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7 Imaging > L3 LE > Flashcards

L3 LE Flashcards

1
Q

Pelvis plain films

A
  • include only an AP view
  • sometimes can do an oblique view
  • inlet view vs outlet views
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2
Q

Inlet views

A

AP translation

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3
Q

Outlet Views

A

cephalad/caudad translation

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4
Q

What type of imaging is the best view of posterior ring?

A

CT

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5
Q

Pelvic Trauma

A
  • AP is best, CT scan is second line
  • > 1 cm in pubic symphsis is abnormal
  • pelvic fractures occur in more than one area, and cause hematomas and organ damage
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6
Q

Patient does not pelvic x-ray if

A
  • pain free hip rotation and flexion
  • painless compression of iliac and pubic symphysis
  • no complain of pelvic pain
  • no signs of fracture on inspection
  • no other major injuries
  • still conscious
  • > 3 years old
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7
Q

Imaging for AVN of femoral neck

A

MRI is the gold standard

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8
Q

Electrophysiologic Tests

A

rules out lumbar root pathology

will help to rule in peripheral neuropathies about the hip

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9
Q

Dashboard injury

A

posterior dislocation of femoral head

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10
Q

Paget’s disease

A

benign lesion of pelvis

increased sclerosis and enlargement of the entire right hemi-pelvis

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11
Q

Malignant tumors in adults vs children

A

Child = ewing’s sarcoma
Adult = chondrosarcomas

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12
Q

Pelvic Stress Fracture

A
  • history of overuse
  • relief with non WB
  • insidious in nature
  • local pain, tenderness, swelling
  • typical site is in pelvis at pubic ramus
  • bone scan is good for early diagnosis
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13
Q

Hip Imaging positions

A
  • AP view
  • abducted view (frog leg)
  • axial lateral
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14
Q

High yield areas to examine for hip trauma

A
  • pelvis or acetabular fractures
  • femoral neck or intertrochanteric fx
  • widening of joint space
  • hip dislocations
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15
Q

Anterior dislocation of hip

A

head displaced inferiorly and medially

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16
Q

Posterior dislocation of hip

A

most common
head displaced superior and laterally

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17
Q

Hip Fractures

A
  • most common are femoral neck and intertrochanteric
  • nondisplaced hip fractures are best seen with MRI
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18
Q

Fracture of femoral neck

A
  • often due to osteoporosis
  • stress fx may appear sclerotic
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19
Q

Intertrochanteric region fracture

A
  • often due to trauma
  • appears as shortened leg with IR
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20
Q

Hip Pain

A
  • OA is most common cause of chronic hip pain
  • pt presents with pain and loss of mobility, starting with loss of IR
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21
Q

DJD/OA changes include

A
  • joint space narrowing
  • subchondral cysts
  • sclerotic borders
  • osteophytes
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22
Q

Altman’s Criteria for hip pain

A

Cluster 1: hip pain, hip IR <15, hip flexion <115

Cluster 2, if hip IR >15. Pain w/IR, age >50, morning stiffness < 60 min

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23
Q

Aseptiv necrosis of hip causes

A

Anemia (sickle cell)
Steroids
Ethanol
Pancreatitis
Trauma
Idiopathic
Caisson’s Disease

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24
Q

How AVN appears on radiographs

A
  • femoral head is flattened, irregular, and sclerotic
  • best to use a MRI
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25
Q

Klein Line

A

a line drawn along superior border of femoral neck, should intersect with femoral head

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26
Q

Femoral Neck Stress Fracture

A
  • history of overuse
  • relief with non-WB
  • insidious in nature
  • local pain, tenderness, swelling
  • compression or tension
  • bone scan is diagnostic early
  • MRI is 100% sensitive
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27
Q

Tension Side Fracture

A

muscles and tendons are pulling, causing the bone to be pulled apart. Harder to heal

28
Q

Compression Side Fracture

A

medial side, heals better

29
Q

Femur Plain Film Views

A
  • A/P, proximal and distal
  • Lateral, proximal and distal
30
Q

Femur is prone to

A

tumors, benign and malignant

31
Q

Benign Lesions of Femur

A
  • small
  • no associated periosteal reaction
  • narrow transition zone between bone and lesion
  • thin, well defined sclerotic margins
  • fibrous cortical defects, fibrous dysplasia, non-ossifying fibroma
  • often causes pathologic fractures
32
Q

Malignant Lesion

A
  • lytic lesion w/o sclerotic margins is considered malginant until proven otherwise
  • breast and lung cancer produce lytic lesions
  • looks bubbly in appearance
  • Chondrosarcomas are destructive in nature, vary in appearance, and occur in femur, pelvis, ribs
33
Q

Periosteal Reactions

A
  • either benign or malignant
  • typically in long bone
  • have a sunburst pattern
  • causes include infections, osteomyelitis, ewings tumor, osteogenic sarcoma
34
Q

