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KEVIN BURANT IV > Chapter 42 Skeletal TRAUMA (Sailormoon) > Flashcards

Chapter 42 Skeletal TRAUMA (Sailormoon) Flashcards

1
Q

In MVA, what should be done if the patient has no neck pain? (Pg 1015)

A

None.

It is extremely unlikely that a fracture is present

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2
Q

In MVA, if plain films are negative in a symptomatic patient, what is the next diagnostic procedure to be done? (Pg 1015)

A

CT SCAN

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3
Q

What are the views included in a CERVICAL SPINE xray? (Pg 1015)

A

1) cross table lateral to avoid unduly moving the patient who might have a cervical fracture
2) if lateral C-spine is normal, include flexion and extensiom views

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4
Q

If the entire C-spine is not visualized? Repeat film with _____. (Pg 1015)

A

Shoulders lowered

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5
Q

Enumerate the 5 parallel lines for step-offs or disconituity in C-spine (pg 1015 to 1016)

A

1) Line 1- PREVB SOFT TISSUE. It should be several mm from the first 2-3VBs..and should be less than 1VB from C3/C4 to C7 with a smooth contour
2) Line 2- ANTERIOR VBs. Should be smooth and uninterrupted. Interruption is a sign of serior injury.
3) Line 3-POSTERIOR VBs.
4) Line 4- SPINOLAMINAR LINE. Conmects the posterior junction line of the lamina. *The SPINAL CORD lies between Lines 3 and 4.
5) Line 5- TIPS OF SPINOUS PROCESSES. C7 is consistently the largest.

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6
Q

The anterior arch of C1 is ____ from dens (adult). ____from dens (pedia) (pg1016).

A

Adult: no greater than 2.5mm
Pedia: no greater than 5mm

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7
Q

Greater separation of the anterior arch of C1 from dens of C2 is suspicious for disruption of _____(pg 1016)

A

Transverse ligament

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8
Q

An eponym for the type of fracture involving the sliding of the lateral masses of C1 beyond the margins of C2 body.

A

Jefferson fracture

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9
Q

The rule that is seldom violated in Jefferson fracture. (Pg 1016)

A

To break in SEVERAL places.

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10
Q

Little understood process in which the atlantoaxial jt becomes fixed and c1 and c2 bodies move en masse. (Pg1016)

A

Rotatory fixation of the atlantoaxial jt

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11
Q

Rotatory fixation of atlanto axial jt is easily diagnosed with ___ views (pg 1016)

A

Open-mouth odontoid view

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12
Q

Woth rotatory fixation, one of the spaces is ___ than the other even with rotation of the head to the opposite side (pg 1018)

A

Wider

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13
Q

1) Fracture of C6-C7 spinous processes.
2) Mode of injury
(Pg 1019)

A

1) clay-shoveler

2) avulsion of the spinous process by the supraspinous ligaments

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14
Q

1) Fracture of the posterior elements of C2 with anterior dialocation of the C2 body against C3
2) mode of injury
(Pg 1019)

A

1) Hangman

2) hyoerextension and distraction of the upper CS

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15
Q

Anterior displacement of C2 body over C3 is also known as ______.

A

Traumatic spondylolisthesis of axis

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16
Q

1) A type of fracture usually in the posterior VB of CS being displaced into the central canal with assoc. anterioc compression of the VB.
2) mode of injury(1019)

A

1) flexion teardrop

2) severe flexion causing disruption of the posterior ligaments. Often assoc with spinql cord injury.

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17
Q

1) Locking of facets in an overriding position that is occasionally bilateral
2) mode of injury
(Pg 1019)

A

1) Unilateral Locked facets

2) severe flexion with some rotation resulting in rupture of the apophyseal jt ligament and facet dislocation

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18
Q

1) anterior compression fracture at the “waist”
2) what VBs are usually involved?
3) mech of injury
(Pg1019)

A

1) Seatbelt injury
2) T12, L1, L2
3) hyperflexion at the waist (reayrained by a lap belt) causing distraction of the posterior elements and ligaments and anterior compression of VB.

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19
Q

1) fracture similar to seatbelt injury, but occurs in the posterior VBs (pg 1020)

A

Smith fracture

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20
Q

Fracture that occurs through the spinous process (pg 1020)

A

Chance fracture

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21
Q

______ is the break or defect in the pars interarticularis portion of lamina that may or may not be caused by trauma.
Oblique views form the figure of _______.
(Pg 1020)

A

Spondylolysis

Scottie dog

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22
Q

What areas does the “body parts” of Scottie dog represent?

