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Don't cha > Exam 1 (X-Ray images B) > Flashcards

Exam 1 (X-Ray images B) Flashcards

1
Q

Thoracic and Lumbar fractures FACTS:

A

most (90%) occur between T-11 and L-2

FX of mid to upper thoracic uncommon multiple (often contiguous)

fx common compression fractures (MC)

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2
Q

Biomechanical region of T1-T8

A

relatively rigid Ribcage

Kyphosis

Flexion injurt pattern predominates

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3
Q

Biomechanical region of T9-L2

A

transition: immobile-mobile
transition: kyphosis- lordosis

MOST injuries occur here

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4
Q

Biomechanical region og L3-sacrum

A

mobile, lordosis

axial load injuries predominate

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5
Q

Thoracic and Lumbar compression fractures

A

MC fracture of thr thoracic and lumbars

flexion mechanism

osteoporotic compression fx maybe no trauma

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6
Q

Thoracic and Lumbar compresssion fractures CONT.

A

anterior wedging ( decreased ant. height, depression of the superior endplate, posterior body height maintained, may see step defect and zone of condensation

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7
Q

What is this diagnosis

A

Compression fracture

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8
Q

If compression fractures are random, what should you think first?

A

PATHOLOGY. Not normal for trauma

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9
Q

What is a step defect and where does it occur?

A

It is seen on lateral projection, failure of anteriior superior cortex of vertebral body, superior endplate shift compresses and forward anterior cortex fails and creates step

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10
Q

What is zone of impaction aka (Zone or Line of condensation)?

A

radiographically represents as a thick, dense white band just below the compressed endplate

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11
Q

Zone of impaction and step defect represent NEW or OLD fracture?

A

NEW!!!!! It is acute

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12
Q

What is this finding?

A

Zone of impaction

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13
Q

What are 3 pathologies you should think of when a patient has compression fractures without trauma?

A
  1. Osteoporisis, 2. Metastatic Cancer, 3. Multiple Myeloma
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14
Q

Osteroporotic compression fractures FACTS

A

More common after age 50, MC in Females, MC in dorsal and thoracolumbar spine, may increase kyphosis (dowager’s hump), initialy reabsorption of horizontal trabeculae, accentuated vertical striations

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15
Q

Osteoporotic compression fractrures

A

Decreased anterior body height, New vs old diffuclt (old films), if multiple = contiguous, discontinues means CONCERN and needs special imaging

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16
Q

Name this diagnosis?

A

Osteoporosis

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17
Q

Name the diagnosis

A

Osteoporosis caused compression fracture

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18
Q

Difference between Pathlogical fracture and osteoporosis

A

Pathlogical fractures decrease height of the anterior, osteoporosis, metaststis, or multiple myeloma, proper work up needed

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19
Q

BURST fractures ( bursting compression fractures)

A

axial compression mechanism, vertebral body “explodes”, may see vertical cleft on AP, up to 50% cause of cord injury

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20
Q

Bursting fractures continued…

A

may have posterior body convexity, retropulsion of the posterior fragments, CT exam is warranted, widened intrapedicular distance (neural arch FX)

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21
Q

Name this diagnosis

A

Bursting fracture in cervicals…. try to name segment!

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22
Q

Signs of Bursting fractures

A

Decreased height and posterior body convextiy and increased pedicle distance

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23
Q

Name the finding

A

increased PEDICLE distance

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24
Q

Chance Fractures AKA Lap Belt Fractures

A

Horizontal splitting of the arch and body, flexion distraction mechanism, seatbelt acts liek a FULCRUM, MC in L1-L3, “empty vertebra” sign, commonly associated with compression fx

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25
Q

Name this diagnosis

A

CHANCE fractures

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26
Q

Name this diagnosis

A

Chance fracture

If you can be specific by naming level

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27
Q

Transverse process fractures

A

2nd MC lumbar FX, direct trauma or an avulsion, most often at L2 and L3, vertical to oblique in orientation (perpedicular to ground), often unilateral and often multilevel

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28
Q

Transverse process fractures

A

may or may not be displaced, often obscured by gas and fecal material, POTENTIAL renal damage, need a urinalysis for potential hematuria

