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Year 2 Radiology > Lower Limb Trauma X-rays > Flashcards

Lower Limb Trauma X-rays Flashcards

1
Q

Consequences of immobility due to lower limb injury?

A
  • Dehydration and starvation
  • DVT/PE
  • Pneumonia
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2
Q

Imaging modalities that can be used for trauma imaging?

A

X-rays (can be difficult to assess fractures due to overlapping anatomical fractures)

CT scans (cross-sectional and so is unaffected by overlapping structures)

US (shows superficial soft tissue structres, esp. tendons)

MRI (can show deep soft tissue structures and undisplaced fractures, where no soft tissue density is interposed between bone density fracture margins; an MRI provides details info about bone marrow, so can show undisplaced fractures)

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3
Q

How do many lower limb fractures appear?

A

Many appear sclerotic, as lower limb fractures often involve axial force with BONE IMPACTION

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4
Q

Typical sites of lower limb impacted fractures?

A

Femoral neck

Tibial plateau

Calcaneus (often by jumping out of a window and landing on the heel)

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5
Q

Describe pelvic ring fractures?

A

High-energy fractures, e.g: road-traffic accidents, often occurring in young people; usually multiple, as bony ring disruption typically affects more than one site (either bones or symphisis/SI joints)

They may also be low-energy fractures, typically due to a minor fall (may be of insidious onset)

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6
Q

Assessment of high-energy pelvic ring fractures?

A

X-ray (if the pelvis is the only injured site)

CT is the primary imaging modality in polytrauma patients

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7
Q

Assessment of low-energy pelvic ring fractures?

A

MRI is very sensitive

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8
Q

Causes of pelvic soft tissue injury?

A

Sports-related pelvic injury is common; acutely, it is due to muscle tear or tendon avulsion, e.g: acute hamstring tendon avulsion

Chronic overuse can cause bone/soft tissue pain at tendon/ligament attachment sites

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9
Q

Assessment of pelvic soft tissue injuries?

A

US can show acute injuries affecting superficial structures

MRI is method of choice as it provides complete assessment of all soft tissues and bones

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10
Q

Cause of hip dislocation?

A

Road traffic accidents or contact sports, where the hip is flexed

Typically posterior, with acetabular rim fracture

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11
Q

Complications of hip dislocation?

A

Femoral head AVN

Early OA

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12
Q

Types of proximal femoral fractures?

A

Intracapsular - includes femoral head and neck fractures

Extracapsular - includes trochanteric, intertrochanteric, and subtrochanteric fractures

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13
Q

Complications of intracapsular and extracapsular fractures?

A

Interfere with blood supply to femoral head and can result in femoral head AVN or non-union

Extra-capsular fractures do not cause these

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14
Q

Treatment of intracapsular fractures?

A

Hemiarthroplasty

If undisplaced OR if the patient is young, reduction and screw fixation can be tried

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15
Q

Treatment of extracapsular fractures?

A

Internal fixation

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16
Q

What is a proximal femoral fracture cannot be seen but there is clinical suspicion?

A

Repeat X-ray after 10 days

Immediate MRI, which can show undisplaced fractures

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17
Q

Causes and complication of femoral shaft fractures?

A

Tend to be high-energy fracture and obvious on X-rays

There is a risk of blood loss and fat embolus

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18
Q

Injuries of the knee?

A

Fractures can occur but soft tissue injuries are common

19
Q

What can small avulsed bone fragments in the knee indicate?

A

Sometimes indicate significant soft tissue injury

20
Q

Soft tissues of the knee that must be examined?

A

Patellar and quadriceps tendon

Suprapatellar fat space (significant soft tissue injury is usually accom. by an effusion if there is an injury)

21
Q

How can lipohaemarthrosis in the knee be seen?

A

Horizontal beam laterally can show blood and fat collecting in the suprapatellar recess (specific sign of an intra-articular fracture)

22
Q

How to assess knee dislocation?

A

Must check bony alignment carefully, as they are often largely reduced by the time the X-ray is done

23
Q

Consequences of knee dislocation?