Pg 1020, 1022

A 
NOSE- transverse process
EYE - pedicle
EARS - superior articular facet
NECK- pars interarticularis 
FRONT LEG- inferior articular facet
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23
Q

A break or defect in the pars imterarticularis would look like a _______ (pg 1022)

A

Scottie dog with a collar around the neck

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24
Q

If spondylolysis is bilateral and the VB more cephalad slips forward on the more caudal body, ________ is said to be present (pg 1023)

A

Spondylolisthesis

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25
Q

Grading of spondylolisthesis

A 
MEYERDING CLASS
I 0-25%
2 26-50%
3 51-75%
4 76-100%
5 >100%
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26
Q

Another term for Grade 5 meyerding classification

A

Spondyloptosis - 2 endplates are no longee congruent. Usually anterolisthesis at L5-S1 level

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27
Q

Qualifying measurement of a vertebral body suffice to say that it is “compressed”

A

> 20% difference of the anterior VB and posterior VB heights

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28
Q

This typically occurs 1 to 2 weeks post trauma. Progressive wedge compression fracture due to delay of management with resultant sever neurologic deficits (pg 1023)

A

Kummell disease

29
Q

Patients who have spine fusion due to ____ and ____ are at very high risk of fracture from even relatively minor trauma (pg 1024)

A

AS and DISH

30
Q

1) Fracture at the base of the thumb into the carpometacarpal joint.
2) Mode of fragment dislocation
(Pg 1024-1025)

A

1) Bennett fracture

2) adductor pull at the base of the thumb

31
Q

Comminuted fracture at the base of the thumb is called _____.
Fracture at the base of the thumb that does not involve the jt is called _____.
(Pg 1025)

A

Rolando fracture

Pseudo-Bennett fracture

32
Q

Avulsion injury of the distal phalanx (pg 1025)

A

Mallet or baseball finger
Insertion of the extensor digitorum tendon
Flexion without opposition

33
Q

Avulsion of the ulnar aspect of the 1st MCP jt where the ulnar collateral ligament inserts its tendon. (Pg 1025)

A

Gamekeeper’s thumb

34
Q

FOOSH injury that occurs when the ligaments between capitate and lunate are disrupted (pg 1025)

This is best seen on ___ views.

A

Lunate/Perilunate dislocation

Lateral view

35
Q 
Describe the ff (lateral): 
Normal position of lunate/capitate
Lunate disloc 
Perilunate disloc
(Pg 1026)
A

1) NORMAL: capitate seated in the cup-shqped lunate
2) LUNATE: capitate pushes lunate volarly and tips it over with a line through the mid radius
3) PERILUNATE: similar to lunate, but more volar tipping of the lunate with the line passing through the mid radius almost at the posterior aspect of the lunate.

36
Q

On AP view, lunate/perilunate disloc is seen as ____ (pg 1026)

A

Pie-shaped or triangular-shaped lunate.

Normally, it should be rhomboid shape.

37
Q

Most commonly assoc with perilunate fx?(pg 1026)

A

Transcaphoid fracture

Others: capitate, radial styloid, triquetrum

38
Q

Bony protruberance off the hamate on the uknar aspect of the carpal tunnel (pg 1026)

A

Hook of Hamate fx

Special view: carpal tunnel view

39
Q

_____ is a FOOSH injury resulting from the rupture of the scapholunate ligament which causes the ____ to rotate dorsally. It is usu seen in AP as the ______ sign. (Pg 1027)

A

Rotatory subluxation of navicular/scaphoid
Navicular/scaphoid
Terry Thomas sign

40
Q

Eponym for avascular necrosis of navicular in adult and in pedia.

A

Adult: PREISER
Pedia: KÖHLER

*Köhler is also the eponym for patellar avascular necrosis

41
Q

Trauma with pain over the snuffbox of the wrist (pg 1027)

A

Navicular fracture

42
Q

Blood supply of navicular begins _____ and runs ____. Thus leaving the ____pole without blood supply with changes seen as _____. (Pg 1028)

A

Begins Distally
Runs Proximally
Proximal pole w/o blood supply
Increased density as a sign of avascular necrosis.

