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Medicine - Year 1 > Fractures & Dislocations - Radiology > Flashcards

Fractures & Dislocations - Radiology Flashcards

1
Q

List the methods that are used in imaging bone

A
  • X-rays
  • CT scan
  • MRI
  • Ultrasound
  • Dual X-ray absorptiometry (DXA)
  • Bone scintigraphy
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2
Q

What are the advantages and disadvantages of using x-rays for imaging bone

A

Advantages

  • Quick imaging
  • Widely available
  • Cheaper imaging method
  • Can be used on a wide range of people

Disadvantages

  • Exposed to ionsing radiation
  • Poor images of soft tissues
  • Not as high resolution compared to other methods
  • Limit to the numer of X-rays you can ahve in any given time frame due to the ionising radiation
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3
Q

a) What are the indications to use a CT scan?
b) What are the advantages and disadvantages?

A

a)

  • Used selectively for assessing patients with bone and joint disease
  • May be used when skeletal configuratin needs defining
  • When calcific lesions are being assessd
  • When MRI is contraindiated
  • When articular regions are being evaluated

b) Advantages

  • 3D image
  • High spatial resolution so deeper visualisation and detail
  • Very quick so good in trauma

Disadvantages

  • Very expensive
  • May need to use dye which is not useful for people with low renal function
  • Higher radiation exposure so especially not useful for pregnant women
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4
Q

a) What are the indications to use an MRI?
b) What are the advantages and disadvantages?

A

a)

  • Valuable in the assessment and diagnosis of many MSK diseases

b)

Advantages

  • 3D image
  • No radiation exposure
  • Can see boen and soft tissue

Disadvantages

  • Very expensive: costs £10,000 for each person
  • Takes a long time
  • Uncomfortbale due to the small space and loud noise
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5
Q

a) What are the indications to use an ultrasound?
b) What are the advantages and disadvantages?

A

a)

  • Useful investigation for confirmation of small joint synovits and erosions
  • For anatomical location of periarticular lesions
  • Characterisation of tendon lesions
  • Guided injection of joints and bursae

b) Advantages

  • Readily available
  • Can be used on pregnant women
  • Non ionising radiation - not harmful
  • Quick imaging and cheap
  • Clear images of soft tissues
  • Can see moving parts
  • Can measure flow

Disadvantage

  • Image resolution is poor – not as good as X-rays
  • Bone is hard to recognise because it’s too dense for sound waves to pass through, therefore it is not useful for imaging bone
  • Poor imaging of tissue containing air e.g., lungs
  • Requires a lot of personal technique
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6
Q

What are the indications to use a dual x-ray absorptiometry (DXA)

A

It has key role in the diagnosis and managment of osteoporosis

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7
Q

What are the indications to use a bone scintigraphy?

A

Useful in the diagnosis of metastatic bone disease and Paget’s disease of bone

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8
Q

Which body parts do we not x-ray?

A
  • Ribs
  • Nasal bones
  • Coccyx
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9
Q

a) How are rib fractures diganosed?
b) Why is an x-ray not used to confirm rib fractures?
c) When do we x-ray chests?

A

a) Diagnosis is made with a suitable clinical history and localised bone tenderness on examination
b) There is no specific treatment for a rib fracture except pain relief and therefore confirming the diagnosis with an x-ray will not change the patient’s management
c) You x-ray chests in trauma if the patient is short of breath, has pleuritic chest pain or reduced breath sounds to exclude a pneumothorax

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10
Q

a) Why do we not x-ray nasal bones?
b) What are the presence of nasal haematoma or malalignment indication of? And how are these assessed?

A

a) Nasal bones are difficult to x-ray. We can only get a lateral view here we see them isolated from the other facial bones and the x-ray does not influence management
b) They are indications for surgery and are assessed by clinical examination

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11
Q

a) Why do we not x-ray the coccyx
b) How are coccyx fractures diagnosed and what is the type of treatment?

A

a) The shape of the coccyx is highly variable and injury through one of the coccygeal discs will not be visible. Even if a fracture is demontsrated it does not change management.
b) The diagnosis is clinical and treatment is conservativte

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12
Q

List the rules of recognising fractures

A
  • Take a minimum of 2 views, 90 degrees to each other
  • A rigid ring must break in 2 places
  • X-ray the joint above and belw when the paired bones are injured
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13
Q

a) What is the rule about rigid ring fractures
b) Provide examples on bony rings in the body

A

a) A rigid ring must break in at least 2 places Pelivs and

b)

  • Pelvis - Obturatr foramina
  • Paired longbones, forearm, and leg
  • Mandible
  • Zygomatic arch
  • Vertebra
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14
Q

Describe the nmeumonic to describe fractures

A

Open (compound) /closed - A compound fracture is one where the bones are exposed to air

Location

Degree (Complete vs incomplete)

Articulation involvement

Comminution and pattern- transverse, oblique, spiral, longitudinal, comminuted

Intrensic bone quality

Displacement, angluation and rotation

  • Displacement - medial/lateral displacement
  • Angulation- medial (varus)/lateral (valgus) displacement
  • Rotation - internal/external OR overriding with foreshortening/distraction
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15
Q

What can an open (compound) fracture increase the risk of and why?

