Lecture two (x-ray-bones)-Exam 1 Flashcards
1
Q
- Fill in the spaces
- Is this patient upright or supine?
- What is the long vertical radiolucency?
A
- Pt is supine since balls in middle
- Long vertical radiolucency is the trachea
2
Q
- What x-ray is this? Fill in spaces
- What do you want to make sure lined up?
- How can you see odontoid?
A
- odontoid cervical spine
- Want to make sure the lateral masses are lined up, C1 and C2. Don’t want to see them out of line, would indicate fracture of C1 or C2 (depending on which body is displaced).
- Can only see odontoid through pt’s open mouth, so see teeth around it.
3
Q
- What x-ray is this?
- What do you need to clear in trauma? with what views?
- Must see al C vertebrae up to what?
A
- Lateral C-Spine
- Always have to clear C-Spine in
trauma with AP+lateral or cervical series - Must see all C vertebrae up to
C7-T1 articulation to be able to
clear
4
Q
- What x-ray is this? How it is different?
- What can you see?
A
- On oblique, you can see
the intervertebral foramina; not so on lateral.
5
Q
- What view is this?
- What is preferred?
- What is it useful for?
- What is it not used for?
A
- When have cervical collar or unconscious –cannotget open mouth view.
- CT is preferred imaging modality for allC-spine fractures
- The Fuchs view is a type of modified Water’s view to demonstrate the odontoid tip.
- Odontoid process can be demonstrated by an exaggerated reverse Waters view called the Fuchs. When performed correctly is very useful for demonstrating the upper part of the odontoid tip but is not used for trauma imaging.
6
Q
- What diagnosis test is this? What is wrong with the image?
- How many fractures are missed on conventional radiograph?
- What does CT provide?
A
- Up to 20 % of fractures are missed on conventional radiographs.
- C2 vertebral Body Fracture
- CT benefits include excellent visualization of canal and 3Dreconstruction
- Preferred modality if it is available
7
Q
- Fill in the spaces?
- What type of test is this? What is it excellent at?
- What can you identify?
- What is this an example of?
A
- MRI spine imaging
- Excellent soft tissue and vascular contrast
- Can identify bony injury that is not evident on X-Ray
- Here is an example of a MRI image of the cervical spine demostrating a ligamentous injury. Notice that the spinal cord is also very well delinated. A dens fracture is not obvious on the lateral film, but is clearly revealed on MRI. (Med-ed.virginia.edu)
8
Q
What view is this?
What does it enhance?
A
- Swimmers View-> for supine and pt who cannot move or have a large BMI
- Enhances C7-T1 visualization
9
Q
What is this image?
* You should only do this when?
* Why do you do this?
* What can you look for?
A
Flexion and extension C-spine
* Only done if patient is stable and has NO chance for unstable Fracture.
* Flexion and extension views may be used if a pure soft tissue injury is suspected or an injury of questionable stability is noted. The patient should perform the flexion and extension voluntarily.
* Flexion/extension views are absolutely contraindicated in documented unstable injuries.
* Might look for clayshoveler’sfracture (C6, 7, or T1). Someone who shovels clay (heavy) ends up with these fractures.->not necessarily a fracture that causes paralysis. Need todistinguishit from a HANGMAN’S FRACTURE.
10
Q
- Who needs c-spine imaging?
- What does every patient need?
A
- Mental status less than alert or intoxicated
- Reports neck pain
- Midline neck tenderness
- Neurologic signs and symptoms
- Distracting injury (i.e. painful injuries elsewhere, e.g. extremity fractures)
- Every patient needs all 3 views
11
Q
What is NEXUS Criteria for C-Spine Imaging?
A
12
Q
What happens in the field and ED for trauma C-spine?
A
In the field:
* Cross table c-spine: the first and mostimportant radiograph
In the ED
* CT C-Spine w/o contrast
13
Q
Fill in
* Assess the four paraelle line?
* These lines should follow what? Any malaligment should be considered what?
