HomeStretch CRACK vol 2. MSK Flashcards
Fatigue fracture
Insufficiency fracture
Both are “stress fractures” but fatigue is generally referred to as stress fracture
Fatigue fracture = abnormal stress on normal bone
Insufficiency fracture = normal stress on ABnormal bone
Healing times:
Phalanges
Tibia or fem neck/shaft
everything else
fast (3 weeks)
Slow (10 weeks)
everything else = 6-8 weeks
factors for abnormal bone healing
Vitamin D deficiency
Gastric bypass
Drugs/meds: tobacco, nsaids, steroids
What are the low risk stress fxs?
femoral neck (compressive side)
Posterior medial tibial fx (compressive too)
longitudinal patellar fx
2nd and 3rd metatarsal
calcaneus
. . . the rest are high risk (ie need more than conservative tx).
Prieser disease
atraumatic AVN of scaphoid
What is the most important ligament in the scapholunate ligament carpal stability? how about the luno-triquetral?
SL = dorsal band
LT = volar
SLAC wrist
scapho-lunate advanced collapse
occurs with injury or degen via CPPD to the S-L ligament
SNAC Wrist
Scaphoid non-union advanced collapse
DISI
VISI
Dorsal / volar intercalated segmental instability
disi is more common from since it is due to the common SL injury.
Space of Poirier
ligament free (“Poor”) area in the wrist - site of weakness
positive ulnar variance is associated with ?
Ulnar impation syndrome
distal ulna smashes into lunate, degenerating it (cystic change) and tears up the CENTRAL TFCC
Negative ulnar variance is associated with what?
Keinbock’s (lunate AVN)
What do you need to know about the hand’s extensor compartments?
There are 6 of them
1st compartment (APL and EPB) are the one’s affected in de Quervains
3rd compartment (EPL) courses along lister’s tubercle and can have delayed rupture after a non-displaced radial fx.
The 6 compartment - ECU - can get early tenosynovitis in RA
Vaughan-Jackson Syndrome
Sounds like hugh jackman (wolverine)
sequential extensor tendon rupture seen with worsening RA, starting at compartment 5 -> 4, 3, 2, 1
Intersection syndrome
repetitive use issue occurs 5cm proximal to lister’s tubercle
Drummer’s wrist
3rd compartment (EPL) tenosynovitis
Bennet versus Rolando
What tendon causes displacement?
both are fracture of base of thumb
Rolando is the RECKED one! (communited)
APL
gamekeeper’s thumb
associated lesion?
avulsion fx at base of proximal phalanx with associated ucl disruption
associated with Stener Lesion
Stener lesion
occurs in gamekeeper’s thumb
adductor tendon aponeurosis gets caught in torn edges of UCL
Essex-Lopresti
fx of radial head + DRUJ dislocation
Monteggia fx
ulnar fracture with radial head dislocation
Galeazzi fx
radius fx with DRUJ dislocation
osborne’s ligament
epicondylo-olecranon ligament (where the ulnar nerve goes under in cubital tunnel)
Sublime tubercle
medial coronoid, where the elbow UCL attaches to
“luxatio erecta humerii”
inferior GH dislocation, arm stuck straight over head, associated with neurologic (axillary nerve) injury
GLAD, Perthes, ALPSA, True bankart
too long to write. . check the book if need be
Nerve entrapment; which muscles atrophy in:
Suprascapular notch
Spinoglenoid notch
quadrilateral space
supra and infra
just infra
teres minor
Segond fx
fracture of the LATERAL TIBIAL plateau
(second “LT” fx)
associated with ACL tear . . . segond fx? you need a “segond” ACL
occurs with internal rotation
reverse segond fx
fracture of the MEDIAL TIBIAL plateua
associated with PCL and medial menisus tears.
occurs with external rotation.