Myositis Ossificans

A

not pathologic
caused by lots of contusions
bone formed in soft tissue

35
Q

Knee Plain Film Views

A
  • AP view = joint space narrowing
  • lateral view = patella effusions
  • sunrise view = patella and anterior femur
  • tunnel view = tibial spines and femoral condyles

MRI is best for soft tissues

36
Q

Pittsburgh Knee Rule

A

High spin/snout
* blunt or trauma or a fall as MOI plus either of the following –> <12 or >50 yo, inability to walk 4 WB steps in ED

37
Q

Ottawa Knee Rules

A
  • High sensitivity
  • order x rays for acute knee pain if 5 items are present
  1. > 55 yo
  2. isolated tenderness over patella
  3. tenderness over fibular head
  4. Unable to flex >90°
  5. Unable to WB immediately or ED for 4 steps
38
Q

Knees and plain films

A
  • x-rays can be normal even with pathology of knee
  • injuries to soft tissues are not seen on plain films, MRIs are better
  • Joint effusion is best seen on lateral view
39
Q

OA in Knee

A
  • common
  • s/s include pain with motion, limited ROM, redness, swelling, visible deformity
  • xray findings include jt space narrowing, sclerosis, osteophytes
  • cartilage may calcify and break off, causing loose bodies
40
Q

Chondrocalcinosis

A

calcification of articular cartilage

41
Q

Knee fractures

A
  • include patella fractures, fractures of tibia, fibula, and femur
  • tibial fx can be difficult to see, except on AP view, MRI is indicated if S/S are positive but imaging is negative
42
Q

Bipartate patella

A

normal variant that may appear to be a fracture

43
Q

Segond Fracture

A
  • cortical avulsion fx off proximal lateral tibia just distal to tibial plateau at site of insertion of middle third of LCL, caused by IR and varus stress
  • associated with ACLm meniscal tears, PLC structures
  • MRI should be used because of the associated injuries
44
Q

Osteochondritis Dessicans

A
  • lesion involving both bone and cartilage
  • causes 50% of loose bodies in the knee
  • more common in men and posterior lateral aspect of medial femoral condyle
  • can be traumatic, ischemic, abnormal ossification centers, genetic
45
Q

Osgood-Schlatter Disease

A
  • tibial tubercle apophysitis
  • occurs in active kids from 11-15
  • concides with periods of growth spurts
  • self-limiting
  • similar condition is sinding-larsen-johansson, involves patellar tendon
46
Q

Possible injury with posterior dislocation of distal femur

A

popliteal artery

47
Q

Ankle and Foot Plain Film Views

A
  • AP view
  • lateral view
  • oblique/mortise view
48
Q

Most common ankle fractures involve

A

lateral or medial malleolus

49
Q

Ankle effusion

A

appears as anterior fat line in front of joint space on lateral view

50
Q

Order ankle x-ray series if

A

pain in malleolar zone AND any one of following
1. bone tenderness in post half of distal tibia/fibula
2. unable to bear weight 4 steps after injury

51
Q

Order foot x-ray series if

A

pain in midfoot zone AND any one of following
1. bone tenderness over navicular or base of 5th MT
2. unable to bear weight for 4 steps after injury

52
Q

Ottawa rules are

A

sensitive and not specific

53
Q

Danis-Weber Classification

A

Uses the position of level of fibular fx in its relationship to its height at the ankle joint

54
Q

Weber A

A

fracture below the ankle joint

55
Q

Weber B

A

fracture at the level of joint, with tibiofibular ligaments usually intact

56
Q

Weber C

A

fractures above the joint level which tears the syndesmotic ligaments

57
Q

Maisonneuve Fracture

A

ER force to ankle w/transmisiion of the force thru the interosseous membrane, exiting through a proximal fibular fracture

58
Q

Jones Fracture

A

base of 5th metatarsal

59
Q

Base of 5th metatarsal fractures

A

Stress = most distal
Jones = middle
Avulsion = proximal

60
Q

Lisfranc fracture

A

fracture of 2nd, 3rd, 4th, 5th MT with lateral dislocation

medial plantar bruising is a hallmark sign

MOI–foot caught in a stirrup

61
Q

March Fracture

A

stress fracture of 2nd, 3rd, 4th MT

seen in new recruits, athletes, dancers

62
Q

Gout

A

involves the 1st MCP joint

63
Q

Bunions

A

hallux valgus

64
Q

Bone islands

A

benign finding
sclerotic bone growth

65
Q

Bone and joint infections

A

Periosteal reaction is thickening of periosteum, appears white on x ray

seen with normal healing fracture, osteomyelitis, tumors

a radiating periosteal reaction = sun burst = sign of malignancy

7 Imaging (4 decks)

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