A
Assess four parallel lines. These are:
1. Anterior vertebral line (anterior margin of vertebral bodies)
2. Posterior vertebral line (posterior margin of vertebral bodies)
3. Spinolaminar line (posterior margin of spinal canal)
4. Posterior spinous/process line (tips of the spinous processes)
- These lines should follow a slightly lordotic curve, smooth and without step-offs.
- Any malalignment should be considered evidence of ligmentous injury or occult fracture, and cervical spine immobilization should be maintained until a definitive diagnosis is made.
14
Q
What do you need to do first for clearing the c spine?
A
Examine each spinal line to ensurethat itis smooth and contiguous. Anyinterruption is abnormal.
* Anterior Vertebral line
* Posterior Vertebral line
* Spinolaminalline
* Posterior Spinous
15
Q
Play close attention to thespinolaminal line on t he lateral c-spine film to avoid what?
A
to avoid missinga C2 traumatic spondylolisthesis (hangman’s fracture)
16
Q
What do you do second for clearing the c-spine?
A
Examine all seven cervical vertebralbodies to determine the following:
* Cortical margins are intact (no step offs)
* Height is maintained, no evidence ofcompression
* C7 is in normal alignment with T1
17
Q
Clearing the C-spine:
* What should the anterior margin of the forament magnum line with?
* The posterior margin of foramen magnum should line up with what?
A
- The anterior margin of the foramen magnum should line up with the dens.
- The posterior margin of foramen magnum should line up with the C1 spinolaminal line.
17
Q
A
18
Q
What is the 3rd, fourth and fifth steps for clearing C-spine?
A
3.Determine whether the spinous processesare intact
4. Evaluate disk spaces for abnormalwidening or narrowing
5. Measure predental space (see arrow)
19
Q
What is this?
A
Predental space
20
Q
What is the 6th, 7th and 8th steps for clearing the c-spine?
A
- Examine odontoid process to be sure it isintact and does not protrude into the baseof the skull
- Measure the prevertebral soft tissues
- Assess the normal cervical lordosis
21
Q
A patient arrived at the ED on backboard and a cervical collar. He has a blood alcohol level of 0.2. He does not complain of any neck pain.
* Should the patient get a complete cervical series?
A
YESSSSSSS, mental impaired
22
Q
- What is the predental space?
- The prevertebral soft tissues can be used as an indicator of what?
- The normal width of the prevertebral tissue decreases down from what vertabrae?
- What is the normal measurement from C1-C4? Below C5?
- Air within soft tissue could suggests what?
A
- Predental space, the distance between the anterior surface of the odontoid process and posterior aspect of the anterior ring of C1.
- The prevertebral soft tissues can be used as an indicator of an acute swelling or hemorrhage resulting from an injury, and may sometimes be the only indicator of an acute injury on an x-ray.
- The normal width of the prevertebral tissue decreases down from C1 to C4 and increases from C4 downwards.
- Normal measurements from C1 to C4 are less than 7 mm (less than half of the vertebral body at this level), and less than 22 mm below the C5 (less than the vertebral body at this level).
- Air within soft tissue could suggest rupture of the esophagus or trachea.Space between lower cervical vertebrae and trachea should be < 1 vertebral body.
23
Q
What are the soft tissue measurement?
A
24
This patient was involved in an MVA. He complained of severe neck pain shortly after the event. The lateral film is obtained.
* What's your assessment?
Cervicothoracic junction is a very common site of injury
* Nothing yet becasue have to see C7-T1
25
What is this?
C-Spine Fractures
26
What are the unstable cervical spine fractures?
* Jefferson (C1)
* Bit (B/L)
* Off (odontoid)
* A (any combo of fracture dislocation)
* Hangman’s (pedicles break)
* Thumb (tear-drop fracture)
27
What is a jefferson's (C1) fracture?
* Right: the lateral displacement of C1 indicates a Jefferson fracture.