Arcuate Sign
avulsion of the proximal fibular, insertion at the arcuate ligament complex
associated with PCL tear
cyclops lesion
arthrofibrosis (scar associated with ventral ACL graft)
“palpable audible clunk”
Pilon fx
communited, articularly impated tibial plafond fracture
Maissonneuve
unstable fx involving medial tibilar malleulos and/or disruption of the distal tibiofibular syndesmosis
look for fracture of the proximal fibular shaft
critical angle of Gissane
intra-articular fractures of the calcaneus will have a fracture line through this
jone’s fx
the fractures from proximal to distal . . .
extra-articular fx at the fifth metatarsal base, 1.5 cm distal to the proximal tuberosity at the metadiaphysial junction.
avulsion, jones, stress
POPS
painful os peroneus syndrome
its in the peroneus LONGUS
Lisfranc ligament connects what two structures?
medial cuneiform to the 2nd metatarsal base on the plantar aspect
Master knot of henry
It’s a “harry dick”
Where dick (FDL) crosses of Harry (FHL) at the medial ankle
acute flat arch should make you think of what?
PTT tear
Mulholland deformity
Haglund’s deformity
calcaneal bony prominence
the syndrome adds bursitis and tendon thickening
Where are Looser Zones usually seen?
What do they mean?
Bilateral femoral neck and pubic rami
type of insufficiency fracture
osteomalacia, rickets, and OI
DEXA Scan
T score means what?
What designates osteoporosis?
What is the Z score?
T score = Density relative to young adult
Z score = Zame age = density relative to age-matched control
Sudeck atrophy
Complex regional pain syndrome AKA Reflex symphathetic dystrophy
Osteochondritis Dissecans versus Panner’s disease
Panner’s is a little younger (5-10 yo) since peter pan wants to stay young and no loose bodies.
McCune Albright Syndrome
Polyostotic fibrous dysplasia
Girl
Cafe au lat spots
Precocious puberty
(in contrast to Mazabraud syndrome, which has soft tissue myxomas)
Mazabraud Syndrome
Polyostotic fibrous dysplasia
Middle aged woman
soft tissue myxomas
Increased risk of osseous malignant transformation
(in contrast to McCune-Albright = girl with precocious puberty)
adamantinoma
potentially malignany tibial lesion that resembles dysplasia
fibroxanthoma
wastebasket term for non-ossifying fibroma (>3cm) and fibrous cortical defect.
Jaffe-Camanacci Syndrome
Syndrome of multiple NOFs, cafe-au-lait spots, mental retardation, hypogonadism, and cardiac malformations.
Ollier dz
multiple enchondromas
(in comparison to maffuci’s - has “less”)
Maffucci Syndrome
Multiple enchondromatosis
(has “more” = phleboliths and increased risk of chondrosarcoma)
Plasmacytoma in the vertebral body has what appearance?
Mini-brain appearance
POEMS
Basically myeloma with sclerotic mets
plasma cell proliferation (MM), neuropathy and organomegaly
liposclerosing myxofibroma
characterstic location = femoral intertrochanter
geographic lytic lesion with sclerotic margin
looks non-aggressive but 10% malignant potential
trevor disease
dysplasia epiphysealis hemimelica
basically osteochondroma pointing towards joint
ligament of struthers
ligament that attaches to an avian sput and can smash the median nerve.
osteofibrous dysplasia
NOF in the anterior tibia with anterior bowing
calcium hydoxyapatite deposition disease
calcific tendonitis
Engelmann’s disease
progressive diaphyseal dysplasia
fusiform bony enlargement with sclerosis
b/l and symmetric
predilection for long boners
hone on bone scan
can involve skull and cause optic nerve compression
Malignant fibrous histiocytoma
name changed to pleomorphic undifferentiated sarcoma
common, happens in older people, central location
dark to intermediate on T2
associated with spontaneous hemorrhage
bone infarcts can turn into MFH (sarcomatous transformation of infarct)
radiation is a risk factor.
Jaccoud’s Arthropathy
very similar to SLE (reducible deformity of joints without articular erosions)
Chloroma
Granulocytic Sarcoma
destructive mass in a bone of a leukemia patient
its some kind of colloid tumor
