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DIAGNOSTIC IMAGING II > Fractures Hip and Ankle > Flashcards

Fractures Hip and Ankle Flashcards

1
Q

What is a Navicular fracture?

A

Fracture through the body or waist of the navicular bone

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2
Q

What is the MOI of a Navicular fracture?

A
  • Crush injury
  • Fall from a height
  • MVAs
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3
Q

What are the radiographic features of a Navicular fracture?

A
  • Loss of cortical continuity
  • Irregular margins
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4
Q

How do you manage of Navicular fracture?

A

Closed reduction with a short leg cast

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5
Q

What is a Lisfranc fracture/dislocation?

A

Dislocation between the midfoot and the forefoot with concomitant fractures of nearby metatarsal bones

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6
Q

What is the MOI of a Lisfranc fracture/dislocation?

A

Crush injury with a shearing force between the midfoot and forefoot

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7
Q

What do we observe radiographically with a Lisfranc fracture/dislocation?

A

Complete loss of articulation between the midfoot and forefoot with a fracture line through the base of the fourth metatarsus

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8
Q

What ligament is torn in a Lisfranc fracture/dislocation?

A

Lisfranc ligament

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9
Q

How do you treat a Lisfranc fracture/dislocation?

A

Surgical fixation

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10
Q

Describe the Lisfranc Ligament

A
  • Strong ligament
  • Between lateral aspect of medial cuneiform and medial aspect of base of second metatarsal bone
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11
Q

Name the three parts of the Lisfranc Ligament

A
  • Dorsal
  • Interosseous
  • Plantar
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12
Q

What is the function of the Lisfranc Ligament?

A

It assists in the maintenance of the transverse arch of the foot

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13
Q

What is a Chopart fracture/dislocation?

A

Dislocation between the hindfoot and midfoot (talonavicular joint) associated with a fracture of a nearby tarsal bone (cuboid)

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14
Q

What are the MOIs for a Chopart fracture/dislocation?

A
  • Falls from a height
  • MVAs
  • Severe twisting basketball injury landing on an inverted, plantar flexed foot
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15
Q

What do we observe radiographically in a Chopart fracture/dislocation?

A

Complete loss of contact between the head of the talus and the navicular bone

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16
Q

How do you treat a Chopart fracture/dislocation?

A

Surgical intervention needed to avoid severe disability

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17
Q

Describe a March fracture through the 2nd metacarpus

A

Stress fracture through the metaphysis of either the third or fourth metatarsal bone

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18
Q

What is the MOI of a March fracture through the 2nd metacarpus?

A

Repetitive training exercises which place excessive loads on the forefoot

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19
Q

What do we observe radiographically in a March fracture through the 2nd metacarpus?

A

Amorphous (callus formation) radiopacity perpendicular to the long axis of the affected metatarsal bone

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20
Q

How do you treat a March fracture through the 2nd metacarpus?

A

Rest and cease all repetitive activities placing stress on foot

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21
Q

Describe a Jones fracture

A

Transverse fracture through the base of the fifth metatarsal bone

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22
Q

What is the MOI of a Jones fracture?

A

Large adduction force applied to the forefoot with the ankle in plantar flexion

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23
Q

What do we see radiographically in a Jones fracture?

A

Transverse radiolucent break of the fifth metatarsal bone 1.5 to 2.0 cm distal to its tuberosity (styloid process)

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24
Q

How do you treat a Jones fracture?

