Final Exam Terms Flashcards
swimmers view is used to better visualize what bones
C7-T1
slipped capital femoral epiphysis aka SCFE is what type of fx?
salter 1
Hills-sachs defect is MC assoc with what type of injury
anterior shoulder dislocation
fx in what area is bad news for blood supply?
scaphoid
type of fx that obliterates the epiphysis
salter 5
follow up with a fx patient that is now 8MO post fx…on xray fx is not healed—name of this condition?
non-union
17 YOM football player presents after being tackled and slammed onto his right dominant shoulder forcefully 2 hours ago during a game, he has full active and passive ROM, but some pain with abduction. no obvious deformity, the skin over the shoulder is intact and not broken. what study do you order?
xray of shoulder in 2 views—-NOT MRI because this is still an acute trauma and we want to r/o posterior dislocation right away
image study of choice for orbital blow out fx
CT
which fx can cause leg length differences, angulation of bone and secondary osteoarthritis
salter 4 of lower extrem
what is the term for a fx that occurs following a force insufficient to break normal bone?
pathologic fx
what causes blurred film
movement of PT
___ results in direct force to the anterior shoulder, or indirect force applied to the arm combining adduction, extension and internal rotation
posterior shoulder dislocation
term used to describe the lighter areas on an exposed and processed film
radiopaque
waters view is done with which type of xrays
facial bone xrays
overall darkness of blackness on film=?
density
types of fx involves the growth plates of children
salter harris fxs
why do we get two views on xray -which views
visualize bone better and better localize abnormality AP lateral
can xray detect soft tissue swelling
only if it is significant
imaging modality to visualize bone marrow and soft tissues, muscles, tendons, ligaments
MRI
what would appear as decreased density on xray (3)
osteoporosis
localized osteolytic mets
MM
avascular necrosis of bone appears as incr or decr density
focal increased density (whiter)
MC cause in men of osteoblastic mets
prostate CA
common places for avasc necrosis (3)
scaphoid in wrist femoral head humeral head
most sensitive imaging to detect avasc necrosis
MRI
MC primary malignancy of bone in adults
multiple myeloma
how does MM show on xray
decr density
multiple, small, sharply-circumscribed (punched-out) lytic lesions of approximately the same size
disseminated MM
hallmark of MM
diffuse spinal osteoporosis
what is MM associated with
- diffuse spinal osteoporosis 2. multiple compression fxs
lytic lesions or punched out lesions
MM disseminated
joint space narrowing
arthritis
erosion and new bone formation that may occur in the same joint
psoriatic arthritis
pencil in cup
psoriatic arthritis
ankylosing spondylitis -MC in? -presentation -can be assoc with? -hallmark finding
MC in young males presentation: neck/low back pain, worse at night, better with exercise assoc with UC hallmark: sacroiliitis *fusion of lumbar spine and sacro-iliac joints
compression fx of spine -MC in -secondary to ? -s/s -study of first choice
women >>> men typically occur secondary to osteoporosis s/s *kyphosis *loss of overall body height conventional spine radiographs 1st image done
osteoporotic commpression fractures mc involve? spare what?
anterior and superior aspects of vertebral body—- SPARING posterior body
red flags for back pain (4)
- neuro deficits 2. tumor, hx of CA, weight loss, pain worse at night 3. infection or immunocomp 4. trauma
rules of 2 for imaging (4)
*2 views: ap and lateral *2 joints: above and below fx *2 sides: both limbs *2 occasions: some non-displaced fx wont show up for 10-14 days
This is an 81-year-old male with chronic back pain. What is the most likely diagnosis?
Multiple myeloma
These are the hands of a 45-year-old female with a rash. What is the most likely diagnosis?
Psoriatic arthritis
define incomplete fx
only part of the cortex is fx
causes of incomplete fx and list the types
soft bones (kids), bone dz like Paget Dz
Types: greenstick and Torres/Buckle
define buckle fx
compression of cortex
how can you describe a fx (4) and give ex for each
- number of fx fragments–simple or communited (more than 2)
- Direction of fx line–transverse, oblique, spiral
- Relationship of one fragment to another—displacement, angulation, shortening, rotation
- open to the atmosphere—closed or open (compound)
MOA for a transverse fx
force applied perpendicular to long axis of bone—fx occurs at point of impact
MOA for obliqe fx
force applied along the long axis of bone—fx occurs somewhere along shaft
MOA for spiral fx
- stable or unstable
- assoc with?
twisting or torque injury
EX: planting foot in a hole while running
***unstable***
*assoc with soft-tissue injuries like tears in ligaments and tendons
dislocation and subluxations only occur where
at the joints
subluxation
bones that originally formed the two components of a joint are in partial contact with eachother
amount by which the distal fragment is off-set, front-back and side-side, from proximal fragment
displacement
describe angulation
angle b/w distal and proximal fragments as a function of degree to which the distal fragment is deviated from the position it wuld have assume were it in its normal position
-decr in degrees
this term describes how much, if any, overlap there is of the ends of the fracture fragments
shortening
opposite term from shortening?
