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Clin D III > Lecture 7- Ortho > Flashcards

Lecture 7- Ortho Flashcards

1
Q

first line for bones?

A

Xray

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2
Q

when to use CT

A
  • bone detail: extent and severity of fracture
  • fracture fragment evaluation
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3
Q

when to use MRI?

A
  • occult (hidden) fracture evaluation
  • tumor eval
  • soft tissue injuries (ligaments, meniscus, rotator cuff)
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4
Q

Describe use of bone scans

A
  • involves IV injection of radioactive tracer that accumulates in bone that is undergoing rapid turnover/growth
  • imaging of choice for detecting skeletal metastases
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5
Q

describe use of US in ortho

A

newer applications- include evaluating superficial structures (tendons), guiding injections, screening long bone fractures

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6
Q

Xray Views

oblique

A
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7
Q

Xray Views

IR/ER AP

A
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8
Q

Xray Views

Stressed

A
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9
Q

Xray Views

WB or NWB

A
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10
Q

Xray Views

Flexion/Extension

A
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11
Q

Xray Views

comparison views

A
  • esp use in kids
  • compare R & L respectively
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12
Q

Xray Views

scaphoid

A
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13
Q

Xray Views

scapular Y

A
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14
Q

Xray Views

odontoid

A
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15
Q

Xray Views

tunnel

A
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16
Q

Xray Views

sunrise

A
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17
Q

Xray Views

syndesmosis/mortise

A
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18
Q

Xray Views

swimmers

A
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19
Q

how to systematically read xray

A
  • adequacy
  • alignment
  • bones (sometimes nutrient vessels look like fractures)
  • cartilage (is there space where cartilage would be? can’t actually see cartilage)
  • soft tissue
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20
Q

how to view xray

A
  1. look at each bone (smooth contours, lucencies/opacities)
  2. look at each joint
  3. look at soft tissue
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21
Q

what color usually are fracture lines?

A

lucent (black)

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22
Q

Shoulder

tips for shoulder view

A
  • don’t forget to view clavicle (separate image)
  • need to know view to read image
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23
Q

Shoulder

Grashey vs AP

A
  • Grashey: glenohumeral joint, humeral tuberous
  • AP: better for acromialclavicular joint, some parts of humerus
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24
Q

Humeral View

when to order? what should be visible for good image?

A
  • only order if concern for shaft fracture or tumor
  • joint above & below
  • always do IR & ER unless fracture or dislocation
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25
Q

Elbow Imaging

what is soft tissue issue

A
  • pos fat pad sign (sail sign)
  • dark area displacing the fat pad indicating blood/injury
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26
Q

Elbow Imaging

how to get proper AP view

A

lay arm as flat as possible

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27
Q

Elbow Imaging

purpose of the radiocapitellar line?

A
  • helps us know if it is dislocated
28
Q

Forearm Imaging

components

A
  • just changing from pronation to supination does not give 2 proper views of radius/ulna
  • make sure entire unit moves together
  • bones should mostly overlap on lat view
  • must include wrist + elbow
29
Q

Wrist Imaging

components

A
  • does not have to include fingers
  • does not have to include radius/ulna shaft
  • too much radius/ulna are sometimes signs of bad images
  • scaphoid view ordered here
30
Q

Hand Imaging

components

A
  • “ok” sign for lat view
  • finger tips should be visible
  • oblique view to look at metacarpals
31
Q

Hip Imaging

components

A
  • AP, frog leg, pelvis most common
  • cross table lateral possible not common
  • MAKE SURE TO LOOK AT PUBIC RAMI
  • bilat hip is different from pelvis
32
Q

Femur Imaging

components

A
  • AP should include knee and hip to be adequate
  • difficult to accomplish lateral because of lead in groin and overlap of pelvis structures
  • ok if not perfect, caution w reshooting
33
Q

Knee Imaging

components

A
  • several views possible, based on problem
  • look at fibula & tibial tubercule
  • should be WB unless fracture & pt can’t stand
34
Q

Knee Imaging

when to use tunnel imaging?