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29
Q

Name this diagnosis

A

Transverse process fractures at L2 and L3

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30
Q

Name this diagnosis

A

Transverse process fracture (Look for hemorrhage)…

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31
Q

Spondylolisthesis

A

spondylolysis= interuption of the pars, spondylolisthesis= anterior displacement, prespndylolithesis= spondylolysis without the anterior, pseudospondylolisthesis= anteriorly without pars defects

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32
Q

Spondylolisthesis

A

1st described in 1782 by beligian obstetrition (DON’T MEMORIZE), 5-7% prevalence in white population, 40% prevalence among alaska eskimos

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33
Q

NAME this diagnosis

A

left= Spondylolysis because of no displacement

Right= anterior displacement is spondylolisthesis

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34
Q

Spondylolisthesis (clinical)

A

May or may not have pain, if painful may or may not be due to spondylo, displaced RARE after 18 (usually happens before and during puberty

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35
Q

Spondylolisthesis

A

Conservative management, some require more aggressive management, onset: isthmix= (child) degenerative= late (2nd MC reason)

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36
Q

Name this Diagnosis

A

Spondylolisthesis

37
Q

Spondylolisthesis Classifications

A

Type 1: Dysplastic (Congenital) RARE,

Type II: Spodylolytic (isthmic) MC,

Type III: Degenerative 2nd MC,

Type IV: Tramatic RARE,

Type V: Pathological RARE,

Type VI: Post Surgical RARE

38
Q

Where is Spondylolisthesis most commonly located?

A

L5

39
Q

CONGENITAL spondylolisthesis

A

Rare, malformation of sacrum and L-5, congenital predisposition, such as a congentially thin pars, NEVER present as birth

40
Q

Spodylolisthesis (Spondylytic)

A

Isthmic, stress FX, elongated pars or acute fx (rare), biomechanical stress, MC type for the younger age onset, MC at L5

41
Q

Spondylolithesis (degenerative)

A

Due to degeneration of the posterior joints, Pars in tact (pseudospondylo), most commmon at L-4, more common in females, Most commmon type in the older age onset

42
Q

Name this diagnosis

A

Degenerative Spondylolisthesis

43
Q

Spondylolisthesis (Traumatic)

A

Acute one time trauma is rare, MC type would be HANGMAN’S fracture of C2

44
Q

Name the diagnosis

A

traumatic (Hangman’s)

45
Q

Spondylolisthesis (Pathologic)

A

Gernalized or localized bony disorders, metastasis, Paget’s, Osterpetrosis, RARE

46
Q

POst surgical Spondylolithesis (Latragenic Spondylolithesis)

A

Stress Fx at the level above or below anthrodes, or at the level at laminectomy, RARE

47
Q

Spondylolisthesis (RADIOGRAPHIC)

A

Best detected by George’s line, graded by Meyerding’s method and / or %, may or may not need obliques, trapezoidal L-5

48
Q

Why don’t spondylolisthesis have huge effects?

A

During puberty a big change young enough can be accomadated

49
Q

Spondylolisthesis (Radiographic)

A

Inverted Napoleon hat, Bow line of Brailsford, Gendarmes cap, may or may not jave pars defects

50
Q

Name this finding?

A

Inverted Napoleon hat

51
Q

What is uniquw with Type 2 spondylolisthesis

A

Scotty dog pedicle fractures

52
Q

What is unique radiographically with Type 3 spondylolisthesis?

A

On the film, you would see degeneration of the facet joints. It looks brighter than rest of the film

53
Q

Sacral fractures

A

Direct trauma or results of fall on buttocks, associated with other pelvic fractures, most are horizontal near 3rd and 4th segs, examine sacral foramen CAREFULLY

54
Q

Sacral fractures continued….