distraction
describe distraction
distance the bone fragments are sep from each other
rotation almost always involves
long bones—femur or humerus
fx produces two fragments
simple fx
fx produces more than 2 fragments
comminuted fx
fx line is perpendicular to the long axis of the bone—what kind of fx is this
transverse
fx line is diagonal in orientation relative to the long axis of the bone–what kind of fx
oblique
are spiral fx stable or unstable
unstable
upper extrem spiral fx in a child suggestive of
child abuse
stress fx also called
linear fx
fx=one thin line with no additional lines splintering from it and no compression or distortion of the bones
linear fx or stress fx
stress fx MC where
skull
another term for open fx
compound fx
complication of compound fx
osteomylitis
shortening=?
distraction=?
shortening=overlap
distraction=lenghening
to appreciate rotation, what must you do
visualize joint above and below the fx
MC elbow fx in adults and children
fx of the radial head=adult
Supacondylar fx of the distal humerus=children
supracondylar fx of the distal humuers— MC elbow fx in kids
supracondylar fx of the distal humerus in a child will produce?
posterior displacement of distal humerus
+posterior fat pad***
+posterior fat pad sign
radial head fx
*swelling of the joint capsule due to traumatic hemarthrosis
PT complaining of pain—- but the xray is normal–what would this suggest
stress fx
***appears normal in up to 85% of fxs
if a stress fx is not shown on xray, when will it be diagnosable?
not until after periosteal new bone formation occurs
appearance of a thin, dense zone of sclerosis across the medullary cavity of the cancellous
stress fx
common locations for stress fx (3)
shafts of long bones—prox femur or prox tibia
calcenous
second and third metatarsals
what is a march fx
stress fx of the second and third metatarsals
remodeling of bone begins when
8-12 weeks post fx
Healing of the fracture fragments occurs in a mechanically or cosmetically unacceptable position
malunion
This implies that fracture healing will never occur. It is characterized by smooth and sclerotic fracture margins with distraction of the fracture fragments
nonunion
The fracture does not heal in the expected time for a fracture at that particular site (e.g., longer than 6 to 8 weeks
delayed union
study of choice for skull fx
ct with bone windows
skull fx may be assoc with
epidural hematoma
MC bone fx in a basilar skull fx
temporal bone
basilar skull fx
- MC in?
- can cause?
- PE findings
MC in young men–>secondary to high risk behaviors
- can cause tear in dura mater–>CSF rhinorrhea and/or otorrhea
- battle’s sign–echymosis behind ear
- racoon eyes
if temporal fx suspected in basilar skull fx, what imaging is indicated
high resolution CT done on temporal bone
MOA causing orbital flow blowout fx
- what part of orbit is fx
- what muscle can get trapped–what can happen as a result
direct impact on the orbit
-ball hitting the eye for ex
**causes sudden rise in intra-orbital pressure–>fx of the inferior orbital floor or medial wall of orbit
-inferior rectus muscle can get trapped–>restriction of upward gaze + diplopia
decrease visual acuity
diplopia (esp with upward gaze)
orbital emphysema
epistaxis
orbital flow blowout fx
image test of choice for orbital floor blowout fx
-sign?
CT scan
*shows teardrop sign
tear drop sign on CT
orbital floor blowout fx
*herniating tissue and muscle
MC facial fx?
nasal bone injury
waters view
view done to look at nasal bone injury on xray
*pt gazes upward
*angled PA image
MC type of spinal fx
compression fx
MC region for spinal fx
and cause
cervical spine
MCC= trauma
2nd MC region of spine injured in fxs
thoracolumbar junction
b/w T11-L4
NEXUS criteria (5)
- absence of midline cervical tenderness
- absence of focal neruo deficits
- normal level of consciousness/alert
- no evidence of intoxication
- absence of painful distracting injury
CCR criteria
age >65, dangerous MOI
what is most imp view for c-spine
lateral
what do we do if we cannot visualize C7-T1
obtain swimmers view—taken with one arm over head
compression fx of the bony ring of C1
+lateral masses splitting
Jefferson fx
unstable
***AP open mouth image***
MOA for Jefferson fx
axial (loading) blow to the vertex of head
-diving injury for ex
fxs through pars interarticularis of the axis (C2) separates posterior aspects of C2 vertebral body from anterior aspect of C2
Hangman fx
MOA for hangman fx
hyperextension/compresion injury—forced extension of an already flexed neck
EX: MVA—chin hits dashboard
which view is hangmans fx best seen on
lateral
is hangmans fx associted with neuro deficits
no—even tho it is an unstable fx
hangman fx leads to ??
overall widening of the spinal canal
another term for compression fx
burst fx
multiple noncontiguous thoracic fractures are assoc with?
burst fracture in nearly 50%— so finding a fx should make one continue to look for another
what can also be present with throacic spine fx
rib rx
describe the Y view
humeral head should be at the center of the Y of the scapula
*used with shoulder dislocations
MC site for fx in shoulder
surgical neck
anterior dislocation
- describe
- MOI
- best view to see dislocaiton
- assoc with?
