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Radiography > Mod 2 > Flashcards

Mod 2 Flashcards

1
Q

How to describe an x-ray?

A

Confirm patients name and DOB and date of x-ray
Determine adequacy of image. Two orthogonal views, joints above and below
O - open or closed?
L - location (part of bone?)
D - degree (complete vs incomplete)
A - articulate extension (dislocation, fracture-dislocation, intraarticular salter-Harris)
C - comminution/pattern (transverse, oblique, spiral, comminuted, avulsion, impacted, fissure, greenstick)
I - intrinsic bone quality (normal, osteopenia, osteopetrosis)
D - displacement (LARA: length, alignment, rotation, apposition/translocation)
S - soft tissue

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2
Q

Complications of fractures

A

Immediate - bleeding (hypovolaemic shock), nerve damage, organ damage (pneumothorax, organ puncture), pain, disability, soft tissue entrapment between bone fragments, joint damage

Early - infection, tetanus, compartment syndrome, rhabdomyolosis (lead to kidney failure), fat embolism, thromboembolism,

Late - non-union, malunion (deformities), DVT, pressure ulcers, avascular necrosis, secondary OA, growth retardation, osteomyelitis, loosening of fixation

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3
Q

March fracture

A

Fatigue/stress fracture classically 2nd metatarsal of foot

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4
Q

Salter Harris classification

A 
1 - straight across
2 - metaphysics and physis
3 - physis and epiphysis 
4 - metaphysis, physis and epiphysis 
5 - crush injury
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5
Q

Bankart lesion

A

Glenoid fracture affecting the labrum due to multiple shoulder dislocations

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6
Q

Hill-Sachs lesion

A

Humeral head fracture typically secondary to anterior shoulder dislocation
Increases risk of future dislocations

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7
Q

Galeazzi fracture

A

Distal radius fracture with dorsal/Volta displacement+ intact ulna + dislocation of distal ulna

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8
Q

Monteggia

A

Ulna shaft fracture with distal radial dislocation

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9
Q

Nightstick

A

Isolated transverse fracture of ulna resulting from direct blow

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10
Q

Colles fracture

A

Fracture of distal radius
Dorsal angulation of distal fragment
Usually results from fall on extended wrist

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11
Q

Smiths fracture

A

Distal radius fracture
Volar angulation of distal fragment
Usually results from fall on flexed hand

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12
Q

Boxers fracture

A

Transverse fracture of 5th metacarpal

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13
Q

Scaphoid fracture

A

Neck of scaphoid
Usually results from fall on outstretched hand
Hard to detect, requires many views
Risk of avascular necrosis
Risk bigger the more proximal the fracture is due to blood supply from distal to proximal end

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14
Q

Types of hip fractures

A

Intracapsular (sub-capital, trans-cervical, basi-cervical)
Extracasdular (intertrochanteric)
Subtrochanteric

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15
Q

Garden classification

A

Neck of femur fractures using trabecular pattern
1 - incomplete stable with impaction in valgus
2 - complete but undisplaced with two groups of trabecula in line
3 - complete fracture, incomplete displacement, impaction in varus
4 - completely fractured and displaced

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16
Q

Weber classification of ankle fractures

A

A - below tibiofibular syndesmosis, lateral malleolus fracture (sometimes medial), intact ligaments
B - at level of tibiofibular syndesmosis, medial malleolus may be fractured
C - fibula fracture above ankle joint, disrupted tibiofibular syndesmosis

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17
Q

Gustillo anderson fracture of open fractures

A 
1 <1cm
2 1-10cm
3 >10 cm
A
B
C arterial injury limb salvage repair
18
Q

Plain radiograph signs of osteoporosis

A

More than 50% bone loss is required to detect decreased bone density (not sensitive)

Loss of cortical and trabecular bone 
Compression fractures (wedge) and vertebrae plana
19
Q

Plain film signs of pagets

A 
Cottonwool appareance 
Losers sign (pseudofractures)
Large well defined lyric lesions
Picture frame vertebrae
Tam o’shanter sign
Bowing of long bones
20
Q

Plain film signs of Osteomalacia/rickets

A

Bowing of long bones, losers zone, enlargement of epiphysis (tickets)

21
Q

Plain film signs of multiple myeloma

A

Pepper pot/raindrop skull and endosteal scalloping

22
Q

Spinal stenosis due to posterior disc bulge

What type of imaging and signs?