A

Osteomyelitis beacuse the bone is exposed to air

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16
Q

Put in order of least stable to most stable fracture pattern: spiral, comminuted, longitudinal, oblique, transverse

A
  1. Transverse
  2. Oblique
  3. Spiral
  4. Longitudinal
  5. Comminuted
17
Q

Describe the type of force applied and the healing process of: transverse, spiral, oblique, butterfly fracture and comminuted fractures

A

Transverse

  • Force impacts directly on yh bone
  • Fractures are stable but the area of the bone in contact for healing is small, union takes 2x as long in spiral fractures

Spiral

  • Low velocity fractures
  • Fracture healing is more rapid because of the large areas in contact

Oblique

  • A combincation of rotational and direct forces
  • These heal quickly provided another bone in the limb does not keep the fracture ends apart

Butterfly

  • Caused by a driect blow combined with evolving fractures
  • Healing is often slow

Comminuted fractures

  • Usually the result of great force
  • There are more than two bony fragments to the fracture configuration
  • Blood supply is often compromised leadingto delayed healing, even though there is a large contact area
18
Q

What is the difference between a dislocatio and subluxation

A

A dislocation of a joint is defined as displacement of two adjacent bones so that there is no overlap in the articular surfaces.

If there is some articuar surfaces, then this is subluxation.

19
Q

List the type of fractures that can occur in children

A
  • Plastic
  • Torus
  • Greenstick
  • Growth plate fractures
  • Non-accidental injury
20
Q

What is the name of the classificication that classifies growth plate fractures

A

Saltr-harris classification

21
Q

What are the Salter-harris classifications for growth plate fractures?

A

Straight across growth plate

Above growth plate

Lower or BeLow growth plate

Through growth plate

cRushed or eRasure

22
Q

Which type of fractures are highly suspicious for non-accidental injury in children?

A

Metaphyseal corner fractures

23
Q

What type of special fracture can you have

A

Fatigue fractures - march frractures, stress fractures

Insufficincy fractures

Pathological fractures

24
Q

What are pathological fractures?

A

Pathological fractures occur through or next to focal bone abnormalities

These can be either benign or malignant e.g., Paget’s disease, myeloma

25
Q

a) What radiographic signs in bone suggest there is a fracture?
b) What supplementary radiographic signs are suggestive of a fracture?

A

a)

  • Lucent lines
  • Sclerotic lines
  • Corticol breach
  • Disruptionof trabeculate
  • Change in bony contour

b)

  • Hemarthrosis
  • Lipohaemarthrosis
  • Soft tissue swelling
26
Q

a) What is a lucent line?
b) What are the two reasons why you can see a lucent line on an x-ray

A

a) On an x-ray “lucent” is something that let too much of the x-ray beam through to the x-ray plate or detector. The result is that a lucent line on a radiograph is dark
b) 1. The fracture fragments are seperated
2. There has been resorption of the bone at the fracture site

27
Q

a) Describe what occurs to the vessels in subcapital (intracapsular) hip fracture in an adult and what this can lead to
b) What is the managment?

A

a) In a subcapital fracture the neck of femur and the cervical arteries that perfuse the femoral head are torn. This leades to avacular necrosis of the femoral head and
b) A hemiarthroplasty (femoral head replaced) or complete hip surgery (femoral head and socket replaced) is required

28
Q

a) Decsribe what occcurs in an intertrochanteric fracture and what occurs to the vessels?
b) What is the management?

A

a) In an intertrochanteric fracture neck of femur, the fracture occurs outside the joint capsule sparing the cervical arteries.
b) These fractures can be repaired, and the femoral head saved by a dynamic hip screw or intramedullary nail

29
Q

What are sclerotic lines?

A

When fracture fragments are mpacted the bne trabeculae overlap to produce lines created by twice the density of bones: sclerotic lines

30
Q

Describe the four shades of grey found on most x-rays

A

Near white is bone

Black is air

Fat is dark grey

Water is light grey

31
Q

What has happened if the subcutaneous fat is not visible and is swollen?

A

The subcutaneous fat has been filled with water from localised haemorrhage or oedema = tissue swelling

32
Q

When does a hemarthrosis (bleeding in joint) in a fracture occur?

A

A hemarthrosis (bleeding into a joint) will accompany any fracture that extends into a joint

33
Q

What is lipohaemarthrosis?

A

If blood in a joint has time to settle, then the serum and red blood cells can be seen as seperate layers and if fat leaks out of the marrow this will float to the topof the effusion

34
Q

a) How many rings are there in the pelvis?
b) State where these rings are found
c) How maay places must these bones break in a fracture?

A

a) 3
b) large ring of pelvis and 2x obturator foraman
c) The bones surrounding each obturator foramen must break in at least two places and the larger ring of the pelvis must also break in at least two places.

35
Q

a) Why are the radius and ulna and tibia and fibula considered as bony rings?
b) If one of the paired bones breaks then what does that mean for the other bone or the ligaments connected?

A

a) They are rigidly fixed to each other at either end
b) If one of the paired bones breaks, then so must the other one or one of the ligaments connecting the two bones must be torn.

36
Q

What must you do when paired bones are injured?

A

x-ray the joint above and below

Medicine - Year 1 (61 decks)

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