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Radiology Trauma > Introduction > Flashcards

Introduction Flashcards

1
Q

complete or incomplete disruption in continuity and structure of bone and cartilage

A

fracture

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2
Q

fracture creates insult to what 3 things

A

bone marrow, periosteum, soft tissues

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3
Q

bone is ___ and withstands varying mechanical forces differently

A

anisotropic - meaning unequal in length

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4
Q

*
cortical bone is stronger on ___ forces

cortical bone is less resilient to ___ forces

cortical bone is most vulnerable to ____ forces

A

stronger on compression

less resilient on distraction

vulnerable to shearing

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5
Q

fracture occurs involving what 3 forces? is one more dominant than the others?

A

compression, distraction, shearing

yes, one predominates

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6
Q

trauma is absorbed by what before they fail to provide support resulting in injury

A

muscles and ligaments

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7
Q

*

fracture always involves varying but significant ___ damage

A

soft tissue

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8
Q

repeated loading of muscles and bones results in __ which would lead to fracture more easily

A

fatigue

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9
Q

surgical pin holes or sight of bone resection weakens the bone forming what

A

stress raiser

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10
Q

incomplete fractures are most common seen in what people

A

children

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11
Q

what are the 3 different types of incomplete fractures

A

torus - cortical buckling on compression

green stick - incomplete fracture on tension

plastic deformity - bending of bone without angular break or remodeling

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12
Q

what are the 3 different types of complete fractures

A

transverse
oblique
spiral

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13
Q

fractured fragment of bone being detached by the tension from muscles or ligaments

A

avulsion fracture

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14
Q

corner fracture that is chipped rather than avulsed

A

chip fracture

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15
Q

fracture that results in telescoping of osseous trabeculae

no radiolucent lines are seen but instead there is zone of sclerosis or condensation

A

impaction or compression fracture

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16
Q

fracture found in the calvaria/cranial vault or tibial plateau

A

depression fracture

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17
Q

fracture caused by repeated stress to normal bone leading to bone marrow hyperemia and bone resorption

A

fatigue or stress fracture

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18
Q

where do stress fractures most often occur? and what is the name of each?

A

march fracture - 2nd or 3rd MT stress fracture

runners fracture - tibial stress fracture

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19
Q

fracture caused by normal stresses to bone such as weight bearing or walking movements applied to osteoporotic or involuted bone

A

insufficiency fracture

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20
Q

where do insufficiency fractures occur

A

osteroportic vertebral bodies or sacrum

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21
Q

fracture caused by weakened bone due to neoplasm, infection, or collagen defect

A

pathological fracture

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22
Q

what is a fracture called with more than 2 segments

A

comminuted fracture

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23
Q

what are the 2 types of comminuted fracture

A

segmental fracture - 2 separate fracture lines producing an isolated segment

butterfly fragment - wedge shaped fragment produced at apex of the maximum force *

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24
Q

which fracture may is very complex in any bone resulting in instability along with neuro and vascular complications

A

comminuted

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25
Q

many comminuted fractures require what for treatment

A

surgical fixation

a simple cast will not due

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26
Q

what fractures are most commonly seen in flat bones

A

depressed fracture

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27
Q

when skin is intact and no communication with the outside air is present, the fracture is considered ____

A

closed fracture

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28
Q

when skin is punctured and communication with the outside air is present, the fracture is considered ____

A

open fracture

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29
Q

stating the relative position of fractures is based on what?

A

region of bone (met, di, epiphysis) affected by the fracture

super important to distinguish what region of bone is affected!

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30
Q

if the fracture extends into the joint it is called?

what are the complications?

A

intra-articular fracture

complications - delayed healing, abnormal healing, chondrolysis, secondary OA

31
Q

what does apposition mean

A

displaced either anterior, posterior, lateral, or medial

32
Q

when bone ends are not aligned we say they have loss of what?

A

loss of apposition

33
Q

what are the varying types of apposition

A

bayonet apposition - overlap of one fragment over another

distraction apposition - complete loss of apposition due to traction forces

alignment apposition - valgus (away from midline) and varus (towards midline) bone alignment relative to distal fragment *

34
Q

what classification method is used for pediatric growth plate injury

A

salter harris classification

35
Q

what are the most vulnerable regions for fracture in the pediatric skeleton?

why?

A

epiphyseal growth plate and growth apophysis are most vulnerable in pediatric skeleton

because they of there cartilaginous nature and metabolic activity

36
Q

how many salter harris classifications are there? how many do we talk about?

A

9 total

5 main types that we discuss in class

37
Q

salter harris __ - fracture through growth plate itself that is often unrecognized because of minimal displacement

A

salter harris type 1

38
Q

most common salter harris fracture >75%

A

salter harris type 2

39
Q

salter harris __ - fracture through physis and metaphysis / metaphyseal corner forming a thurston holland fragment

A

salter harris type 2

40
Q

which salter harris fracture forms a thurston holland fragment

A

salter harris type 2

41
Q

salter harris type __ - fracture through epiphyseal plate and into epiphysis resulting in intra-articular extension

A

salter harris type 3

42
Q

salter harris type __ - fracture that transverses metaphysis, physis, and into epiphysis

A

salter harris type 4

43
Q

salter harris type __ - crush injury to growth plate often unrecognized or confused with type 1 fracture but causes damage to the physeal blood supply

A

salter harris type 5

44
Q

what two salter harris fractures show the highest complications?

what may these lead to?

