Imaging! Flashcards
are Ottawa ankle and foot rules highly sensitive or specific
sensitive
what are the Ottawa ankle rules
-TTP to distal 6cm posterior edge of fib/lateral mall
-TTP to distal 6cm tibia/Med malleolus
-TTP base fith MT
-TTP to navicular
-inability to WB 4 steps after injury
what position does the leg need to be in to view the mortise
in IR 15-30 degrees
what is the Danis Weber classification
type a: below ankle joint, syndesmosis is intact
type b: at level of ankle joint, syndesmosis may be intact or partially torn
type c: above ankle joint, syndesmosis is disrupted
what is the Lauge Hansen classification
supination with addiction
supination with ER
pronation with ABD
pronation with ER
what is a Maisonneuve fracture
ER Force at the ankle with transmission up to the fibular head, resulting in Prox fibular fracture
tillaux fracture
type III SH, peds, distal tibial epiphysis, anterolaterally
what is a Lisfranc fracture
mid foot fracture of the tarsal metatarsal joint at 2nd MT and medial and middle cuneiform
what is a hallmark sign of a lisfranc fracture
planter bruising
what is a jones fracture, and what is the best view to see it on
5th MT and with an oblique view
how will a shin split stress fracture appear on imaging
as a cloudy periosteum
what is Sever’s disease
calcaneal apophysitis, must rule out avulsions
correct order of imaging for OCD lesion
x-ray, then MRi than CT
what type of image is best for posterior pelvic ring
CT
what is considered abnormal widening of the symphysis
> 1cm
a pelvic exam in an alert patient is highly sensitive. what components are part of the exam
over 3 y/o, good cognition, no injuries seen in pelvis, no pain with compression of iliac and pubis, and no pain with hip IR/ER
what are some signs of sxs of stress fractures and osteitis pubis
relief with NWB, insidious, local pain, swelling and tender, pubic ramus and symphysis.
what is the most common type of hip dislocation, and which way will it go on imaging
posterior most common, will go superior ad lateral
how does an anterior hip dislocation look on imaging
inf and medially
what type of fracture will have a shortened leg with IR
intertrochanteric
what are the Altman criteria for hip OA
hip pain cluster 1: hip pain, hip IR<15, hip flex < 115
cluster 2: hip IR>15, pain with IR, age over 50, morning stiff less than 60 minutes
what is a good hip CPR
squat as aggravating factor, decreased flexion, scour test with lateral hip pain, pain with extension and IR <25 degrees.
what is AVN of the femoral head and what ages
LCP, 4-10 y/o
what is the best image for LCP
MRI
which side is work for a femoral neck stress fracture
tension side is worse
what is a sunrise or merchant view on x-ray
knee to look between patella and anterior femur
what is a tunnel view x-ray
to look at tibial spine, between femoral condyles
what are the Pittsburg knee rules
trauma/fall or blunt injury under ager 12 or over age 50, and inability to walk 4 steps.
are the knee imaging rules highly sensitive or specific
sensitive
what are the ottawa knee rules
-age over 55
-patellar tenderness
-TTP at fibular head
-inability to flex knee 90
-inability to WB 4 steps
what is a fabella
normal bone formation in the lateral GN
is a bipartite patella pathogenic
no, the superolateral border of the patella is ok.
which way is the most common way to dislocate a patella
laterally
what is a segond fracture
lateral tibial plateau avulsion fracture, usually with ACL. lateral capsule area is where this type of fracture occurs.
which condyle is it more common to have a OCD lesion
medially in men 85%
what is Sinding Larson Johansson
inferior patella version of Osgood Schlatter’s
are the Canadian c/s rules sensitive or specific
sensitive
what are the Canadian c/s rules
-high risk factors (over 65y/o, dangerous MOI (fall over 3 feet, 5 steps, axial loading, MVC, rollover, ejection, bike accident), paresthesia in extremity?)
-low risk (simple rear end (rollover, oncoming traffic, hit by bus/truck), sitting position in ED, ambulatory, delayed onset neck pain, absence of midline tenderness) IF YES….
