Midterm Study Guide

Question 1

What is the relation between occipitalization and basilar invagination/impression?

Answer 1

Occipitalization is where C1 never separated from occiput (C0 and C1 are one).
I.e. Non segmentation of occiput from C1. Basilar impression is complication because of occipitalization. Basilar impression is that the dens of C2 is riding too high. I.e. Odontoid encroachment into foramen magnum. Causing compression of dens against brainstem.

Question 2

Where do you find a posterior pontacle?

** Check this one

Answer 2

Partial or complete ossification of the oblique portion of the atlanto-occipital membrane. Arcuate foramen outlined by bone now. Around the vertebral artery and cervical nerve. Most unilat and can compress artery and nerve.

Question 3

What is the significance of George’s line?

Answer 3

Line of posterior aspects of vertebrae

Question 4

Why is an os odontoideum clinically significant?

Answer 4

Os odontoideum- two halves of odontoid unit, do not fuse to C2 body (chunk of bone where dens is, seperate from C2). Now C1 moves on own. Prob dt old fx. Transverse ligament intact but unstable

Question 5

What are the radiographic differences between congenital block vertebra and an acquired fusion of the spine?

Answer 5

Block vertebra/synostosis. Non segmentation of two adjacent segments. Born w non segmentation. Decreased AP diameter, rudimentary disc, apophyseal joint fusion, possible malformation or fusion of SPs If fusion can use screws and hardware. But someones no hardware. No disc (taken out). Wont have malformation or fusion of SPs like congenital.
Congenital block most common C2-3.5-6

Question 6

What is the significance of the spinolaminar junction and spina bifida occulta in the lateral view?

Answer 6

Missing spinolaminar junction is spina bifida occulta. Need AP to dx but can see on lateral.

Question 7

7. Why is it common to see disc space narrowing adjacent to a limbus vertebra and/or Schmorl’s node?

Answer 7

Schmorls nodes are herniation of nucleus pulposus through vertebral endplant (primarily L spine). Dt developmentally weak endplate, trauma, or pathological process(osteoporosis) may be painful but usu asymptomatic. On lateral radiograph see focal indentation into vertebral body with sclerotic margin. Assoc disc usually narrowed. By the time you see these things usually asymp bc takes while to develop.

Anterior limbus bone. Herniation of disc through ant super corner of vert body in lumbar spine. Usually asymp bc dont see when it happens. Posterior limbus can cause stenosis but less common.
Disc space narrowing bc part of nucleus in bone (w schmorls) and in ant bone (w limbus)

Question 8

How can you tell whether a rib at the cervicothoracic junction is a cervical rib or first rib?

Answer 8

Most commonly at C7. Look at tp and find where rib one is.

Question 9

What is a transitional lumbosacral vertebra?

Answer 9

Undifferentiated L5 or s1. Transverse process is spatulated unilat or bilat may form accessory articulations. Or could become attached(sacralization). L/S disc hypoplastic. Many times have degeneration. Many variations

Question 10

Name a dysplasia that may present with tall stature and hypermobile joints? What complications may be associated with this condition?

Answer 10

Marfan’s Syndrome.
Cardiovascular issues, floppy valve. Aortic arch aneurysms. Blindness, retinal detachment and kens dislocations. Hypermobile joints. Thin cortical bine (no osteoporosis). Connective tissue issue.

Question 11

What is the most common cause of dwarfism? What neurologic condition may these individuals have that affects the legs?

Answer 11

Achondroplasia is most common form of dwarfism. Hereditary autosomal dominant disturbance in epiphysical condroblastic growth and maturation.
Congenital spinal stenosis leading to paraplegia.

Question 12

Fragile osteopenic bones are associated with which dysplasia?

Answer 12

Osteogenesis imperfecta. Generalized osteoporosis of entire skeleton w multiple fractures and deformities.
Two forms: congenita (fatal) and tarda (normal life expect.)
Tarda - blue sclera
Diffuse decrease in bone density.

Question 13

What are the radiographic findings of new vs. old fractures?

Answer 13

Old fracture is trying to form callus btwn bones. Takes at least two Weeks to see callus on X-ray.