A
  • Conservative care with a walking boot and rest for 4-6 weeks
  • Surgical fixation may be necessary
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25
Not a Jones fracture if ___ involved
joint surface
26
Dancer fracture if ___ involved
joint surface
27
Describe a Dancer fracture
Avulsion fracture through the tuberosity of the fifth metatarsal bone
28
What is the MOI of a Dancer fracture?
Twisting force applied to the forefoot with the ankle in plantar flexion with a pull from the peroneus brevis tendon
29
What do we see radiographically with a Dancer fracture?
Transverse radiolucent break of the fifth metatarsal bone through its tuberosity (styloid process)
30
How do you treat a Dancer fracture?
- Conservative care with a walking boot and rest for 4-6 weeks - Surgical fixation may be necessary
31
What is a Salter Harris Type IV fracture?
Fracture through the metaphysis, epiphyseal plate and the epiphysis
32
Salter Harris Type IV Fracture: Common or Rare?
Rare occurrence
33
What is the MOI of a Salter Harris Type IV fracture?
Blunt force trauma with axial loading as in kicking an immovable object
34
What do we see radiographically in a Salter Harris Type IV fracture?
Radiolucent break through the metaphysis and epiphysis of the proximal phalanx of the 1st toe
35
How do you treat a Salter Harris Type IV fracture?
Surgical reduction is mandatory to prevent deformity
36
What is a Bedroom fracture?
Fracture of a phalanx of the foot
37
What is the MOI of a Bedroom fracture?
Direct injury as in kicking the edge of the bed post
38
What is the most common locations for a Bedroom fracture?
Commonly affects the first or the fifth toes
39
What do we see radiographically with a Bedroom fracture?
Radiolucent break of the proximal phalanx of the fifth toe
40
How do you treat a Bedroom fracture?
Rest with a walking boot is usually all that is needed
41
What is needed if the Bedroom fracture is comminuted?
Surgical planning
42
What is a Sesamoid bone fracture?
Fracture through a sesamoid bone
43
What are common MOIs of a Sesamoid bone fracture?
- Landing too hard on the foot after a jump or fall - Common in dancers with axial loading and hyperextension
44
Sesamoid fracture: More common in medial or lateral one?
More common in the medial one
45
What is the first line of treatment for a Sesamoid bone fracture?
Conservative care with rest and a walking boot for 6-8 weeks
46
What is the second line of treatment for a Sesamoid bone fracture?
Surgical intervention is needed (Sesamoidectomy)
47
What imaging modalities are best for a Sesamoid bone fracture?
- MRI w/o Contrast - Bone scan
48
What is a DDX for a Sesamoid bone fracture?
Bipartite Hallux
49
Describe the search pattern for Chest radiographs?
Are There Many Lung Lesions - Abdomen - Thorax - Mediastinum - Lungs
50
What is required to fracture ribs?
Significant force is required for fractured ribs
51
Rib fractures: More common in adults or kids?
Tends to occur more in adults
52
What % of rib fractures are missed?
~50%
53
What are sensitive imaging modalities for rib fractures?
- Ultrasound - Bone scan
54
What are common radiographic features of rib fractures?
- Fracture line - Cortical offset - Altered rib orientation - Pleural deflection - Callus formation - Pleural effusion - Pneumothorax - Subcutaneous emphysema - Diaphragmatic elevation
55
Which ribs make up the Upper Ribs?
Ribs 1-3
56
What do Upper Rib fractures typically require to be present?
Requires high grade force
57
What are Upper Rib fractures associated with (5)?
Soft tissue injury to: - Trachea - Aorta - Great vessels - Brachial plexus - Spine
58
What are the Great Vessels?
- Brachiocephalic - Carotid - Subclavian
59
What demographics commonly see Upper Rib fractures?
- Weightlifters - Stress fracture in throwing athletes
60
What ribs make up the Middle Ribs?
Ribs 4-9
61
Where are fractures of the Middle Ribs typically seen?
Lateral aspects
62
What are Middle Rib fractures commonly associated with?
Associated liver or splenic injury
63
What are the named fractures of the Middle Ribs?
- Flail Chest - Golfer's fracture - Passion (Bear hug) fracture - Cough (Post-Tussive) fracture
64
What ribs make up the Lower Ribs?
Ribs 10-12
65
Are Lower Rib fractures common?
Uncommon due to mobility
66
What are Lower Rib fractures associated with?
Kidney damage
67
Describe a Flail Chest
