Chapter 42 Skeletal TRAUMA (Sailormoon) Flashcards
In MVA, what should be done if the patient has no neck pain? (Pg 1015)
None.
It is extremely unlikely that a fracture is present
In MVA, if plain films are negative in a symptomatic patient, what is the next diagnostic procedure to be done? (Pg 1015)
CT SCAN
What are the views included in a CERVICAL SPINE xray? (Pg 1015)
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
If the entire C-spine is not visualized? Repeat film with _____. (Pg 1015)
Shoulders lowered
Enumerate the 5 parallel lines for step-offs or disconituity in C-spine (pg 1015 to 1016)
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.
The anterior arch of C1 is ____ from dens (adult). ____from dens (pedia) (pg1016).
Adult: no greater than 2.5mm
Pedia: no greater than 5mm
Greater separation of the anterior arch of C1 from dens of C2 is suspicious for disruption of _____(pg 1016)
Transverse ligament
An eponym for the type of fracture involving the sliding of the lateral masses of C1 beyond the margins of C2 body.
Jefferson fracture
The rule that is seldom violated in Jefferson fracture. (Pg 1016)
To break in SEVERAL places.
Little understood process in which the atlantoaxial jt becomes fixed and c1 and c2 bodies move en masse. (Pg1016)
Rotatory fixation of the atlantoaxial jt
Rotatory fixation of atlanto axial jt is easily diagnosed with ___ views (pg 1016)
Open-mouth odontoid view
Woth rotatory fixation, one of the spaces is ___ than the other even with rotation of the head to the opposite side (pg 1018)
Wider
1) Fracture of C6-C7 spinous processes.
2) Mode of injury
(Pg 1019)
1) clay-shoveler
2) avulsion of the spinous process by the supraspinous ligaments
1) Fracture of the posterior elements of C2 with anterior dialocation of the C2 body against C3
2) mode of injury
(Pg 1019)
1) Hangman
2) hyoerextension and distraction of the upper CS
Anterior displacement of C2 body over C3 is also known as ______.
Traumatic spondylolisthesis of axis
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)
1) flexion teardrop
2) severe flexion causing disruption of the posterior ligaments. Often assoc with spinql cord injury.
1) Locking of facets in an overriding position that is occasionally bilateral
2) mode of injury
(Pg 1019)
1) Unilateral Locked facets
2) severe flexion with some rotation resulting in rupture of the apophyseal jt ligament and facet dislocation
1) anterior compression fracture at the “waist”
2) what VBs are usually involved?
3) mech of injury
(Pg1019)
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.
1) fracture similar to seatbelt injury, but occurs in the posterior VBs (pg 1020)
Smith fracture
Fracture that occurs through the spinous process (pg 1020)
Chance fracture
______ 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)
Spondylolysis
Scottie dog
What areas does the “body parts” of Scottie dog represent?
Pg 1020, 1022
NOSE- transverse process EYE - pedicle EARS - superior articular facet NECK- pars interarticularis FRONT LEG- inferior articular facet
A break or defect in the pars imterarticularis would look like a _______ (pg 1022)
Scottie dog with a collar around the neck
If spondylolysis is bilateral and the VB more cephalad slips forward on the more caudal body, ________ is said to be present (pg 1023)
Spondylolisthesis
Grading of spondylolisthesis
MEYERDING CLASS I 0-25% 2 26-50% 3 51-75% 4 76-100% 5 >100%
Another term for Grade 5 meyerding classification
Spondyloptosis - 2 endplates are no longee congruent. Usually anterolisthesis at L5-S1 level
Qualifying measurement of a vertebral body suffice to say that it is “compressed”
> 20% difference of the anterior VB and posterior VB heights
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)
Kummell disease
Patients who have spine fusion due to ____ and ____ are at very high risk of fracture from even relatively minor trauma (pg 1024)
AS and DISH
1) Fracture at the base of the thumb into the carpometacarpal joint.
2) Mode of fragment dislocation
(Pg 1024-1025)
1) Bennett fracture
2) adductor pull at the base of the thumb
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)
Rolando fracture
Pseudo-Bennett fracture
Avulsion injury of the distal phalanx (pg 1025)
Mallet or baseball finger
Insertion of the extensor digitorum tendon
Flexion without opposition
Avulsion of the ulnar aspect of the 1st MCP jt where the ulnar collateral ligament inserts its tendon. (Pg 1025)
Gamekeeper’s thumb
FOOSH injury that occurs when the ligaments between capitate and lunate are disrupted (pg 1025)
This is best seen on ___ views.
Lunate/Perilunate dislocation
Lateral view
Describe the ff (lateral): Normal position of lunate/capitate Lunate disloc Perilunate disloc (Pg 1026)
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.