Hemorrhage, hematoma, step defect, and zone of impaction indicates fracture less than two months old. Old fractures often show contiguous disc degeneration. Bone scans may usually show hot spots for up to 24 months

Question 14

What are the possible long bone fracture orientations?

Answer 14

Closed, open, complete, avulsion, incomplete, growth plate fx, stress fx, pathological fx, dislocation, subluxation, fx dislocation, bone edema

Question 15

What are the types of incomplete fractures of pediatric long bones and how do they differ?

Answer 15

Torus. Buckling of cortex.from axial load of impact. Greenstick. Interruption of one cortex w angulation resembling a broken branch. Usually lateral force. Bowing. Bending w no obvious cortical defects

Question 16

Which is the most common type of Salter Harris fracture?

Answer 16

These are growth plate fracture in kids. Most common is type II. Type two is a fx through growth plate and metaphysis. Sparing epiphysis. Takes approx 2-3 weeks to heal

Question 17

What is the difference between a malunion and a nonunion fracture?

Answer 17

Malunion has bad union. Not formed back together is nonunion.

Question 18

What significant finding is demonstrated in the APOM view with a Jefferson’s fracture?

Answer 18

Jefferson fx is bursting fx of the atlas. Classically bilateral anterior and posterior arch fracture of c1. Dt compressive blow to vertex of head. Best visualized on AP open mouth film. APOM increased lateral paraodontoid space bilat. Offset lat masses of the atlas. Prevertebral sweeling. Rupture of transverse ligament.

Question 19

What is traumatic spondylolisthesis and what cervical level does it usually occur at?

Answer 19

Hangmans fx is traumatic spondylolisthesis of c2. Bilat pedicle (pars) fx. Caused by hyperextendion, usually result of mva. Usu no neuro findings.

Question 20

What are the key radiographic differences between an un-united secondary ossification center of the spinous process at the cervicothoracic junction and a clay shoveler’s fracture?

Answer 20

Ununited secondary growth center doesn’t get pulled inferiorly so will still be in line and also wont have corticated edge. Also ununited doesnt cause pain or isnt caused by trauma.

Clay shovelers fx usually from avulsion of SP tip dt abrupt flexion or reorested stress pulls from muscles. Also assoc w extension or direct trauma C7 most common. Stable fx

Question 21

What is the most common fracture of the spine and how do you differentiate new from old? (hint: it occurs usually at T12-L2)

*** Check this one

Answer 21

Compression Fracture.

Question 22

List and describe the unstable fractures of the pelvis.

Answer 22

Unstable fx. One that may move during healing and result in neuro damage. Fx may cause sig organ or vascular damage

Question 23

What is the most common type of acetabular fracture?

Answer 23

Central acetabular fracture. Aka explosion fracture. Splits ilium into sup and inf halves. May be oriented transverse or obliquely.

Question 24

What is the most common hip (proximal femur fracture) and what age do these often happen in?

Answer 24

Most common in elderly. Sub capital most common (and most challenging to see on xray)

Question 25

Name and describe the proximal femur fracture that happens only in adolescents?

Answer 25

Slipped capital femoral epiphysis 10-15 yo. Usually occurs during rapid adolescent growth period. The femoral neck slips up off the femoral head. Its actually a salter harris type one fracture. More common in males but if bilat more common in females.

Question 26

Which direction does the patella usually dislocate?

Answer 26

Usually superolateral dislocation

Question 27

What is a Jones’ fracture and what bone does it occur in?

Answer 27

Also called dancers fracture. Transverse fracture of the base of the fifth metatarsal. Most fommon of all bony injuries of the foot. Mechanism is plantar flexion and inversion exert traction upon peroneus brevis etc.

Question 28

Name an associated injury that must be evaluated for when a patient presents with a calcaneal compression fracture.

Answer 28

Calcaneus is the most frequently fx tarsal bone. Talis is second. Ten percent associated with thoracolumbar spinal fractures

Question 29

What disease will you see champagne glass pelvis?

Answer 29

Achondroplasia. Another important finding is the posterior vertebral bodies will be scalloped/concave.

Question 30

When will you see Protusio acetabulae?

Answer 30

OI, RA, paget’s…protrusion of femoral head into acetabulae