A

salter harris type 4 and 5

leads to premature plate closure, limb deformities, and limb shortening

45
Q

which salter harris fracture has good healing prospects

A

salter harris type 2

46
Q

which two salter harris fractures may go unnoticed and unrecognized?

A

type 1 and type 5

except type 5 has much worse prognosis can lead to premature plate closure

47
Q

subtype of insufficiency fracture that develops in bones with insufficient osteoid

A

pseudo-fracture

48
Q

pseudo fractures are most commonly seen in patients with what disease

A

rickets and osteomalacia

others but not as common include hyperparathyroidism, renal osteodystrophy, and paget disease

49
Q

what is a pseudo-fractures characteristic appearance on xrays

A

widened transverse radiolucent lines oriented at right angles that are medial to the cortex of long bones *

50
Q

pseudo-fractures are often referred to as what

A

looser zones
milkman lines
umbau zones

51
Q

intraosseous edema found in bone during injury is called a

A

bone bruise

52
Q

what is the best way to detect a bone bruise on imaging

A

MRI

53
Q

pain in snuff box and FOOSH injury should require repeat xray after how many days?

A

7 days

occult scaphoid fracture may be diagnosis

54
Q

what type of fracture occurs in bones due to mismatch of bone strength and chronic mechanical forces placed upon the bone

A

stress fracture

55
Q

abnormal stresses on normal bone results in _____

normal stresses on abnormal bone results in _____

A

fatigue fracture

insufficiency fracture

56
Q

what is it called when there is complete loss of articular contact or alignment as a result of injury of periarticular restraints

A

dislocation

57
Q

what is it called when there is partial loss of articular alignment

A

subluxation

58
Q

what is it called when there is separation of fibrous joints

A

diastasis

59
Q

where do diastasis most often occur

A

suture diastasis in skull

pubic symphysis diastasis

60
Q

anterior dislocation of a joint refers to what being displaced anteriorly

A

the proximal bone

61
Q

growing skull fracture is also called

A

leptiomeningeal cyst

NOT A TRUE CYST

62
Q

when does a leptomeningeal cyst or growing skull fracture develop?

how does this happen?

A

develops prior to closure of skull sutures < 3 years old

results from tear in dura mater followed by leptomeningeal and brain herniation with CSF pulsations - NOT A TRUE CYST

63
Q

traumatic disruption of bone and periosteum causes significant hemorrhage that initiates what process

A

fracture healing

64
Q

what are the 3 phases of fracture healing

A

inflammatory - first 48 hours
- hematoma and inflammatory cells initiate chemotaxis which brings phagocytes and repair cells to location of injury

repair - 7-14 days
- cells involved in inflammation gradually form granulation tissue while also removing unwanted tissue

remodeling - 9-24 months
- cells evolve into fibroblasts, chondrocytes, and osteoblasts forming new bone mineralization

65
Q

what are the requirements for fracture healing

A
  • good fragment apposition and normal blood supply
  • immobilization with adequate physiological stress
  • absence of infection
  • absence of systemic factors complicating good health and healing
66
Q

which is the shortest phase of fracture healing

A

inflammatory phase - first 48 hours

67
Q

during what phase of fracture healing does the hematoma become vascularized and appears more translucent on xrays

A

repair phase - 7-14 days

68
Q

during the repair phase of fracture healing, the fracture callus is very vulnerable to __ forces but may be stimulated to grow and develop faster if limited __ forces are applied

A

vulnerable to shearing forces

stimulated by axial forces

69
Q

when does fracture callus formation occur

A

repair phase - 7-14 days

70
Q

due to vascularity of the periosteum, ___ fractures heal quicker

A

pediatric

71
Q

what are the 3 types of disturbances seen in fracture healing

A

delayed union - takes twice as long unionized

non union - no healing greater than 9 months - also called psuedoarthrosis

malunion - healing occurred in abnormal position

72
Q

what are the 3 types of non union disturbances in fracture healing

A

hypertrophic - abnormal exuberant callus

hypotrophic - weak callus with insufficient vascularization and new bone formation

atrophic - absent callus with synovial fluid or infected exudate between fracture ends

73
Q

what are the major complications of fractures

A

immediate - neuro and blood supply, acute compartment syndrome, renal failure, pulmonary fat embolism, gas gangrene

intermediate - osteomyelitis, sepsis, complex regional pain syndrome, RSDS, non union or malunion

late - ischemic necrosis, AVN, secondary OA

gun shot wounds - may lead to lead toxicity (if bullet lodged in synovial or serous cavity it will be degraded by hyaluronic acid leading to lead being released into the system)

Radiology Trauma (6 decks)

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