* Axial compression refers to force applied directly over the vertex in the caudal direction. This compression force "like smashing a cracker" may result in Jefferson fracture, a bursting fracture on the atlas.
| 3-4 breaks, altis gone
28
What are the odontoid fracture types? (3)
29
What is this?
Odontoid Process Fractures
30
What is this?
Type one of odontoid fracture (just tip)
31
What is an hangman's fracture?
Hangman's Fracture (C2)
* fractures through the pars interaticularis of the axis resulting from hyperextension and distraction
| Straight through vert body
32
What is this?
What is common cause of hangman's
Hyperextension refers to excessive extension of the neck in the sagital plane. A common cause of hyperextension injury is hitting the dash board in MVA, which may result in Hangman's fracture.
33
* What is a teardrop fracture?
* What is a common cause?
* What does it result in?
* Hyperflexion refers to excessive flexion of the neck in the sagital plane.
* It results in disruption of the posterior ligament. A common cause of hyperflexion injury is diving in shallow water, which may result in flexion tear drop fracture. Jefferson fracture may co-occur.
34
What is bilateral facel dislocation? What causes this?
complete anterior dislocation of the vertebral body resulting from extreme hyperflexion injury. It is associated with a very high risk of cord damage.
35
* What is this?
* What does is result from?
* Could be confused with what?
Unilateral Facet Dislocation
* Facet joint dislocation and rupture of the apophyseal joint ligaments resulting from rotatory injury of the cervical vertebrae: simultaneous flexion and rotation.
* Could be confused with spondylolisthesis
36
What is shaken baby syndrome mechanism and what is shown on X ray?
Atlanto-occipital dissociation
37
* What is this?
* What is the cause of this fracture?
Clay Shoveler's Fracture
* Fracture of a spinous process in cervical and upper thoracic spine
* Powerful hyperflexion, usually combined with contraction of paraspinous muscles pulling on spinous processes (e.g. shoveling).
| NOT UNSTABLE so no need to immobilize
38
* What is this?
* What causes this?
Wedge Fracture
* Compression fracture resulting from flexion.
* Very common in ED setting
39
* What is this?
* What is injury to?
Burst Fracture:
* Axial Compression Fracture
* Injury to spinal cord, secondary to displacement of posterior fragments, is common.
40
What is a normal predental space in an adult c-spine evaluation?
<3mm
41
All suspected and confirmed fractures need to be what?
Fracture Management
* All suspected and confirmed fractures need to be immobilized.
42
What is this?
Thoracic (T) Spine
43
Thoracic (T) Spine:
* Routine exam consists of what?
* The lateral view is obtained during what?
* In the normal spine, the anterior cortex should have what?
* What gets larger on lateral view?
* What can usually be seen in AP view? ANy displacement can be a sign of what?
* The routine examination consists of AP and lateral views.
* The lateral view is obtained during quiet respiration to blur out the overlying pulmonary vessels.
* In the normal spine, the anterior cortex should have a smooth margin in the lateral view.
* Also on lateral view, vertebral bodies and disc spaces get larger with caudal progression.
* On the AP view, a paravertebral soft tissue line can usually be seen. Any displacement of this line can be a sign of swelling helpful for the diagnosis of injury.
44
What image is this?
Lateral T Spine
45
Lateral T Spine:
* Take what often? What does it do?
* Look for what?
Take shallow breaths often – blurs the ribs and see vertebrae better. Look for cracks and step-offs, compressions (decreased height), wedging of vertebral bodies.
46
What is this?
CT/MR T-Spine
* betterfor backboard/ cant move, large bmi pts
47
Fill in and what image is this?
48
What is the scottie dog apperarance?
49
Is flexion C-Spine xray appropriate if you suspect teardrop fracture?
No, have cervical damage
flexion xray one if they have no c-spine trauma
50
Which cervical injury mandates neurosurgery consultation in absence of any neurovascular compromise?
1. Clay Shovelers Fracture
2. Wedge Fracture
3. Odontoid Fracture
4. Compression Fractur
| Which one sis unstable?
odontoid because it is unstable
51
* What is degen joint disease?
* What are the two main types?