A

ligament damage

35
Q

Tib/Fib Imaging

Components

A
  • often anlged on film because leg is too long
  • must include knee _ ankle jointsonly performed for fractures and tumors
    *
36
Q

Knee Imaging

which views should be wt bearing

A

Ap, Lat, oblique

37
Q

Ankle Imaging

components

A
  • AP + Lat: arthritis
  • AP + Lat + Mortise: injuries
  • mortise “straightens” things out
  • don’t ignore post ankle
38
Q

Fracture Terminology

Simple Closed fracure

A

2 fracture fragments, skin intact
may take 7-10d to be visible on xray

39
Q

Fracture Terminology

compound (open) fracture

A

2 fracture fragments, skin is penetrated

40
Q

Fracture Terminology

comminuted (complex) fracture

A

2+ bone fragments

41
Q

Fracture Terminology

transverse

A

fracure like — across bone

42
Q

Fracture Terminology

oblique fracture

A

diagonal fracture ( / )

43
Q

Fracture Terminology

angulation

A
  • to describe direction of fracture
  • dorsal, radial, ulnar, valgus, varus, lateral, medial
44
Q

Fracture Terminology

displacement

A
  • describe the DISTAL fragment when looking as displacement (proximal part of bone is the “anchor”)
  • can be full displacement or side to side movement of the fragments
45
Q

Fracture Terminology

Distraction vs Overriding

A
  • distraction: fragments have been pulled apart
  • overriding: overlap of fragments/shortening
46
Q

Fracture Terminology

impaction

A

fragments have been driven together

47
Q

Fracture Terminology

stress fracture

A
  • opaque on imaging NOT lucent
  • summation of microfractures caused by unusal or excess stress (athletes)
  • tibia is common site of stress fx in all ages
48
Q

Fracture Terminology

Pathologic Fractures

A
  • fracture through bone abnormality (benign or malignant leading to bone weakness)
  • minimal or no trauma
49
Q

Fracture Terminology

Avulsion fracture

A
  • fracture of bony fragment that is produced by the pull of a ligamentous or tendinous attachment
50
Q

Fracture Terminology

describe avulsion fracture of the knee

A
  • Segond fracture
  • highly associated with ACL tear, get an MRI
51
Q

Pediatric Fracture Terminology

  • physis
  • diaphysis
A
  • physis: grwoth plate, bone formation here, weakest part of bone
  • diaphysis: shaft
52
Q

Pediatric Fracture Terminology

Salter-Harris Fracture types for physis fractures

SALTER

A

Type 1: straight across physis
Type 2: above physis (meta)
Type 3: below physis (epi)
Type 4: through everything
Type 5: crushed

53
Q

Pediatric Fracture Terminology

greenstick fracture

A
  • incomplete fractures where the bone “bends like a twig” and the cortex cracks
54
Q

Pediatric Fracture Terminology

torus fractures

A
  • buckle fracture, type of incomplete
  • creates a “bump” without an obvious fracture line
  • very common- seen w/ falls on outstretched hands (FOOSH)
55
Q

Fracture Healing Terminology

callus formation

A

fracture line is no longer clean + lucent
bony bridging of fracture line

56
Q

Fracture Healing Terminology

nonunion

A
  • causes: infection, inadequate immbolization, inadequate blood supply, inadequate nutrition
  • non healing fracture
57
Q

Fracture Healing Terminology

rate of fracture healing depends on?

A

age, type of fracture, nutritional/hormonal status, adequacy of tx

58
Q

Fracture Healing Terminology

malunion

A

healed in bad positioning

59
Q

Common Fractures

Scaphoid- overview

A
  • 5% have complications (nonunion, osteoarthritis, avascular necrosis)
  • surgically repair, refer to ortho if you see it
60
Q

Common Fractures

colles fracture overview

A
  • fracture of the distal radius with dorsal angulation of the distral fragment
  • +/- ulnar styloid fracture
  • FOOSH (hyperextension injury)
61
Q

Common Fractures

Smith Fracture

A
  • fracture of distal radius with palmar angulation of the distal fragment
  • fall on back of flexed hand
62
Q

Common Fractures

Radial head fracture

A
  • easily missed- look for pasterior fat fat sign
  • most common elbow fracture in adults
  • caused by call on outstretched arm or direct blow to elbow
63
Q

Common Fractures

boxer fracture

A
  • fracture of head of 5th metacarpal
  • usually result of punching solid object
  • usually closed
  • prescribe abx; if they punched someone in mouth give abx
64
Q

Common Fractures

hip fracture risk factors

A
  • old people more common due to brittle bones
  • risk factors: osteoporosis, age, high energy trauma, pathologies that weaken bone
65
Q

Common Fractures

Hip fracture- what part of bone most common

A
66
Q

Fracture Terminology

Spiral fracture

A
  • “spiral” break in bone (curling)
  • caused by rotational forces
  • common in children (femur), aging females (humerus)

Clin D III (11 decks)

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