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RAD415 PT2 > imaging of trauma in upper limb > Flashcards

imaging of trauma in upper limb Flashcards

1
Q

how might work cause upper limb disorders

A
  • prolonged repetitive work
  • uncomfortable/awkward working postures
  • sustained/ excessive force
  • long tasks with not suitable break
  • working with hand help power tools for long periods of time
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2
Q

what are the front line and secondary roles of radiography in terms of upper limb injuries

A

front line = xray or CT in major trauma

secondary = MRI and us

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3
Q

what is a simple fracture

A
  • minimally displaced
  • good alignment
  • minimal treatment
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4
Q

what imaging modality is suitable for simple fractures

A

plain film radiography

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5
Q

what is the purpose of a surveillance imaging

A
  • check on healing process
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6
Q

what are the 4 steps of bone healing

A
  1. hematoma formation (0-2 weeks)
  2. soft callus formation (2-3 weeks)
  3. hard callus formation (3-6 weeks)
  4. bone remodelling (8 weeks - 2yrs)
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7
Q

adaptive technique is needed for complicated fracures

A
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8
Q

for complicated fractures, what type of scan is used for pre-operative planning

A

CT scans

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9
Q

what in specific about CT is helpful in pre-operative planning

A
  • 3d reconstruction
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10
Q

what imaging modality is used during surgery for complicated fractures

A

fluroscopy

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11
Q

why are fixation plates and screws not used to fix paediatric fractures

A
  • they can stunt growth of rapidly growing bones
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12
Q

what instead of fixation plates and screws are used for paediatric fractures

and how

A
  • K wires (kirschener) inserted in medulla of long bone to stabilise and healing alignment
  • k wires can be removed when healing begins
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13
Q

what is the main diagnostic tool for identifying dislocations

A

plain radiography film

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14
Q

how can you tell if there is posterior or anterior dislocation of the shoulder

A

anterior = humoral head goes down and medial

posterior = humeral head moves laterally, no articulation with joint

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15
Q

what imaging modality is used to spot soft tissue injuries

A
  • MRI
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16
Q

what is carpal tunnel syndrome / its cause

A

It is caused by pressure on the median nerve in the carpal tunnel of the wrist.

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17
Q

what is shoulder impingement

A
  • When you lift your arm, the rotator cuff tendon passes through a narrow space at the top of your shoulder, known as the subacromial space.
  • when the tendon catches onto the acromion, this is shoulder impingement
18
Q

what imaging modality is commonly used to analyse rotator cuffs

A

ultrasound

19
Q

what 3 things is a shoulder ultrasound good for diagnosing

A
  • shoulder impingement
  • shoulder instability
  • rotator cuff disorders
20
Q

why might US be used instead of MRI for shoulder soft tissue injuries

A
  • as accurate as MRI
  • focused examination
  • rapid, real time
  • cheap and dynamic
21
Q

what is the gold standard for looking at soft tissue and bony attachments etc

A

MRI

22
Q

what 3 bones articulate with the scaphoid

A
  • distal radius
  • trapezium
  • capitate
23
Q

what is the main way to cause a fractured scaphoid

A
  • fall onto outstretched radially deviated hand
24
Q

what is a non-union

A
  • if the bone fracture is not treated correctly, the bone can fail to heal
25
Q

what are the 4 radiographic views of the scaphoid

A
  • PA
  • PA with ulnar deviation
  • lateral
  • semi-pronated oblique
26
Q

what percentage of the blood supply of the scaphoid comes form which artery ?

A

20-30% from volar branch of radial artery (enters at tubercle)

70-80% from dorsal branch of radial artery (travels towards proximal pole)

27
Q

what is a common complication of the scaphoid fracture

A

avascular necrosis

28
Q

risks of avascular necrosis depends on the area of fracture on the scaphoid, which area = high risk

A

proximal 3rd = high risk

middle 3rd = moderate risk

distal 3rd = low risk

29
Q

what can occur as a result of undiagnosed or undertreated scaphoid fractures and what causes this

A

as the blood supply is tenuous theres increased risk of non-union particularly with fractures at wrist or proximal end

30
Q

describe the arterial flow through the scaphoid

A
  • arterial flow enters scaphoid via distal pole and travels to proximal pole
31
Q

if non-union of scaphoid fracture isnt treated correctly, what can this lead to

A

wrist osteoarthritis

32
Q

blood supply to the proximal pole is entirely dependant on the interroseous blood flow making it highly susceptible to AVN

A
33
Q

if no scaphoid fractures are seen, it is essential to recommend repeat xray (with dedicated scaphoid views), how many days after

A

7-10

34
Q

if after 7-10 days the repeat scaphoid xray shows no fracture but clinical suspicion still persists, what is done next

A

MRI
or
radionuclide
or CT

35
Q

why might CT be used for suspected scaphoid fractures

A
  • if nothing shows on plain radiography
  • readily available,
  • staging scaphoid fractures for surgery
  • if complex fracture of scaphoid
  • good for assessing bone union
36
Q

what is bone grafting

A

Bone grafting is a surgical procedure that uses transplanted bone to repair and rebuild diseased or damaged bones.

37
Q

what type of screw is used to fix a fracture through the waist of the scaphoid

A

herbert screw

38
Q

if you see a Lucent part in the distal radial metaphysics on a radiograph, what is this

A

site of bone-graft harvest

39
Q

what imaging modality is able to detect undisplayed fractures within 24 hours of injury

A

MRI

  • most sensitive for trabecular fractures
  • useful in assessing avascular necrosis
40
Q

what is a heamtoma

A

a solid swelling of clotted blood within the tissues.

41
Q

on a radionuclide scan, what are the radiographic signs of an occult fracture or avascular necrossi

A

fracture = dark region of increased uptake

AVN = photogenic region (white)

42
Q

after how many days of injury will bone scans be most sensitive

A

3-4 days

RAD415 PT2 (14 decks)

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