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MSK 2 Flashcards

1
Q

1

A

normal trans-scapular y view

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2
Q

95% of shoulder dislocations are

A

anterior

5% are the WORST

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3
Q

adduction internal rotation and extension is common holding for an individual with

A

posterior dislocation

cannot externally location

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4
Q

common mechanism of posterior dislocation

A

High force; direct blow, seizure, MVA or fall SEIZURES

■ Usually will have associated injuries

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5
Q

what % of posterior should dislocations are misdiagnosed

A

50

seizures

motor vehicle accident

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6
Q

Arm held in abduction, external rotation,

extension

A

anterior shoulder dislocation

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7
Q

ice cream on a cond lightbulb on a stick is a comon discription of

A

posterior dislocation in AP view

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8
Q
A

normal Y

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9
Q
A

posterior dislocation lateral to the Y

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10
Q
A

anterior medial to the Y

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11
Q
A

axial view of posterior humeral head is oppostie to the corocoid process

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12
Q
A

normal axial

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13
Q
A

anterior dislocation axial

humeral head overlaps coracoid

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14
Q

this deformity is due to repeated anterior dislocations (and on every baord exam ever per Lauri)

A

● Hill-Sachs Fx/Deformity

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15
Q

Luxatio Erecta is what kind of fx

A

Uncommon but distinct shoulder dislocation

● Inferior glenohumeral dislocation

● Arm abducted - held above head, can’t move it (“arm up”)

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16
Q

Humeral head impingement under anterior glenoid rim

○ Predisposes to future dislocations

A

Hill-Sachs Fx/Deformity

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17
Q

Small fracture of glenoid rim that is frequently caused by reductions that don’t get enough clearing or dislocation

A

Bankart Fx

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18
Q
A

bankhart

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19
Q

mechanism behind scapula fx

A

Significant mechanism, high force, direct impact ○ Ex: Fall from height, MVA

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20
Q

dx of scapula

what views do you need

A

Often detected on CXR, AP shoulder

need

AP with arm in abduction

○ “Y View” is money! Very useful to detect fx, angulation

○ Order a CT scan (often complex fx’s)

○ CXR mandatory

best view is going to be on your Y

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21
Q

major sites of scapula

A

6 major sites :

acromion,

coracoid,

spine,

glenoid,

scapular neck,

body

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22
Q

most scapula fractures involve what other connecting

A

>80% involve body, neck or glenoid

○ Isolated acromion, coracoid fx’s less common

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23
Q

MC site for clavicle fx

what views do you need

A

Middle third is #1 MC Fx site

need to ask for AP and angeled view

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24
Q

common clavicle fx site in elderly

A

Distal third – common in elderly

because they fall on the shoulder straight down

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25
Q

clavicle is the only bone that you can describe like this

A

proximal or distal displacement/angulation

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26
Q

fracture of clavicle near sternum

A

usually from direct blow

really need to worry about the chest

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27
Q

MC fx in children

A

clavicle

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28
Q
A

greenstick fx of clavicle in angeled view

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29
Q
A

middle third fx with complete displacement and 30 deg superior angulation of PROXIMAL segment

this is the only bone you can describe proximally

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30
Q
A

Partial tear of AC with no displacement

Type (Grade) I

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31
Q

Disruption of ACL and widening of joint

is characteristic of what type of Acromioclavicular seperation

A

Type II

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32
Q

what will we see in type II

A

AC joint > 8mm wide/displaced

Clavicle displaced superiorly

No coracoclavicular space widening

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33
Q
A

Acromioclavicular (AC) Separation

● Rockwood Classification

type II

in most acromioclavicular sperations weight bearing views are hlepful

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34
Q
A

○ Type III : Disruption of AC and coracoclavicular ligaments

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35
Q

TYPE III rocwood classification criteria

A

AC joint disrupted

Clavicle displaced superiorly (riding too high)

Coracoclavicular space wide >13mm

coracoclavicular ligaments are also disrubted here leading do that widening

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36
Q

Compression is what Rockwood Classification

A

Type IV : Compression

Acromioclavicular (AC) Separation

● Rockwood Classification

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37
Q

Humerus Fracture MC single site of humerus fx

A

Surgical neck - most common single site

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38
Q

when are we worried about avascular necrosis with humerus fx

A

Fx at anatomic neck = risk of avascular necrosis

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39
Q

humeral shaft is anything below

A

surgical next. described in thirds

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40
Q
A

comminuted compltely displaced mid-shaft fx with 30 deg medial angulation and 2cm shortening

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41
Q

standard views for the elbow

and what are the special views

A

AP, Lateral (90 degree handskae with figure 8 and fat pads) - standard views

medial lateral oblique and capitellum are all special

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42
Q

adequate films of the elbow

A

soupination radial head and capitellum NOT superimposed should be fully extended

43
Q

money shot of the elbow

A

lateral view

90 degrees forearm in handshake position

condyles are superimposed in a figer 8

44
Q

two fat pads seen in the elbow lateral film

A

supinator fat stripe

and anterior fat pad

45
Q

approach to elbow

A

Hourglass”? “Fig 8”? True lateral?

where they able to do 90 degree handshake

“Fat pads”? Anterior?