43
Q

Avascular necrosis of lunate (pg 1029)

A

Kienböck malacia

44
Q

One of the most common fractures of the forearm after FOOSH. Dorsal angukation of the distal forearm and wrist (pg 1029)

A

Colles fracture

45
Q

FOOSH fracture that angulates volarly is _____. (Pg 1029)

A

Smith fracture

*remember, the point of dislocation is always the distal fractured segment

46
Q

Traumatic bending of the radius and ulna without a frank fracture (pg 1029)

A

Plastic bowing deformity

*similar to Torus for there is no fracture line (“bulging”)

47
Q

RADIUS- disloc (proximal)
ULNA - fracture
(Pg 1030)

A

Monteggia fracture

*mUnteggia = fractured Ulna

48
Q

RADIUS -fracture
ULNA - disloc (distal)
(Pg 1030)

A

Galeazzi fracture

49
Q

Eponym for radial head avascular necrosis in Monteggia fracture

A

Brailsford (truelaloo)

50
Q

A helpful indicator of elbow fractures seen on lateral view. (Pg 1030)

A

Displaced posterior fat pad: OLECRANON FOSSA

  • Displaced anterior fat pad: CORONOID FOSAA
  • INDICATES EFFUSION
51
Q

An elbow sail sign is indicative of _____ and _____ fractures in adult and pedia, respectively (pg 1030)

A

ADULT: radial head fracture
PEDIA: supracondylar humeral fracture
*anterior humeral line should intersect the capitellum in most children.

52
Q

Most common shoulder dislocation (pg 1031)

A

Anterior dislocation

*subcoracoid (resnick)

53
Q

AP shoulder finding of anterior disloc of shoulder (pg 1031)

A

Inferomedial displacement of HH to glenoid.

54
Q

The HH often impacts on the inferior lip of the glenoid causing posterosuperior indentation on the HH (pg 1031)

A

Hill-Sach’s deformity

55
Q

A bony irregularity or a fragment off the inferior glenoid at the anteroinferomedial aspect of the HH (pg 1032)

A

Bankart

56
Q

In a patient with posterior dislocation of the shoulder, the bony overlap of the humeral head and glenoid known as the _____ sign is absent. (Pg 1032)

A

Crescent sign

57
Q

Best way to unequivocally diagnose shoder dislocation is ____ (pg 1032)

A

Transscapular view

58
Q

In transcapular view, what anatomical parts are represented by the “Y” ? (Pg 1032)

A

Coracoid- anterior
Acromion- posterior
Blade

59
Q

Difderential diagnosis for anterior dislocation of the shoulder (pg 1032, 1034)

A

Traumatic hemarthrosis: INFEROLATERAL HH

True anterior disloc: INFEROMEDIAL HH

60
Q

Anatomic landmarks to examine in pelvic fractures (pg 1035)

A 
Pelvic ring
Obturator foramen
Sacral arcuate lines
SI jt (NV: 2-4mm)
Symphysis pubis (NV: not greater than 5mm)
61
Q

Patchy or linear areas of sclerosis on the sacral ala after Rad Tx. They have a characteristic _____ appearance on radionucleid scan. This is only seen in ______ fractures (pg 1035-1036)

A

Sacral stress fractures
“HONDA SIGN”
bilateral stress fractures

62
Q

Also termed as INSUFFICIENCY FRACTURES (pg 1036)

A

SACRAL STRESS FRACTURES

63
Q

Common site for pelvic avulsion ( pg1036)

A

ISCHIUM
superior and inferior ANTERIOR ILIAC SPINES
ILIAC CREST

64
Q

Most serious and one of the rarest stress fractures (pg 1037)

A

FEMORAL NECK STRESS FX

65
Q

An often overlooked and misdiagnosed stress fracture is ________(pg 1038)

A

Calcaneal stress fracture

Ddx: heel spur

66
Q

1) 2 main divisions of the Anatomic classification of proximal femur fx, and their subdivisions
2) Garden classification of the _______ division.

A

1) Anatomic: INTRACAPSULAR (subcapital and transcervical), EXTRACAPSULAR (basicx, intertroch, subtrochanteric)

2)GARDEN CLASS OF INTRACAPSULAR:
1- incomplete/impacted
2- complete, non displ
3- complete, part. Displa
4- TOTAL displa.
67
Q

Long bone fracture sign such as in tibial plateau fracture (1039)

A

Fat-Fluid level

68
Q

Medial border of the 2nd metatarsal is not in line with the medial border of the 1nd cuneiform (pg 1039)

A

Lisfranc fracture
Most commonly seen in in those who catch their forefoot in a hole in the ground, horseback rider falling and hanging by the FOREFOOT. Also seen in Charcot joint (DM)

69
Q

A normal anatomical landmark for fracture of calcaneus (pg 1039)

A

Böhler angler
Less than 20 degrees indicates compression of calcaneus (jumping injury)
NV: 20-40 degrees

KEVIN BURANT IV (20 decks)

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