* Note what?
* What is decreased?
* What might be present?
52
* What is spondylosis and spondylolysis and spondylolistehsis?
53
What are these images?
Left spondylolysis
Right Spondylolisthesis
54
What are these images?
Spondylolysis and Spondylolisthesis
55
HPI reports that patient fell off the roof and has bilateral calcaneal fractures
Left: Fracture through the vertebrae body?
Right: compression and teardrop
56
What is this?
burst
57
What is this?
58
What must be done on a scoliosis patient?
Scoliosis series
* Must perform entire spine in one image
59
What is this?
Sacroilliac Joint Series
60
What images are these
Sacrum/Coccyx Series
61
* What are the five bones that comprise the pelvis?
* Most trauma to the pelvis and hips can be evaluated with what?
* CT of the pelvis is the technique of choice for evaluating what?
* Symptoms from fractures of the hip, acetabulum and pelvis may be quite similar, thus, what needs to be done?
* The femurs should be positioned how?
* The five bones that comprise the pelvis are the ilium, ischium, pubis, sacrum, and coccyx.
* Most trauma to the pelvis and hips can be evaluated with an AP projection of the pelvis and hips. Other injuries require special projections such as anterior and posterior obliques views of the pelvis, frog-lateral view of the hip and groin-lateral view.
* CT of the pelvis is the technique of choice for evaluating complex fracture patterns, degree of displacement and soft tissue injury.
* Symptoms from fractures of the hip, acetabulum and pelvis may be quite similar, thus, a full AP pelvis radiograph including the hip must be obtained if any of the above fractures are expected.
* The femurs should be internally rotated when obtaining an AP pelvis film so that the femoral necks can be appropriately assessed for fractures.
62
Fill in
* What is severe pelvic trauma is associated with what?
Severe pelvic trauma is associated with hemorrhage in approximately 60% of cases. Hemorrhage is a principle factor leading to death in this patient population.
63
* What is this?
* Most commonly what is disrupted?
Calcified healed sacral fracture in image
64
What is this?
65
Skeletal Imaging:
* What is the preferred method of imaging?
* CT and MRI should be selected how?
* Order x-rays that include what?
* Lower extremities may include what?
* What should you descibe?
66
Why Weight-bearing vs non weight-bearing?
* Some physicians feel you can assess joint space narrowing (JSN) better with weight-bearing films rather than the non weight bearing films.
* Its usually standard practice to get both with lower extremity fractures.
67
What do you need to do first with fracture?
68
Explain the different fractures
69
What is the OLD ACID menemonic for fracture?
70
What is intraarticular, supracondylar, intertrochanteric, subtrochanteric?
What is a fracture/dislocation?
What is dislocation with fracture?
71
How do you need to orient the fracture line?
Some physicians feel you can assess joint space narrowing (JSN) better with weight-bearing films rather than the non weight bearing films.
Its usually standard practice to get both with lower extremity fractures.
72
What do you need with location of fracture?
73
How do you describe intrinsic bone quality?
74
Same or different fracture?
75
lateral midshaft femur
76
subtrochanteric
77
suparchondylar
78
medial midshaft displacement of radius and ulna
79
intrarticular radial head fracture
80
What is an open fracture?
* All require what?
* What is a risk?
81
Open Fractures:
* What an increased risk?
* What may occur?
* What is Txt?
* Ask about what?
82
Where can a fracture occur?
83
What is salter harris?
84
What are the different types of salter harris?
85
What is this?
86
What is this?
87
What is this?
88
What are these fracture?
89
What is this?
Salter-Harris III
* Physis and epiphysis
* fractures
* Usually requires surgical intervention
90
What is this?
91
What is this?
92
93
Label structures
94
Wha is a normal hand series?
Evaluation of the elbow is not necessary for a patient with suspected distal forearm injuries if an adequate physical exam does not reveal symptoms at the elbow. This, however, may not be so in a patient with distracting injuries or who is unresponsive or incommunicative.