A

Complex soft tissue disruption

Potential for popliteal artery injury

24
Q

Describe tibial plateau fractures

A

Mostly affect the LATERAL CONDYLE, following a valgus force with the foot planted (“bumper injury”)

They can have variable appearances, from an obvious fracture line to subtle subchondral sclerosis

25
Q

Assessment of tibial plateau fractures?

A

CT scan shows area of condylar involvement/depth of depression

26
Q

Assessment of extensor mechanism injuries?

A

I.e: quadriceps and patellar tendon tears, can be clarified using US

Acute, intra-articular soft tissue injuries may also be difficult to assess clinically due to swelling and pain (shown by MRI)

27
Q

Soft tissue knee injuries shown by MRI?

A
  • Meniscal tears
  • Cruciate, collateral or other capsular/ligamentous injuries
  • Hyaline cartilage damage
  • Subtle fractures
28
Q

Function of mensci?

A

Fibrocartilaginous medial and lateral menisci buttress knee joint margins, spreading the load between femur and tibia

29
Q

Complications of meniscal tears?

A

Torn meniscus can displace into the intercondylar notch and patient can present with a “locked knee”

30
Q

Assessment of hyaline cartilage injury?

A

Predisposes to early OA but is invisible on X-ray

MRI can define extent of injury and any resulting loose bodies; it can also assess the success of surgical repair

31
Q

Assessment of undisplaced fractures?

A

MRI

32
Q

What is a Maisonneuve fracture?

A

Spiral fracture of the proximal 1/3rd of the fibula, assoc. with a tear of the distal tibiofibular syndesmosis and the interosseous membrane

There is an assoc. fracture of the medial malleolus OR rupture of the deep deltoid ligament

This type of injury can be difficult to detect

33
Q

Mechanism of ankle injury?

A

Inversion or eversion usually

34
Q

Assessment of ankle injuries?

A

X-ray (AP and lateral views)

CT can be helpful to clarify fracture anatomy

US and MRI may be needed to define soft tissue injury

35
Q

Signs of ankle fractures?

A

Soft tissue swelling

Confirm uniform joint space (non-uniform joint space indicate instability, often with ligamentous damage)

Look for malleolar fractures, which may be solitary, as they are often avulsion or undisplaced fractures (look carefully at the lateral view for undisplaced fractures)

36
Q

Describe ankle fractures

A

Tend to be multiple and can affect the:
• Lateral malleolus
• Medial malleolus
• Posterior malleolus (posterioinferior tibia)

37
Q

What is a tarsal dome margin fracture?

A

Excessive inversion or eversion can cause injury to the cartilage and underlying bone of the talus within the ankle joint; this can cause chronic pain/instability

38
Q

Diagnosis of tarsal dome margin fractures?

A

MRI

39
Q

What is a 5th metatarsal base fracture?

A

Follows inversion and clinically resembles a lateral malleolar fracture, so check this area on lateral X-ray

They are transerve and resemble a normal longitudinal ossification centre

40
Q

What is a calcaneal fracture?

A

Usually follows axial compression, such as falling from a height onto the heel; they are often comminuted

Normal calcaneus has a central peak but fracture causes loss of this peak and increased bone density

41
Q

Accessory ossification centres and when & where they are seen?

A
  • In adolescents, the 5th metatarsal has a longitudinal accessory ossification centre at its base
  • Fragmented accessory ossification centre is normally seen along the posterior calcaneus in children
  • Fabella is a sesamoid bone within the lateral head of the gastrocnemius, often visible posterior to the proximal femur
  • Os trigonum is commonly seen posterior to the talus
  • Rounded sesamoid bones may arise at multiple sites within the foot, but are invariably present on the medial and lateral plantar aspects of the 1st metatarsal head
42
Q

Most common ankle tendon injuries?

A

Achilles and most other ankle tendon can be affected

Tendon rupture may follow a single high-energy event but is often due to recurrent minor tears

43
Q

Factors that predispose to tendon rupture?

A

DIABETES, RA and STEROIDS

44
Q

What is a lisfranc fracture?

A

1/more of the metatarsal bones are displaced from the tarsus; usually, several TMT joints are involved with multiple ligamentous avulsion fractures, shown best by CT

Year 2 Radiology (7 decks)

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