Lower extremity imaging Flashcards
What should you always look at when looking at bone x-rays?
A - adequacy, alignment
B - bones
C - cartilage
S - soft tissues
EVERYTIME
What makes your viewing adequate?
minimum of 2 views - AP & lateral, 3 views are even better with an oblique view!
Is the exposure sufficient?
What are you looking for in regards to alignment?
anatomic relation of bone axes – fractures/dislocations can alter normal axes
What’s a lisfranc injury?
dislocation of the second metatarsal
What can soft tissue help recognize?
swelling can speak for an occult fracture that may not be visible
What are examples of occult fractures?
- distal radius fracture (pronator quadratus fat pad sign +)
- neck of femur fracture
- radial head fracture (sail sign may be +)
- scaphoid fracture
- supracondylar fracture (loss of alignment)
What are the 4 anatomical classes of bones?
long, short, flat, and irregular
What are the benefits of splintage?
reducing pain and blood loss, pressure on skin, pressure on adjacent neurovascular structures, and reducing risk of fat embolism and further damage
What is: the assessment and reassessment of neurovascular status before and after any manipulation or handling of the fracture?
principles of immobilization
Always immobilize joints ____ and ____ the fracture
above and below
What type of fracture is simple, noncomplicated, with no skin wounds at or near fracture site?
closed fracture
What type of fracture is complicated, with a skin wound, and may be comminuted and dislocated?
open fracture
How are long bone fractures described?
reference to direction of fracture
What’s a transverse fracture?
fracture passes at right angles to shaft of bone
What’s a displaced fracture?
loss of alignment along the long axis
What can medial angulation of a displaced fracture also be called?
varus
What can lateral angulation of a displaced fracture also be called?
valgus
What can a proximal migration of the distal fracture result in?
shortening
what type of fracture is when the bone is crushed?
compression
What type of fracture is when one end of the extremity is fixed but the rest of the extremity remains in motion?
spiral fracture
In who are accidental spiral fractures of the tibia common?
preschool children who fall short distances onto an extended leg “toddler’s fractures”
What type of fracture should you suspect abuse?
spiral fractures
What type of fracture is urgent in children?
epiphyseal fractures because they are growth plate fractures – it could result in a limb that is crooked or unequal in length
Where are growth plates found?
long bones of the body – femur, radius, ulna, metacarpal
most have at least 2 growth plates on ends of the bone
What are salter-harris fractures?
fractures around the end of the bone
What is a fracture that breaks through the bone at the growth plate separating the end of the bone and disrupting the growth plate?
Type 1 Salter-Harris fracture
What is a fracture that break through part of the bone at the growth plate and crack through the bone shaft but not entirely?
Type 2 Salter-Harris fracture – MC growth plate fracture
What is a fracture that crosses through a portion of the growth plate and breaks off a piece of the bone at the end? (90 degree angle)?
Type 3 Salter-Harris fracture - MC in older children
What is a fracture that breaks through the bone shaft, the growth plate, AND the end of the bone (diagonal)?
Type IV Salter Harris fracture
What is a fracture that occurs due to a crushing injury to the growth plate from a compression force?
Type V Salter Harris fracture
What is a fracture that results in more than 2 separate bone components like “butterfly” or “segmental”?
comminuted fractures
What type of fracture results from 2 oblique fractures forming a “butterfly” fragment?
butterfly fracture (comminuted)
What type of fracture is when segments of bone are separated from both proximal and distal portions of tibial and fibular shafts?
segmental fracture (comminuted)
What type of fracture occurs when force results in bending such that the bone doesn’t break completely “incomplete break” but still results in a fracture?
greenstick fracture!
What type of fracture is common in young children, especially less than 10 years, commonly mid-diaphyseal, affecting forearm and lower leg?
greenstick fracture
What type of fracture is at the lower end of the fibula and medial mallelous of tibia and is associated w/ a rolled ankle and eversion of the ankle and tear of the deltoid ligament?
Pott fracture
What type of fracture is caused by the radius overriding the rest of the bone causing a dinner fork deformity?
Colle’s fracture
What type of fracture is a distal radial fragment is tilted into a posterior angulation and may be displaced ventrally (REVERSE COLLE’s)?
Smith’s Fracture
How many views does the elbow usually require?
3 - AP, oblique w/ elbow extended, and lateral with the elbow flexed
What fat pads should you be analyzing in the elbow?
anterior and posterior
seeing a posterior fat pad is NEVER normal
What is important to remember about ossification in the elbow?
develops during childhood and can be mistaken for fractures
What order does the elbow ossification occur?
CRITOE
capitellum - radial head - internal/medial epicondyle - trochlea - olecranon - external/lateral epicondyle
When the imaginary line drawn from front of humerus does NOT intersect the middle-anterior 1/3 of the capitellum, what should you suspect?
supracondylar fracture
When the imaginary line down the middle of the radius does NOT pass through the middle of the capitellum, what should you suspect?
radial head dislocation
What is the sail sign?
elevated anterior fat pad
What is the most common metatarsal fractured?
5th metatarsal
What is the most important weight-bearing structure in the forefoot?
metatarsals
What are the attachments of the 5th metatarsal?
peroneus brevis, tertius, lateral band of plantar fascia
How is the fifth metatarsal supplied by arterial branches?
dorsalis pedis, posterior tibial, peroneal arteries
nutrient artery from 4th plantar metatarsal artery and inserts into plantar medial diaphysis – vulnerable to increased nonunion rates due to anatomic location of the bloody supply which results in watershed
What is the fifth metatarsal?
pinky toe but below the toe part and in the foot part
What type of fracture is at the distal portion of the fibula above the lateral mallelolus w/ associated tear of tibiofibular ligaments and the deltoid ligament and therefore affects BIMALLEOLAR ligaments?
dupuytren fracture
This is a reminder
to review xray anatomy!
