sterile areas
strike-through
total hip replacement, total hip appliance
THR, THA
total knee replacement, total knee appliance
TKR, TKA
the use of artificial joint implants to restore motion and function of a joint–for example, total hip replacement is common orthopedic procedure performed on patients with degenerative joint disease
total joint arthroplasty
the process of putting a limb, bone, or group of muscles under tension with the use of weights and pulleys to align or immobilize the part
traction
battery-driven, battery-operated, mobile x-ray units are powered by what?
10 to 16 rechargeable, sealed, lead acid-type 12-volt batteries connected in series
battery-driven, battery-operated, mobile x-ray units have an average walking speed of what?
2.5 to 3 mph
what is the maximum incline of a mobile x-ray unit?
7 degrees
what can mobile x-ray units be regarded at?
110 or 220 V
one projection should be taken:
only as a last resort
what are the essential attributes of the radiologic technologist in surgical radiography
confidence, communication, problem-solving skills, and mastery
a physician licensed and trained in general surgery or a specialty such as cardiovascular or orthopedic procedures
surgeon
who has the primary responsibility for the entire surgical procedure and for the well-being of the patient prior to, during, and immediately following surgery?
surgeon
person who specializes in administering anesthetic drugs to induce and maintain anesthesia in the patient during surgery
anesthesiologist
this person has be responsibility of ensuring the safety of the patient and monitoring physiologic functions and fluid levels of the patient during surgery
anesthesiologist
what are the surgical assistant’s range of responsibilities?
may include suctioning, tying and clamping blood vessels, and assisting in cutting and suturing tissue
who can the surgical assistant be?
a physician, physician assistant, certified surgical technologist (CST), or registered nurse (RN)
a health professional who prepares the OR by supplying it with the appropriate supplies and instruments
certified surgical technologist (CST)
what are other CST responsibilities?
preparing the patient for surgery and helping connect surgical equipment and monitoring devices; during surgery, they have the primary responsibility for maintaining the sterile field
a nonsterile CST or RN who assists in the OR by responding to the needs of scrubbed members in the sterile field before, during, and after the surgical procedure
circulator
what are the duties of a circulator?
may include recording of pertinent information, retrieval of additionally needed items, and connecting nonsterile surgical equipment
a CST or RN who prepares the sterile field scrubs, gowns, and members of the surgical team, and prepares and sterilizes the instruments before the surgical procedure is begun
scrub
the ability of a system to magnify the image for better visualization of structures
magnification mode
used to create an x-ray beam that pulsates at timed increments to reduce exposure
pulse mode
activates a digital spot, which results in a higher quality computer-enhanced image as compared with a held fluoroscopic image
snapshot or digital spot mode
allows for exposure by the operator if desired, or the use of automatic exposure control (AEC)
auto/manual exposure control
a technique in which an initial image is recorded during continuous fluoroscopy; the initial image is then used as a filter for the next fluoroscopic images
subtraction
a method of image display wherein a specific fluoroscopic image is held on the screen in combination with continuous fluoroscopy; similar to subtraction in that it removes stationary structures from the viewing screen; especially useful in interventional procedures that require the placement of catheters
roadmapping
the primary source of radiation exposure to the fluoroscopy staff is from
scattered radiation from the patient
what is necessary if the person’s back is repeatedly turned toward the patient?
wrap-around apron
studies have shown that even a 30 degree C-arm tilt will increase the dose to the face and neck region of an operator of average height who stands next to the C-arm by a factor of what?
