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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
Q

Not a Jones fracture if ___ involved

A

joint surface

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26
Q

Dancer fracture if ___ involved

A

joint surface

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27
Q

Describe a Dancer fracture

A

Avulsion fracture through the tuberosity of the fifth metatarsal bone

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28
Q

What is the MOI of a Dancer fracture?

A

Twisting force applied to the forefoot with the ankle in plantar flexion with a pull from the peroneus brevis tendon

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29
Q

What do we see radiographically with a Dancer fracture?

A

Transverse radiolucent break of the fifth metatarsal bone through its tuberosity (styloid process)

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30
Q

How do you treat a Dancer fracture?

A
  • Conservative care with a walking boot and rest for 4-6 weeks
  • Surgical fixation may be necessary
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31
Q

What is a Salter Harris Type IV fracture?

A

Fracture through the metaphysis, epiphyseal plate and the epiphysis

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32
Q

Salter Harris Type IV Fracture: Common or Rare?

A

Rare occurrence

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33
Q

What is the MOI of a Salter Harris Type IV fracture?

A

Blunt force trauma with axial loading as in kicking an immovable object

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34
Q

What do we see radiographically in a Salter Harris Type IV fracture?

A

Radiolucent break through the metaphysis and epiphysis of the proximal phalanx of the 1st toe

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35
Q

How do you treat a Salter Harris Type IV fracture?

A

Surgical reduction is mandatory to prevent deformity

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36
Q

What is a Bedroom fracture?

A

Fracture of a phalanx of the foot

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37
Q

What is the MOI of a Bedroom fracture?

A

Direct injury as in kicking the edge of the bed post

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38
Q

What is the most common locations for a Bedroom fracture?

A

Commonly affects the first or the fifth toes

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39
Q

What do we see radiographically with a Bedroom fracture?

A

Radiolucent break of the proximal phalanx of the fifth toe

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40
Q

How do you treat a Bedroom fracture?

A

Rest with a walking boot is usually all that is needed

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41
Q

What is needed if the Bedroom fracture is comminuted?

A

Surgical planning

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42
Q

What is a Sesamoid bone fracture?

A

Fracture through a sesamoid bone

43
Q

What are common MOIs of a Sesamoid bone fracture?

A
  • Landing too hard on the foot after a jump or fall
  • Common in dancers with axial loading and hyperextension
44
Q

Sesamoid fracture: More common in medial or lateral one?

A

More common in the medial one

45
Q

What is the first line of treatment for a Sesamoid bone fracture?

A

Conservative care with rest and a walking boot for 6-8 weeks

46
Q

What is the second line of treatment for a Sesamoid bone fracture?

A

Surgical intervention is needed (Sesamoidectomy)

47
Q

What imaging modalities are best for a Sesamoid bone fracture?

A
  • MRI w/o Contrast
  • Bone scan
48
Q

What is a DDX for a Sesamoid bone fracture?

A

Bipartite Hallux

49
Q

Describe the search pattern for Chest radiographs?

A

Are There Many Lung Lesions
- Abdomen
- Thorax
- Mediastinum
- Lungs

50
Q

What is required to fracture ribs?

A

Significant force is required for fractured ribs

51
Q

Rib fractures: More common in adults or kids?

A

Tends to occur more in adults

52
Q

What % of rib fractures are missed?

A

~50%

53
Q

What are sensitive imaging modalities for rib fractures?

A
  • Ultrasound
  • Bone scan
54
Q

What are common radiographic features of rib fractures?

A
  • Fracture line
  • Cortical offset
  • Altered rib orientation
  • Pleural deflection
  • Callus formation
  • Pleural effusion
  • Pneumothorax
  • Subcutaneous emphysema
  • Diaphragmatic elevation
55
Q

Which ribs make up the Upper Ribs?

A

Ribs 1-3

56
Q

What do Upper Rib fractures typically require to be present?

A

Requires high grade force

57
Q

What are Upper Rib fractures associated with (5)?

A

Soft tissue injury to:
- Trachea
- Aorta
- Great vessels
- Brachial plexus
- Spine

58
Q

What are the Great Vessels?

A
  • Brachiocephalic
  • Carotid
  • Subclavian
59
Q

What demographics commonly see Upper Rib fractures?

A
  • Weightlifters
  • Stress fracture in throwing athletes
60
Q

What ribs make up the Middle Ribs?

A

Ribs 4-9

61
Q

Where are fractures of the Middle Ribs typically seen?

A

Lateral aspects

62
Q

What are Middle Rib fractures commonly associated with?

A

Associated liver or splenic injury

63
Q

What are the named fractures of the Middle Ribs?

A
  • Flail Chest
  • Golfer’s fracture
  • Passion (Bear hug) fracture
  • Cough (Post-Tussive) fracture
64
Q

What ribs make up the Lower Ribs?

A

Ribs 10-12

65
Q

Are Lower Rib fractures common?

A

Uncommon due to mobility

66
Q

What are Lower Rib fractures associated with?