95
Boxer's Fracture:
* When does it occur?
* Usually involves what?
* Watch for what?
* What are S/S
96
Bennett Fracture:
* What is this?
* THe most common mechanism is what?
* What is the most common dislocation?
97
What is this?
98
* What is this?
* Fractures are usually what?
* What is needed for diagnosis?
* Soft tissue abnormatliies of what?
99
99
* What is this?
* Occur when?
Lunate dislocation
Occur due to fall on an out-stretched hand or a blow to the palm that results in severe dorsiflexion and ulnar deviation. Best seen on lateral view
100
What is this?
101
What is this?
102
What is the scaphoid arterial supple?
103
The anatomical snuffbox is formed by what/
The anatomical snuffbox is formed by the tendons of the extensor pollicis longus, and brevis and abductor pollicis longus
104
What is this?
105
What is this?
106
What is this?
* What are the S/S?
* What is the test and txt?
107
What is this?
* Opposite of Colle’s Fracture, “Smith Fracture” or “Reverse Colles” has volar angulation of distal radius
* Swelling, tenderness, deformity
108
109
Elbow injuries:
* What is a complete exam include?
* Why is a true lateral view important?
* A complete exam includes AP, lateral and 2 oblique views.
* A true lateral view is most important in assessing soft tissue signs
110
What is this?
Galeazzi Fracture
* Fracture of the proximal radius with associated distal radioulnar joint dislocation.
* Also known as a Reverse Monteggia Fracture.
111
* What is this?
* Most common in what population?
* Most commonly injured nerve is?
Median nerve
## Footnote
Medial condylar injury
112
What is this?
* May result from?
* Most commonly, PE reveals what?
113
One way to remember the difference between Galeazzi and Monteggia fractures is what?
One way to remember the difference between Galeazzi and Monteggia fractures is the mnemonic GRUM: Galeazzi Radius, Ulna Monteggia.
114
* What is a tranverse tracture?
* What is a greenstick fracture
* What is a bowing fxr?
* Wha tis torus/buckling fracture?
Note both transverse and bowing fractures in the left image
115
Torus or Buckle fracture:
* Occurs after what?
* Fractures are aht?
* Heals when?
116
What is this?
Mideshaft (diphysis) fracture
117
What fracture is this?
* Most commonly cause by what?
* Most common fracture in who?
* May not be evident on x-ray so you need to look for what?
118
Scaphoid Fracture
119
Fill in
120
Shoulder Imaging:
* Radiographic exam includes what?
* Certain shoulder injuries require what?
* Radiographic examination of the shoulder typically includes AP views of the shoulder with the humerus in internal and external rotation.
* Certain shoulder injuries require additional views such as axillary and/or transscapular "Y" views for proper diagnosis.
121
* What is this?
* What is this a result from?
* What does it warrant?
122
What is this?
123
What is this?
* Result from what?
124
Acromio-Clavicular Joint Separation:
* What are the different types?
125
How do you differentiate type 2 from type 3?
To differentiate Type II from Type III, one can take an AP stress view of the AC joint, where the patient suspends 10-15 pound weights from each wrist. Type 2 in picture above.
126
What is this?
Acromio-Clavicular Joint Separation
127
What is this?
* In association with what?
* Make sure not to miss what?
128
129
What are the common orders for hip x-ray?
130
What is this?
* Occur most commonly where?
* Associated with?
* What is a complication?
* What will we see?
* What sign?
Typical clinical presentation will show external rotation and shortening.
131
What is this?
* What is the most common mechanism?
* What nerve might be injured?
* What will we see?
Typical clinical presentation is internal rotation and adduction
132
What is this?
* Occurs in who?
* What is the mechanism?
133
134
Knee Imaging:
* What is the most commonly injured? These injuries are best evaluated by what?
* Wha tis the next most common injury?
135
What is this?
X Ray Evidence of Effusion
136
* What is this?
* What view maybe the only view with a positive sign?
137
What is this? What is it caused by?
138
What is this?
* Most common?
* What typically result of acute injury?