On AP view, lunate/perilunate disloc is seen as ____ (pg 1026)
Pie-shaped or triangular-shaped lunate.
Normally, it should be rhomboid shape.
Most commonly assoc with perilunate fx?(pg 1026)
Transcaphoid fracture
Others: capitate, radial styloid, triquetrum
Bony protruberance off the hamate on the uknar aspect of the carpal tunnel (pg 1026)
Hook of Hamate fx
Special view: carpal tunnel view
_____ 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)
Rotatory subluxation of navicular/scaphoid
Navicular/scaphoid
Terry Thomas sign
Eponym for avascular necrosis of navicular in adult and in pedia.
Adult: PREISER
Pedia: KÖHLER
*Köhler is also the eponym for patellar avascular necrosis
Trauma with pain over the snuffbox of the wrist (pg 1027)
Navicular fracture
Blood supply of navicular begins _____ and runs ____. Thus leaving the ____pole without blood supply with changes seen as _____. (Pg 1028)
Begins Distally
Runs Proximally
Proximal pole w/o blood supply
Increased density as a sign of avascular necrosis.
Avascular necrosis of lunate (pg 1029)
Kienböck malacia
One of the most common fractures of the forearm after FOOSH. Dorsal angukation of the distal forearm and wrist (pg 1029)
Colles fracture
FOOSH fracture that angulates volarly is _____. (Pg 1029)
Smith fracture
*remember, the point of dislocation is always the distal fractured segment
Traumatic bending of the radius and ulna without a frank fracture (pg 1029)
Plastic bowing deformity
*similar to Torus for there is no fracture line (“bulging”)
RADIUS- disloc (proximal)
ULNA - fracture
(Pg 1030)
Monteggia fracture
*mUnteggia = fractured Ulna
RADIUS -fracture
ULNA - disloc (distal)
(Pg 1030)
Galeazzi fracture
Eponym for radial head avascular necrosis in Monteggia fracture
Brailsford (truelaloo)
A helpful indicator of elbow fractures seen on lateral view. (Pg 1030)
Displaced posterior fat pad: OLECRANON FOSSA
- Displaced anterior fat pad: CORONOID FOSAA
- INDICATES EFFUSION
An elbow sail sign is indicative of _____ and _____ fractures in adult and pedia, respectively (pg 1030)
ADULT: radial head fracture
PEDIA: supracondylar humeral fracture
*anterior humeral line should intersect the capitellum in most children.
Most common shoulder dislocation (pg 1031)
Anterior dislocation
*subcoracoid (resnick)
AP shoulder finding of anterior disloc of shoulder (pg 1031)
Inferomedial displacement of HH to glenoid.
The HH often impacts on the inferior lip of the glenoid causing posterosuperior indentation on the HH (pg 1031)
Hill-Sach’s deformity
A bony irregularity or a fragment off the inferior glenoid at the anteroinferomedial aspect of the HH (pg 1032)
Bankart
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)
Crescent sign
Best way to unequivocally diagnose shoder dislocation is ____ (pg 1032)
Transscapular view
In transcapular view, what anatomical parts are represented by the “Y” ? (Pg 1032)
Coracoid- anterior
Acromion- posterior
Blade
Difderential diagnosis for anterior dislocation of the shoulder (pg 1032, 1034)
Traumatic hemarthrosis: INFEROLATERAL HH
True anterior disloc: INFEROMEDIAL HH
Anatomic landmarks to examine in pelvic fractures (pg 1035)
Pelvic ring Obturator foramen Sacral arcuate lines SI jt (NV: 2-4mm) Symphysis pubis (NV: not greater than 5mm)
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)
Sacral stress fractures
“HONDA SIGN”
bilateral stress fractures
Also termed as INSUFFICIENCY FRACTURES (pg 1036)
SACRAL STRESS FRACTURES
Common site for pelvic avulsion ( pg1036)
ISCHIUM
superior and inferior ANTERIOR ILIAC SPINES
ILIAC CREST
Most serious and one of the rarest stress fractures (pg 1037)
FEMORAL NECK STRESS FX
An often overlooked and misdiagnosed stress fracture is ________(pg 1038)
Calcaneal stress fracture
Ddx: heel spur
1) 2 main divisions of the Anatomic classification of proximal femur fx, and their subdivisions
2) Garden classification of the _______ division.
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.
Long bone fracture sign such as in tibial plateau fracture (1039)
Fat-Fluid level
Medial border of the 2nd metatarsal is not in line with the medial border of the 1nd cuneiform (pg 1039)
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)
A normal anatomical landmark for fracture of calcaneus (pg 1039)
Böhler angler
Less than 20 degrees indicates compression of calcaneus (jumping injury)
NV: 20-40 degrees