A

Cortical offset on the lateral, potential angulation (compare old films), vertical fractures can occur from indirect trauma, re-exam may be needed, obscured by bowel gas and fecal material

55
Q

Name the classification

A

Denis classification

56
Q

Name diagnosis

A

Sacral fracture

57
Q

Coccygeal fracture

A

Most are horizontal in orientation, direct trauma, best last seen on the lateral, potential angulation (although may be normal), Correlate clinically

58
Q

Pelvic fractures are stable if they have a _____ break of the ring. Unstable fractures usually occur with _______ ring breaks

A

Single ring break = Stable

Double ring break = Unstable

59
Q

T/F 2/3 of pelvic fractures are unstable

A

FALSE

2/3 are stable

60
Q

Unstable fractures usually result from ___________ and has considerable ___________ injury

A

Severe trauma

Soft tissue

61
Q

Pathology

-What mechanism of injury is most commonly associated with this?

A

Duverney Fracture

  • a.k.a Iliac wing fracture
  • Direct lateral force

-

62
Q

T/F Duverney Fractures are stable

A

True

-Single break of the ring = stable

63
Q

Pathology

A

Duverney Fracture

64
Q

Pathology

(lowest 2 arrows)

A

Ischiopubic Rami Fractures

(in this case, superior and inferior fractures)

-Medial portion of the inferior rami is most common

65
Q

Most common stable fracture of the pelvis

A

Ischiopubic Rami Fracture

66
Q

Radiographic findings

-What is the Dx?

A

Cortical offset of the ramus that is absent on the opposite side

-Inferior Ischiopubic Rami Fracture

67
Q

Pathology

A

Superior and Inferior Ischiopubic Rami Fractures

68
Q

Pathology

A

Malgaigne Fracture

-Ipsilateral double vertical shearing fracture of superior and inferior pubic rami with fracture or dislocation about ipsilateral SI joint

69
Q

Most common unstable pelvic fracture

A

Malgaigne Fracture

70
Q

Pathology

A

Malgaigne Fracture

  • Superior and inferior ischiopubic rami fractures
  • Widened/dislocated/fractured SI joint ipsilaterally
71
Q

What patient profile would lead you to consider a possible avulsion fracture of the pelvis?

A

Adolescent with athletic participation in sports that involve sprinting, long jumping, hurdling, gymnastics, etc. (Muscular traction leads to the avulsion)

72
Q

Location and muscle associated with avulsion fractures of the pelvis

A
  • ASIS = Sartorius
  • AIIS = Rectus Femoris
  • Ischial Tuberosity = Hamstrings (most common)
73
Q

Pathology

A

Avulsion Fracture of the Left ASIS

-Curvillnear ossific density near the affected side (“Finger nail clip”)

74
Q

Most common avulsion of the pelvis

A

Ischial Tuberosity avulsion

75
Q

Pathology

A

Avulsion Fracture of the Lesser Trochanter of the Femur

-Less common

76
Q

Name the finding

A

Healing avulsion fracture of the pelvis

NOT TUMOR

77
Q

Bucket- Handle Fracture

A
  • Contralateral double vertical fx
  • Superior and inferior pubic rami (BE SPECIFIC ON TEST)
  • Fx or dislocation about contralateral SI
  • UNSTABLE
78
Q

Is a Bucket-Handle fracture stable?

A

NO.

79
Q

Name the Diagnosis

A

Bucket- Handle fracture on pubic Superior rami and contralateral SI

80
Q

What is the difference between Bucket-Handle fracture to Straddle fracture

A

Staddle fractrue is BILATERAL superior and inferior rami FX

-Substantial soft tissue injury

81
Q

T/F Staddle fractures are stable

A

FALSE

unstable

82
Q

Name Diagnosis

A

straddle fracture

83
Q

Sprung Pelvis AKA

A

“Open Book”

Diastasis of pubic symphisis

Diastasis od one or both SI joints

84
Q

T/F Sprung Pelvis is UNSTABLE

A

TRUE

85
Q

Name Diagnosis

A

Sprung Pelvis

86
Q

T/F Complex Pelvic Fractures are STABLE

A

F

UNSTABLE

87
Q

What causes complex pelvic fractures

A

Usually from a severe injury (Car accident)

88
Q

Complex pelvic fractures are difficult to _____________ and are complex ____________ fractures

A
  • Classify
  • Multiple
89
Q

Name Diagnosis

A

Complex pelvic fracture

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