139
What is this?
* Occur most often when?
* When depression is not present, what might be difficult?
140
What is this?
* What does it appear as?
* What is more sensitive?
141
What is this?
* What causes this?
* What is also commonly associated with this fracture?
142
Hip Fracture
143
Standard radiographic examination of the ankle includes AP, lateral and mortise views of the joint.
144
What are the common ankle x-ray views?
145
What is this?
146
What are the ottawa ankle rules?
147
What is this?
* What is it also known as?
* What is necessary?
* What other imagining is warranted?
148
What is this?
* What does Radiological exam revels waht?
* Patient usually has what?
149
What is this?
150
What is this?
* Child?
* Results from what?
151
What is this?
* Fracture of what?
* Results from what?
* Disruption of what?
152
Standard radiographic examination includes AP, lateral and oblique films.
153
What is this?
* Similar to what? Why?
154
What is this?
* Where is the tx or dislocation?
* Seen in who?
155
Infection Imaging:
When do we do it?
* Owing to lack of what?
* What can be become infected?
156
Osteomyelitis in Diabetics:
* Osteomyelitis can occur in who?
* 94% of cases of diabetic osteomyelitis in the foot are associated with what?
157
Osteomyelitis in Diabetics:
* Where are the most common ulcers?
158
What is this?
Charcot (Neuropathic Joint)
159
Osteomyelitis in Diabetics:
* When do xray become positive?
* Infection imaging protocol should begin with what?
160
What are radiographic signs of osteomyelitis?
Concomitant septic arthritis is indicated by what?
161
What is this?
Osteomyelitis of the first distal phalanx in a diabetic patient.
Left: Initial radiograph shows cortical erosion in an area where there is an ulcer.
Right: 14 days later, pathologic fracture.
162
What is this?
Advanced Osteomyelitis
163
Osteomyelitis in Diabetics, what are the Nuclear Medicine Scans
* Tc99m MDP (Methyl Diphosphonate)
* Tc99m HMPAO-WBC (Ceretec)
* Indium 111 WBC
164
Nuclear Medicine Scans:
How does it work?
* Essentially tag radioactive agent to a biological vehicle.
* Goes to any area of increased osteoblastic activity with MDP – cancer or infection
* If tagged to WBC – will go to where there is an infection
165
* Triple phase Tc99m MDP scans are designed to do what?
* What are nuculear medicine WBC scans?
166
Osteomyelitis in Diabetics – Nuclear Medicine Scans:
* What is the most frwq ordered imaging after plain flims?
* The triple phase scan was designed to differentiate between cellulitis and osteomyelitis, explain
167
Osteomyelitis in Diabetics – Nuclear Medicine Scans:
* A 4th phase (24 hours) is sometimes added in equivocal cases, why?
* Cellulitis will demonstrate what?
* Bone infarctions, avascular necrosis, degenerative joint disease and many bone tumors will show what?
168
What is this?
Bone Scan
169
Osteomyelitis in Diabetics – Nuclear Medicine Scans:
* What are false positives scans due?
* Cellulitis can give false positive results due to what/
170
Osteomyelitis in Diabetics – Nuclear Medicine Scans
* Hot in all 3 phases?
* If no charcot?
* If have charcot?
* Hot in all 3 phases = osteomyelitis or Charcot’s joint – triple bone scan is a waste of time.
* If no Charcot – do the scan.
* If they have Charcot – do WBC label scan instead.
171
Osteomyelitis in Diabetics – MRI:
* What is sensitivity and specificity?
* What is the gold standard for acute osteomyelitis?
172
* What is the Imaging Protocol for Osteomyelitis in diabetics without a Charcot Joint ?
* What is the Imaging Protocol for Osteomyelitis in diabetics with a Charcot Joint?
173
* Both charcot and osteomyelitis will show increased uptake on a triple phase bone scan, because why? What will have an increase osteoblastic activity?
* Only osteomyelitis will demonstrate what?
* a WBC scan is the procedure to distinguish what?