Two fractures involving the same rib resulting in a segmental section of the rib - Usually seen with multiple rib fractures
68
What kind of motion can occur in Flail Chest?
Flail rib can allow paradoxical motion resulting in hypoventilation in the affected region
69
Describe the Costal Hook Sign seen with Flail Chest
the flail rib may rotate resulting in a hook-like distal end
70
Describe a Golfer's fracture?
Abrupt termination of swing movement may be forceful enough to result in a rib fracture
71
What demographic commonly sees Golfer's fractures?
Golfers
72
Describe a Passion (Bearhug) Fracture.
Fracture following an overly enthusiastic hug
73
What demographic commonly sees Passion (Bearhug) fractures?
Elderly osteoporotic women
74
Describe a Cough (Post-Tussive) fracture
Rib fracture following persistent and/or violent coughing
75
What ribs are involved in a Cough (Post-Tussive) fracture?
Stress fracture involving the lower anterior ribs - Primarily 6th and 7th ribs
76
Rib fractures in kids under the age of 12: Common or Uncommon?
Uncommon
77
What are the radiographic features of child abuse?
- Multiple rib fractures at different stages of healing - Seen along posterior rib margins
78
What is the MOI of a sternal fracture?
Blunt trauma is a common MOI - Steering wheel - Shoulder belt
79
What are the radiographic features of a Sternal fracture?
- Transverse fracture (M.C.) - Common in the upper sternum (lower is generally lethal) - Can be seen with a compression or burst fracture in thoracic spine
80
What is the follow up for Sternal fractures?
Follow up with a CT or MRI
81
What are some complications of a Thorax fracture?
- Pneumothorax - Hemothorax - Chylothorax - Lung Contusion - Diaphragmatic Rupture - Aortic rupture - Tracheal rupture
82
What are the MOIs of Acromioclavicular Injuries?
- Fall on the shoulder - Young adults - Sports collisions - Throwing sports
83
Describe Acromioclavicular Injury Type I
- Mild severity - AC ligament stretched - CC ligament normal - Normal X-ray findings
84
Describe Acromioclavicular Injury Type II
- Moderate severity - AC ligament disrupted - CC ligament stretched - Wide joint space with slight clavicle elevation
85
Describe Acromioclavicular Type III
- Severe - AC ligament disrupted - CC ligament disrupted - Wide joint space with severe clavicle elevation
86
What is the normal measurement of the Coracoclavicular space?
11-13 mm
87
What is the normal measurement of the Acromioclavicular space?
3-4 mm
88
What is the most common location for a clavicle fracture?
Mid-portion (85%)
89
What is the required MOI for a clavicular fracture?
Requires a lot of force
90
What is the follow up for a medial clavicular fracture?
CT scan of the thorax to evaluate for - other fractures - soft tissue injury to great vessels
91
Describe a Midclavicular fracture
Typically a complete fracture
92
What is the MOI of a Midclavicular fracture?
Force is directed from the distal end
93
What are some common radiographic features of a Midclavicular fracture?
- Bayonet apposition is common finding - Heals with extensive callus formation
94
What can a midclavicular fracture result in?
Thoracic outlet syndrome
95
How do you treat a Midclavicular fracture?
Treatment with a sling
96
Lateral clavicular fracture: common or uncommon location?
Uncommon location (15%)
97
What may be helpful with taking views for a lateral clavicular fracture?
Radiographic examination with and without weights may be helpful
98
What might you see with a lateral clavicular fracture?
May see intra-articular extension (increased chance of early DJD)
99
What are some complications of clavicular fractures?
- Neurovascular damage - Non-union - Mal-union - Degeneration - Post-traumatic osteolysis of the clavicle
100
What can a mal-union clavicular fracture lead to?
Bayonet Apposition
101
What are some DDx for a Post-traumatic osteolysis of the clavicle?
- Inflammatory Arthritis - Trauma - Hyperparathyroidism
102
What are the MOIs of a Post-traumatic osteolysis of the clavicle?
Acute trauma or chronic micro-trauma
103
What populations commonly experience Post-traumatic osteolysis of the clavicle?
- Weightlifters - Repetitive overhead lifting and carrying
104
What are other causes of distal clavicular erosions?
- Hyperparathyroidism - Rheumatoid arthritis - Scleroderma - Cleidocranial dysostosis (bilateral usually)

DIAGNOSTIC IMAGING II (9 decks)

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