A

MRI
Compression of nerves
Sagittarius and coronal view

23
Q

Plain film signs of spondylitis and spondyloslisthesis

A

Pars interaticularis defect (fracture) collar on Scottie dog on oblique view
Sagittarius view shows degree of slippage

24
Q

Plain film signs of Bone metastasis in lumbar spine

A

Winking owl sign (disappearance of Pedicles due to tumor or infection

25
Q

Plain film signs of ankylosing spondylitis

A

Sacroilitis - sclerotic lines, loss of joint space (fusion), subchodnral erosion
Dagger sign - ossification of supraspinous and interspinal ligaments
Bamboo spine
- squaring of vertebrae due to erosions at entheses (enthesitis)
- syndesmophytes : formation of “bridges” between vertebrae due to ossification of outer fibers of annulus fibrosus
Fusion of lumbar spine

26
Q

Best imaging technique for Non-radio graphic axial spondyloarthritis

A

MRI may show erosions and bone marrow oedema

27
Q

Plain film signs of psoriatic arthritis

A

RA like - hand involvement, LESS
spondylitis - spine involvement
Arthritis mutilans - resorption of phalanges causing telescoping, severe erosions, sublux etc
DIP involvement

Terminal phalanges resorption 
Mouse ears
Pencil in cup deformities
Dactylitis 
Ivory phalanx
28
Q

Plain film signs of RA

A

LESS -loss of joint space, erosions, soft bone (periarticular osteopenia), soft tissue swelling

Commonly affects hands - MCP PIP, sublux, ulnar deviation, deformities

Feet - MTP

Cervical spine - atlantoaxial subluxation

29
Q

Additive arthritis ddx

A

RA

30
Q

Migratory arthritis ddx

Other signs of presentation

A

Rheumatic fever
Autoimmune disease Following Streptococci infection.
Heart, brain, skin and joint involvement

31
Q

Intermittent arthritis ddx

A

Gout

32
Q

Plain film shows signs of infection in two adjacent vertebrae and a disc between + Brodie’s abscess
What is most likely organism?

A

Mycobacterial

Tuberculosis

33
Q

Plain film signs of OA

A 
LOSS
loss of joint space 
Osteophytes 
Subchondral cysts 
Sclerotic regions

Large weightbearing joints, asymmetric
Lumbar and cervical spine
PIP, DIP and base of thumb , (trapezium)

34
Q

Plain film signs of Gout

A

Diffuse opaque regions typically over first MTP joint indicates characteristic tophi formation
Erosions
Eat bite erosions ( well-defined “punches out erosions with sclerotic margins and overhanging edges)

35
Q

Plain film signs of Pseudogout

A

OA features with unusual joint distribution (symmetrical, non-weightbearing, intercarpal and MCP joints in hands)
LOSS
Chondrocalcinosis
Wrist, knee

36
Q

Plain film signs of DDH

A

AP and frog lateral view
Ossification of superior femora epiphysis should be symmetric

Shenton line
Draw line along inferior border of superior pubic ramus
This line should continue laterally along inferomedial aspect of proximal femur
Dislocations

<6 weeks pavlik harness
Older - closed reduction or open reduction, femoral osteotomy and fixation

37
Q

Plain film signs of SUFE

A

AP and frog leg lateral view
SALTER HARRIS type 1 fracture
Slip is posterior and slightly medial + inferior
Klein’s line
See straight line across lateral edge of femoral neck. Line fails to intersect the epiphysis
Surgery;: open reduction and fixation with screws, prophylactically screwing opposite hip
Femoral osteotomy
Do not attempt closed reduction of severe slips (risk of AVN)

38
Q

Plain film signs of perthes disease

A

Signs of osteonecrosis
Early: no signs
Established: reduction in epiphysis size and lucency (herrings subtypes)
Late: fragmentation and destruction proximal femoral neck widening (Coxa magna)

Phases: initial (sclerotic), fragmentation, healing and remodeling

Treatment: analgesia, physio, monitoring, non-surgical containment, group C may need surgical containment

39
Q

Plain film signs of osteomyelitis

A

X-ray changes after 10 days
Lytic lesions with well defined border
Periosteal reaction elevation (Codman triangle), onion skinning and sunray spicules
New bone formation
Sequestrum may be seen as sclerotic area
Brodie’s abscess may be seen in distal femur

40
Q

What will show up as hot spots on bone isotope scan?

A

Pagets
Malignant bone tumors
Osteoid osteoma of the benign tumors

Radiography (1 decks)

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