- displacement of humeral head anterior to the glenoid cavity
- MOI: indirect force to the arm thru combination of abduction, extension and external rotation
>95% of all shoulder dislocations
- axillary view is best to visualize
- assoc with Hills-Sachs defect
Hills-sachs defect
- define
- assoc with
assoc with anterior shoulder dislocation
-posterolateral humeral head depression fx–resulting from impactiong with the anterior glenoid rim
Hills-sachs defect
*assoc with anterior shoulder dislocation
in anterior shoulder dislocation, where does humeral head lie
under the anterior coracoid process of scapula
posterior shoulder dislocation
- MOI
- best view on image
MOI=direct force to the anterior shoulder–or indirect force appliced to the arm combining adduction, extension and internal rotation
*standard axillary projection and/or AP projection with PT rotated 40 degrees toward affected side is best way to image
+light bulb sign******
Y view xray shows the humeral head lateral to the glenoid in which dislocation
posterior
posterior dislocation, the humeral head is fixed in ____ rotation
internal
where do most clavicular fx occur
mid portion or distal third of clavicle
ulnar fx with dislocation of radial head
Monteggia fx
radius fx with dislocation of distal radioulnar joint
Galeazzi fx
supracondylar fx of distal humerus
- produce?
- how does the anterior humoral line lie?
produces posterior displacement of distal humerus
**the anterior humoral line lies more anteriorly–> + posterior fat pad sign
+posterior fat pad sign
Radial head fx
colles fracture describe
- assoc with?
- MOA
- MC seen in?
fx of distal radius with dorsal angulation of the distal radial fx fragment
*assoc with fx of the ulnar styloid
*FOOSH
MC in elderly women with osteroporotic bone that sustain a low energy fall
repeated microfractures to the foot from trauma
march fx
march fx
- type of fx
- MC affecting?
stress fx
MC affects the shafts of the second and third metatarsals
transverse fx of the 5th metatarsal about 1-2 cm from its base
jones fx
jones fx
- describe
- moi
- complication
*transverse fx
*5th metatarsal 1-2 cm from base
*MOI: plantar flexion of the foot and inversion of ankle
-if not immobilized– nonunion can develop
what takes longer to heal—jones fx or avulsion fx of 5th metatarsal
jones fx
jones fx
list the six fx or dislocations not to miss
- scaphoid fx
- buckle fx of radius and/or ulna in kids
- radial head fx
- supracondylar fx of distal humerus in kids
- posterior dislocation of shouldder
- hip fx in eldery
tenderness of anatomic snuff box after falling on outstretched hand
scaphoid fx
acute and sudden angulation of cortext near the wrisrt
buckle fx
thumb gets pulled backwards-commonly while skiing and ski pole gets stuck in snow
gamekeeper’s thumb
pathologic fx
- occur in?
- MC locations? (3)
*occur in bone with preexisting abnormality–>metastasis, osteoporosis
*ribs, spine, proximal appendicular skeleton (esp humerus and femur)
*
Ottawa Ankle Rules
- descr what?
1. ankle image is requried only when there is pain in the ___ ___ and 3 of the following?
2. foot xray is req only when there is pain in the ___ ___ and 3 of the following?
describe the requirements for plain x-rays within clinical context of ankle injury
- ankle radiograph is required ONLY if there is pain in the “malleolar zone” + any of these:
–>bone tenderness at posterior edge/tip of lateral malleolus
–>bone tenderness at the posterior edge/tip of medical malleolus
–>inability to weight bare, both immediately and after
- A foot x-ray is required ONLY if there is pain in the “mid-foot zone” AND any of these:
–>bone tenderness at the base of 5th metatarsal——Jones fx
–>Bone tenderness at the navicular—-navicular or mortis fx
–>inability to weight bare both immed and after
jones fx
which salter fx can develop arthritic changes or asymmetric growth plate fusion
3
which salter is more likely to develop early fusion of the growth plate with angular deformities and shortening of bone
4 and 5
Fracture of the Epiphyseal plate alone
salter 1
which salter produces a corner sign
2
which salter is MC
2
Fracture of the epiphyseal plate and fracture of the metaphysis
salter 2
Fracture of the Epiphyseal plate and the epiphysis itself
salter 3
Fracture of the epiphyseal plate, metaphysis and epiphysis
salter 4
Crush type of fracture of the epiphyseal plate
salter 5
Slipped capital femoral epiphysis
produces inferior, medial and posterior slippage of the proximal femoral epiphysis relative to the neck of the femur
**salter harris 1 fx**
+growth plate damage