174
* Metastatic bone tumors are much more prevalent than what?
* Almost any kind of malignant tumor may metastasize to where? What are the most common originates from?
* What do they produce?
175
Metastatic Bone Tumors:
* Those lesions that are characteristically lytic are most commonly from what?
* Metastases from carcinoma of the breast are usually what?
* Blastic spread to bone in men is most commonly seen in what?
176
What is this?
Osteolytic Metastases
* Left: Lytic areas of destruction by growing tumor are the rule from kidney, lung, and thyroid carcinoma. Carcinoma of the breast may be lytic or blastic, or mixed.
* Right: The pelvis in a patient known to have carcinoma of the prostate. There are diffusely scattered blastic metastases. Note that the bone is not enlarged, like in a patient with Paget’s disease
177
What is this?
Paget's Disease
* The pelvis in a patient with Paget’s disease. Note the characteristic linear streaking of abnormal disarranged trabeculae and the enlargement of the bone due to subperiosteal new bone formation. It is important to distinguish this condition from the increased density in prostatic carcinoma metastases, because the two diseases are to be seen in the same group of patients (elderly men).
178
Metastatic Bone Tumors:
* Bony metastases may be detected on a nuclear medicine scan before what?
* For that reason, it is common practice to procure bone scans in patients known to have what?
* Generally, if there are “hot spots” in asymmetric areas in such patients, the radiologist assumes What?
179
Normal vs. Abnormal Bone Scan
180
What does this show?
181
What is the Radiographic Analysis of Primary Bone Tumors
182
What is this? How do we know?
183
Heterotopic Ossificans:
* Overgrowth of normal bone of varying severity can be caused by what?
* About every third patient who has total hip arthroplasty (joint replacement) or a severe fracture of the long bones of the lower leg will develop what?
184
What is this?
Heterotopic Ossification
185
What is this?
* When is pain, what is it relived and worst?
* What does it contain?
* Lesion elaborates increase what?
* What might be present?
186
* What is this?
* What does it show features of?
187
What is this?
188
Osteosarcoma – Osteogenic Sarcoma:
* Most common what?
* Evidence of what?
* Can be what?
* May arise from?
* What is useful to delineate boundaries?
189
Osteosarcoma Features:
* Metaphysis of long bone with what?
* Most occur where?
* When? Sex?
* What is the reaction? (2)
* _ foci
* What type of bone destruction? (2)
190
What is this?
Sunburst Periosteal Reaction
191
What is this?
Codman's Triangle-lifting up of periosteum due to rapidly growing lesions that penetrate through the cortex.
192
Ewing Sarcoma:
* What type of bone tumor?
* What is incidence and location?
* What are constitutional symptoms?
193
Ewing Sarcoma:
* What does it have?
* May exhibit what?
* Surgical exposure reveal waht?
* Most common in who?
194
What is this?
Ewing Sarcoma
195
What is this?
196
Multiple Myeloma:
* What may occur?
* Bone resorption due to what?
* What is common?
* What is age, sex and race?
197
Multiple Myeloma:
* Has generalized what?
* What does it have?
* Lesions do stimulate what?
* What why be present?
198
What are these?
199
What is this?
* Where does it typically present?
* What type of deposits?
* Late disease may have what?
200
What is this?
* What imaging is best for extensive?
* What is good for early disease?
* What joints are most common?
* What is seen on x-ray?
201
Tc99 WBC bone scan
202
What are general basic guidelines?
203
Bone and Joint Alignment: Look for what?
204
What do you look at for joint spaces?
205
What are the cortical outline?
206
What do you need to inspect for changes in bone?
207
CT:
* What is not required?
* Ct scans that may require IV contrast?
* CT scans that require prep?
208
What are spiral or helical CT/
209
What is it?
3D Fracture CT
210
What is best for eval of joint support?
211
Pearls:
* Fracture not involving a joint:
* Fracture involving joint:
* Complex fractures requiring reconstruction:
* Spine:
* Back pain:
212
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213
213
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