ANY posterior fat pad - ABNORMAL–> tx fx

LOOK AT ANT HUMERAL LINE

RADIOCAPITELLAR LINE

INSPECT RADIAL HEAD

INSPECT DISTAL HUMERUS

INSPECT OLECRANON AND ULNA

sale sign?

46
Q

special views of the elbow and what they look at specifically

A

lateral oblique: radiocapitellar

capitellum: radial head

medial oblique-condyles of distal humerous

47
Q

special view of the elbow medial oblique

A

condyles

48
Q

which line of normal alignment is critical in kids for the elbow

where should we see this normally

A

anterior humeral line

should intersect the middle 1/3

49
Q

fat pad of elbow indicates

A

hemarthrosis or effusion

anterior lifted=sail sign =fracture

ANY posterior fat pad =subtle fx of radial head and supracondylar

50
Q

MC elbow fx in adults

what is the common mechanism

A

Inspect the Radial Head

● FOOSH injury: “ f all o n o ut s tretched h and” - arm is extended

Mechanism, Sx’s

○ Radiocapitellar line?

○ Posterior Fat Pad?

51
Q

pain with pronation and supination in suspected elbow fx

A

suspect radial head fx

look for posterior fat pat

52
Q

Radiocapitellar line

A

look for when suspecting radial head fx

should bisect the capitellum and align in all views

53
Q

60% all elbow fractures in pediatrics are

A

Supracondylar fx’s = MC elbow fx in kids

54
Q

MC joint dislocation

A

FINGER 1

  1. SHOULDER
  2. ELBOWS
  3. HIPS
55
Q

MC dislocation in children

A

elbow

56
Q

MC of dislocation in children and MOA

A

Elbow Dislocation

Mechanism: Hyperextension

57
Q

most site of elbow dislocation

A

90% posterior

58
Q

fx of the shaft of the ulna

A

Nightstick Fractures

59
Q

common fracture of the radius in children

A

Torus fx’s DISTAL radius

60
Q

ulnar fx with radial head dislocation

A

Monteggia Fx/Dislocation

see Ulna look at montteggia

might teggia a second to realize that radial head is in the rong place

61
Q

MC Monteggia Fx/Dislocation =

A

4 types – radial head displaced anteriorly into the antecubital fossa is MC

62
Q

unstable fracture of the arm that needs operative managmenet

A

Monteggia Fx/Dislocation

OR Galeazzi Fx/Dislocation

63
Q

radius fx at distal 1/3 with distal ulnar dislocation

A

Galeazzi Fx/Dislocation

ulna trynig to escape from the paperrazi

64
Q

Galeazzi Fx/Dislocation

A

Ulna dislocated at radio-ulnar

and carpal-ulnar joints

with radius fraxture

happens from holding something out and something falling on it

65
Q

automatic views for the elbow

A

AP

OBLIQUE

LATERAL

all three should include the distal radius

66
Q

– distal segment of radius has dorsal (posterior) angulation

A

Colles Fx

67
Q

Distal Radius Fx w/ Angulation

types

A

● FOOSH mechanism

almost all of them are FOOSH

all related to angulation of distal radius

  • Colles Fx – distal segment of radius has dorsal (posterior) angulation

● Smith’s Fx – distal radius has ventral/volar (anterior) angulation

● Barton’s Fx – intra-articular, ventral/volar or dorsal angulation

68
Q

Smith’s Fx

A

distal radius has ventral/volar (anterior) angulation

69
Q

intra-articular, ventral/volar or dorsal angulation subluxation

A

Barton’s Fx

70
Q

dinner fork deformity seen with this distal radius fx

A

colle’s

71
Q

distal radius is angulated _____ in colle’s

A

● Distal radius has DORSAL angulation/displacement on lateral

most common injury in the distal forearm

fork is the most common utensil used.