-can you rotate at least 45 degrees to L and R
what does an odontoid view look at
with an open mouth, C1-2
after fx ruled out, what type of view can be ordered to check neural foraminal narrowing and alignment of facet joints?
oblique
swimmers view?
c7-T1
describe atlantodental interval meanings
> 3.5mm instability
7 mm: disrupted transverse ligament
9-10: neurologic injury
what is the george line
should align with vertebrate with flex and ext
cervical gravity line
pass through 7th vert
prevertebral soft tissue should not be over what spacing in C2-5 then C5-7
c2-5 not over 7mm
c5-7 not over 20mm
what are the most common c/s fractures
c1-2
c5-7
T9-L1
what is a jefferson fracture
burst of c1, from axial loading
what is a odontoid fracture
c2
hangman fracture
posterior c2, hyperextension injury,
clay shoveler fracture
SP c6,7,T1,2 from hyperflexion
how does CSF look in T1 vs T2 weighted
T1 CSF will be dark
T2 CSF will be white
what is the single most important question/feature of elbow injury that has a high sensitivity of needing an x-ray
inability to extend the elbow fully
what is the most important elbow view
lateral bent at 90 degrees
what is a fat pad sign/sail sign
means trauma, maybe dislocation, definitely joint effusion
what is the most common site of fracture in the elbow
the radial head
what is a nightstick fracture
mid shaft fracture of either ulna or radius
monteggia fracture
proximal ulna fracture with dislocated radial head
galeazzi fracture
fracture of distal radius with ulnar head dislocation
greenstsick fracture
from kids with soft bones, one side fractures and possible other side that just bends
little league elbow happens at which part of elbow
medial epiocondyle
what is the new orleans criteria
CT needed when you have headache, over 60 years old, NV, drug or alcohol involved and trauma above the calvicle and possible seizures
is ultrasound highly accurate for full or partial thickness RTC tears
full
what view of the shoulder can view a bony Bankart or hill sachs
axillary/west point view
mercedes shoulder view
like a scap y view
stryer view can visualize a
hill sachs
what view looks at the AC joint
zanca view
what is teh direction of most common shoulder dislocation
anterior and inferior
what is the Quebec decision rule for imaging following shoulder dislocation
???
hill sachs vs bankart
hill sachs on humeral head, bankart on inferior glenoid rim
HAGL lesion:
humeral avulsion of the Glenohumeral ligament
ALPSA lesion
anterior labroligamentous periosteal sleeve avulsion
Sprengel Deformity
scapula does not descend
what image is best for labral lesions
mRA
what wrist deviation do you use to image for scaphoid trauma
UD
carpal views are needed for what type of wrist fracture
hamate
arch lines of carpals is called…
gilugli lines
hamate fractrues with what types of activities
golf, baseball
terry Thomas sign
S-L dissociation
what is the second line of imaging in wrist
MRI
Keinboch’s
AVN lunate
most common forearm fracture
Colles : distal radius with dorsal angulation of the distal fragment
smith fracture
reverse Colles. distal fragment is dislocated palmery/volarly
Torus fracture
bucks fracture, compression, in kids
is imaging always (+) for scaphoid fracture
no
if scaphoid fx possible, and initial x-ray (-), what is course of treatment
stabilize the wrist and repeat imaging in 2 weeks
what part of scaphoid fractures
middle (waist)
signs of scaphoid fracture
TTP at snuffbox, scaphoid tubercle, compression with first metacarpal into carpals
scapoid fracture will be painful with what deviation at wrist
radial
signet ring sign is a sign of
scaphoid fracture
Keinboch’s disease,
lunate AVN, males over females, x-ray than MRi
boxers fracture
5th metacarpal
rolando fracture
thumb, base first metacarpal in 3 pieces interarticular
bennet fracture
thumb, base of first metacarpal in 2 pieces interarticular
gamekeepers fracture
avulsion in thumb, UCL is ruptured, and like skiers, cannot grip things
steners lesion
rupture UCL and it reflects out of aponeurosis