A

Kidney damage

67
Q

Describe a Flail Chest

A

Two fractures involving the same rib resulting in a segmental section of the rib
- Usually seen with multiple rib fractures

68
Q

What kind of motion can occur in Flail Chest?

A

Flail rib can allow paradoxical motion resulting in hypoventilation in the affected region

69
Q

Describe the Costal Hook Sign seen with Flail Chest

A

the flail rib may rotate resulting in a hook-like distal end

70
Q

Describe a Golfer’s fracture?

A

Abrupt termination of swing movement may be forceful enough to result in a rib fracture

71
Q

What demographic commonly sees Golfer’s fractures?

A

Golfers

72
Q

Describe a Passion (Bearhug) Fracture.

A

Fracture following an overly enthusiastic hug

73
Q

What demographic commonly sees Passion (Bearhug) fractures?

A

Elderly osteoporotic women

74
Q

Describe a Cough (Post-Tussive) fracture

A

Rib fracture following persistent and/or violent coughing

75
Q

What ribs are involved in a Cough (Post-Tussive) fracture?

A

Stress fracture involving the lower anterior ribs
- Primarily 6th and 7th ribs

76
Q

Rib fractures in kids under the age of 12: Common or Uncommon?

A

Uncommon

77
Q

What are the radiographic features of child abuse?

A
  • Multiple rib fractures at different stages of healing
  • Seen along posterior rib margins
78
Q

What is the MOI of a sternal fracture?

A

Blunt trauma is a common MOI
- Steering wheel
- Shoulder belt

79
Q

What are the radiographic features of a Sternal fracture?

A
  • 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
Q

What is the follow up for Sternal fractures?

A

Follow up with a CT or MRI

81
Q

What are some complications of a Thorax fracture?

A
  • Pneumothorax
  • Hemothorax
  • Chylothorax
  • Lung Contusion
  • Diaphragmatic Rupture
  • Aortic rupture
  • Tracheal rupture
82
Q

What are the MOIs of Acromioclavicular Injuries?

A
  • Fall on the shoulder
  • Young adults
  • Sports collisions
  • Throwing sports
83
Q

Describe Acromioclavicular Injury Type I

A
  • Mild severity
  • AC ligament stretched
  • CC ligament normal
  • Normal X-ray findings
84
Q

Describe Acromioclavicular Injury Type II

A
  • Moderate severity
  • AC ligament disrupted
  • CC ligament stretched
  • Wide joint space with slight clavicle elevation
85
Q

Describe Acromioclavicular Type III

A
  • Severe
  • AC ligament disrupted
  • CC ligament disrupted
  • Wide joint space with severe clavicle elevation
86
Q

What is the normal measurement of the Coracoclavicular space?

A

11-13 mm

87
Q

What is the normal measurement of the Acromioclavicular space?

A

3-4 mm

88
Q

What is the most common location for a clavicle fracture?

A

Mid-portion (85%)

89
Q

What is the required MOI for a clavicular fracture?

A

Requires a lot of force

90
Q

What is the follow up for a medial clavicular fracture?

A

CT scan of the thorax to evaluate for
- other fractures
- soft tissue injury to great vessels

91
Q

Describe a Midclavicular fracture

A

Typically a complete fracture

92
Q

What is the MOI of a Midclavicular fracture?

A

Force is directed from the distal end

93
Q

What are some common radiographic features of a Midclavicular fracture?

A
  • Bayonet apposition is common finding
  • Heals with extensive callus formation
94
Q

What can a midclavicular fracture result in?

A

Thoracic outlet syndrome

95
Q

How do you treat a Midclavicular fracture?

A

Treatment with a sling

96
Q

Lateral clavicular fracture: common or uncommon location?

A

Uncommon location (15%)

97
Q

What may be helpful with taking views for a lateral clavicular fracture?

A

Radiographic examination with and without weights may be helpful

98
Q

What might you see with a lateral clavicular fracture?

A

May see intra-articular extension (increased chance of early DJD)

99
Q

What are some complications of clavicular fractures?

A
  • Neurovascular damage
  • Non-union
  • Mal-union
  • Degeneration
  • Post-traumatic osteolysis of the clavicle
100
Q

What can a mal-union clavicular fracture lead to?

A

Bayonet Apposition

101
Q

What are some DDx for a Post-traumatic osteolysis of the clavicle?

A
  • Inflammatory Arthritis
  • Trauma
  • Hyperparathyroidism
102
Q

What are the MOIs of a Post-traumatic osteolysis of the clavicle?

A

Acute trauma or chronic micro-trauma

103
Q

What populations commonly experience Post-traumatic osteolysis of the clavicle?

A
  • Weightlifters
  • Repetitive overhead lifting and carrying
104
Q

What are other causes of distal clavicular erosions?

A
  • Hyperparathyroidism
  • Rheumatoid arthritis
  • Scleroderma
  • Cleidocranial dysostosis (bilateral usually)

DIAGNOSTIC IMAGING II (9 decks)

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