72
Q

50% of colle’s fxs are assoicated with these fractures

A

50% also have an ulnar styloid fracture

73
Q

fall of a flexed wrist seen with this distal radial fx

A

Smith’s

74
Q

Intra-articular fx of distal radius with displacement, angulation and subluxation of radiocarpal joint.

A

Barton’s Fracture

75
Q

Most commonly fractured carpal bone in adults

A

Scaphoid (Navicular) Fracture

76
Q

Scaphoid (Navicular) Fracture why are they so important

A

Midportion (“waist”) fx of schapoid = risk for AVN of Proximal Pole

Which has no independent blood supply

radial artery comes up with tiny little branches

77
Q

mechanism of schapoid fractures

A

● FOOSH w/ extreme dorsiflexion of hand, snuffbox tender

78
Q

scaphoid fracture best view

will get schapoid view if they are tneder in the snuffbox

A

wrist in ulnar deviation to see this

79
Q

2nd most common carpal fracture

A

Triquetrum Fracture

Usually avulsion fx of the dorsal surface

80
Q

triquetrum fracture best seen on

A

best seen on lateral b/c triquetrum is the most dorsal carpal bone seen on lateral view

81
Q

lunate dislocation usually caused by

A

FOOSH or direct blow to the palm

82
Q

what happens in a lunate dislocation

A

rotates towards the palm

spilled teacup

median nerve can be disrupted

83
Q

Dislocation of capitate from lunate

A

Perilunate Dislocation

84
Q

Perilunate Dislocation how is it different from lnuate dislocation

A

3x more common than lunate

dislocation

● Lateral shows lunate in proper position,

rest of carpals/MC’s dislocated

● Called the “empty teacup”

85
Q

Scapholunate Dissociation

A

“David Letterman” sign – space between front teeth

scaphoid isnpt tlaking to luna

saphoid rotates - seen on end on AP view

86
Q

Boxer’s fx

where do they normally occur

what bone

are they intra-articular?

A

4th or 5th (usually 5th) metacarpal

neck (technically - not shaft, not

intraarticular) distal shaft ?

Volar angulation of metacarpal head

  • describe in degrees
87
Q

when do you reduce a bozer’s fx

A

● Reduce >30° angulation

88
Q

Bennett’s Fracture

A

an intra-articular fx-dislocation of the base of the thumb (name is not as important as the description)

89
Q

MOA of bennets

A

Abductor pollicis longus pulls thumb downward avulsing it off it’s base

90
Q

comminuted bennet’s

A

ROLANDO

comminuted comlicated rolando

91
Q

Phalanx Fractures/Deformities

A

Volar Plate Fracture- flexer surface

Mallet Finger-dorsal avulsion

Boutonniere Deformity

92
Q

Hyperextension injusry of the phalnx

ropbbery

basketball

A

Volar Plate Fracture

dislocation at the PIP

93
Q

when to send volar to surgery

A

>30% of articular surface =

unstable, needs surgical repair

94
Q

Mallet Finger

A

Dorsal avulsion Fx, base of

● DIP, at extensor insertion ● Untreated = deformity

95
Q

Disruption of central slip at PIP

Lateral bands intact, hyperextended DIP

A

Boutonniere Deformity

96
Q

Disruption of ulnar collateral ligament with avulsion fracture at base of proximal phalanx

A

Gamekeeper’s Thumb

Acute injury is also called skier’s thumb , breakdancer’s thumb

97
Q

fixed extension at PIP, Flexion at DIP

Follows untx’d mallet’s

A

“Swan Neck” Deformity

98
Q

Distal Phalanx and Tuft Fracture

usually from

what do you need to check

A

Usually crush injury or skill-saw to fingertip: xray all

● Check ligament function

99
Q

this is the only open fx that is not a surgical emergency!

A

Distal Phalanx and Tuft Fracture

Nail bed injury + Fx = open fracture*

100
Q

dislocation complications (5)

A

hill sachs

bankfart fx

avulasion fx

joint instability

axillary nerve injury

101
Q

how does a chauffeur’s/ hutchenson’s fractured differ from a bartons

A

intraarticular like bartons

but no angulation and no displacement

scaholunate widening is common

102
Q

what is a die punch or lunate load fraxture

A

intraarticular

medial distal radios

impaction of the lunate onto the radius

could see a ulnar styloid fracutre as well

103
Q

tenderness in the snuff box, what view should you order

A

ulnar edivation

aka

scaphoid view

104
Q

second most common fractured carpal pone

A

triquetrum

the most dorsal of the bones!

radiology (13 decks)

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