4
the exposure region on what side of the patient is significantly larger than the other?
the exposure region on the x-ray tube side of the patient is significantly larger than that in the region near the intensifier tower
the practice and procedures used to minimize the levels of infectious agents present in the surgical environment
surgical aspesis
if the sterility of an object is in doubt, it must be considered:
nonsterile
sterile gowns are considered sterile from:
the shoulder to the level of the sterile field, and at the sleeve from the cuff to just above the elbow
OR tables are considered sterile only:
at the level of the tabletop
performed during surgery to demonstrate anatomy of the biliary duct system, drainage into the duodenum, and any residual stones in the biliary ducts
operative (immediate) cholangiography
operative or immediate cholangiography may be performed:
before or following surgical removal of the gallbladder
laparoscopic cholecystectomy provides a less invasive approach for the removal of what?
diseased gallbladders
what happens during a laparoscopic cholecystectomy?
surgeon makes a small opening in the umbilicus and passes an endoscope into the abdominal cavity
why are laparoscopic cholecystectomies performed?
can be performed with a minimal amount of surgical trauma to the patient
retrograde urography is a _____ examination of the urinary system
nonfunctional
what occurs during a retrograde urography procedure?
contrast medium is introduced directly retrograde (backward, against the flow) into the pelvicalyceal system view catheterization by the urologist during a minor surgical procedure
why is retrograde urography considered a nonfunctional study?
the patient’s normal physiologic processes are not involved in the procedure
what is a retrograde urography performed for?
frequently performed to determine the location of undetected calculi or other types of obstruction in the urinary system; may also be performed to study the renal pelvis and calyces for signs of infection or structural defect
fracture fragments are realigned by manipulation and are immobilized by a cast or splint
closed reduction
T or F: closed reduction is a nonsurgical procedure
true
fracture site is exposed, and a variety of screws, plates, or rods are inserted as needed to maintain alignment of the bony fragments until new bone growth can take place
open reduction
during open reduction of fractures, a variety of compression plates, screws, pins, intramedullary rods, nails, or wires are applied to reduce or realign the fracture
internal fixation
use of an external fracture-stabilizing device permits:
bone healing without the immediate requirement for internal fixation
the Ilizarov device is a prime example of what?
an external fixator used to correct a length deficit
intramedullary rods and nails are inserted within the shaft of long bones to:
stabilize fractures
intramedullary fixation devices can:
minimize the amount of tissue exposed during surgery, decrease surgical and healing time, and reduce opportunities for postsurgical infection
common hip fractures include
femoral neck fractures, intertrochanteric fractures, and subtrochanteric fractures
for a hip pinning, the procedure generally involves:
the use of long screws for nondisplaced femoral neck fractures
a surgical procedure performed to alleviate pain caused by neural impingement
laminectomy
a laminectomy is designed to:
remove a small portion of the bone or herniated disk material impinging on the nerve root; intended to give the nerve root more space
what is a spinal fusion?
uses rods, plates, and screws to stabilize surgically altered vertebrae during a laminectomy
titanium cages filled with bone that are inserted between the vertebral bodies to maintain disk space height and fuse the joint, thereby eliminating abnormal movement
interbody fusion cages
a laminectomy is effective in:
decreasing pain and improving function for patients with lumbar spinal stenosis
a condition that primarily afflicts older patients; caused by degenerative changes that result in enlargement of the facet joints; the enlarged joints then place pressure on the nerves
spinal stenosis
a laminectomy can be performed on what?
the cervical or lumbar region
procedure performed to remove bony obstructions such as bone spurs and herniated disk materials that cause pain by impinging on the spinal cord or spinal nerves in the cervical region
cervical laminectomy
procedure performed for a myriad of reasons, including bony obstructions, stenosis, and spinal cord impingement
lumbar laminectomy
a fracture wherein the fragments overlap and the shafts make contact but not at the fracture end defines:
bayonet apposition
a faint fracture line in the bone cortex that is seen on one side of bone with a slight bulging or wrinkle-like defect on the opposite side is a:
greenstick fracture
which of the following fractures will be best demonstrated with a forearm series?
Monteggia’s
how is the CR aligned for a mobile AP chest projection taken on a patient lying partially erect in bed?
align CR perpendicular to long axis of sternum
which of the following positioning routines is required for a postreduction study of the ankle with a cast?
AP and lateral
what type of CR angle is required for the “reverse Caldwell” projection of the cranium?
15 degrees cephalad to OML
the large, sterile clear plastic sheet used during hip pinning procedures to maintain a sterile field over the surgical site is termed a:
shower curtain
