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MSK Flashcards

1
Q

Small, rounded bones located in tendons

A

Sesamoid bones - “accessory ossicles”

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2
Q

more dense white area along the edges of the long bone

A

cortex

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3
Q

very outside part of cortex (white part)

A

Periosteum

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4
Q

bunnies of bone activity resorbers

A

osteoclasts resorbers : remove, destroy: decrease density, lucent appearance

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5
Q

Can remove bone at_____of formation

A

20x rate

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6
Q

responsible for abandoning ship and letting tumor spread in bone

A

osteoclasts

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7
Q

Reparative cells that heals fx’s

A

Osteoblasts - slower

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8
Q

indications of long bone XR

A

Trauma, pain, edema, decreased ROM, FB

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9
Q

what views are mandatory in long boned which ones are alternative

A

Always at least AP, Lateral (orthogonal views - 90°) Oblique is initial 3rd view (hand, wrist, ankle, foot, etc) ○ Special views

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10
Q
A

lateral

operative

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11
Q
A

axial of the calcaneus

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12
Q
A

sunrise view of the patella

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13
Q

3 special views ordered

A

Comparison views” - image of the other side

● “Weight-bearing view” - AC joint, foot (ex: pt holds a weight to stress shoulder joint to expose abnormality)

● Perpendicular - axial plane (sunrise and axial)

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14
Q
A
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15
Q

CT scan indications

A

Complex fractures – characteristics, extent

● Pre-op evaluation

● Occult fracture

● Associated injuries

● Spinal column

● Tumors, infection

● Biopsy, interventional procedures

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16
Q

occult fractures

A

difficult to see on plain scan but suspected due to inability to weight bear

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17
Q

MRI indications

A

best for soft tissue

● Spinal cord injuries → MRI is imaging of choice*

● Occult fractures – hip (elderly), scaphoid ESP. if you can’t see on CT

● Tendons/Ligaments/Soft Tissue

○ MR Arthrography - contrast study of joints

○ Pre-op evaluation

● Certain complex fractures, infections

● Bone marrow abnormalities

● Avascular necrosis

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18
Q

T1 or T2

A

T1 because of black fluid

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19
Q

Bone Scans – Nuclear Med: Indications

A

Occult Fractures

● Stress Fractures

● osteomylitis (Bone Infection)

● Avascular Necrosis

● Osteomyelitis

● Malignancy

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20
Q

AABC’s of film reading

A

○ A dequacy

○ A lignment

○ B ones + Periosteum

○ C artilage (joint space can’t actually see catrilage)

○ S oft tissue

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21
Q

adequacy of plain film

A

● Name, date, L&R label, all views?

● Pt properly positioned

○ “True” lateral or “true” oblique?

○ All structures seen in anatomical alignment?

○ Special views taken properly?

● Must know normal radiographic anatomy to evaluate normal alignment and position

● Ex: forearm film is adequate if it includes both elbow and wrist joints!

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22
Q
A
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23
Q
A

anterior humoral dislocation

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24
Q
A

Torus fracture

lacks smooth margin

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25
Q

Impaction fx caused by falling, commonly missed fx in peds

A

Torus

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26
Q

system for looking at XR for fractures “B” of AABCS

A

Fractures = lucent (black) line passes through cortex

○ Check entire cortical margin for disruption

○ Check for impaction (bulge, increased density)

○ Acute Fx’s linear, jagged - edges not corticated

○ Fx’s should be visible on more than one view

● Decreased density (lucency, osteopenia)?

● Increased density (opaque, sclerosis, impaction)?

○ Generalized process or focal process?

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27
Q

reasons for widening of joint soaces

A

Widening: disruption, calcification, fluid (effusions)

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28
Q

name for a fracture extends into the joint

A

intra-articular Fx

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29
Q

Narrowing of a joint implies

A

Narrowing of a joint implies abnormal thinning of cartilage.

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30
Q

best imaging for ligamentous injury, disruption

A

MRI best for ligamentous injury, disruption

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31
Q

intra-articular Fx

A

Check if fracture extends into the joint

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32
Q

causes of decreased joint space

A

Arthritis - most types (condition of “bone on bone”)

○ Impacted fx, dislocation

usually need replacement

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33
Q
A
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34
Q

reasons for Increased joint space:

A

Fracture, dislocation

○ Hemarthrosis

○ Infection (pus)

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35
Q

what can we visualize in the soft tissue of plain film

A

● Edema

● Effusions in joint

● Fat pad - blood or fluid in fat space (elbow)

● Calcifications in soft tissue - outside of bone, joint

● Masses

● Gas

● Foreign bodies

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36
Q
A

effusion or increased fluid in joint space

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37
Q
A

gas in soft tissue need emergent amputation

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38
Q
A

mets from prostate

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39
Q

what are we worried about with GENERALIZED increased density

A

○ Multiple/diffuse osteoblastic metastases – prostate CA (classic!)

○ Osteopetrosis (“marble bone dz”)

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40
Q

FOCAL increased density of bone suspect

A

Impacted fracture, fracture healing

○ Localized osteoblastic metastases

○ Avascular necrosis

Late finding

May see “crescent lucency” from a subchondral fracture

○ Paget’s Disease

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41
Q

phases of pagets and what bones are typically effected

A

Phases: Early lytic, Mixed, Osteoblastic

● Dense, sclerotic bone changes late

Pelvis, skull, spine, tibia (spares fibula)

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42
Q
A
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43
Q

caharcteristic findings of pagets

A
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44
Q

GENERALIZED lucency suspect

A

Osteopenia

○ Osteoporosis

○ Endocrine/metabolic disorders, steroids (chronic use)

○ Hyperparathyroidism, osteomalacia, rickets

○ Multiple Myeloma (disseminated form)

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45
Q

FOCAL lucency suspect

A

○ Osteolytic metastases, bone cysts , some tumors

○ Multiple Myeloma (solitary form)

○ Osteomyelitis

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46
Q
A

look at how thin the boens are here

Risk for pathologic fracture

Decreased bone mass: generalized characteristic of osteoperosis

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47
Q

who gets osteoperosis

A

F> M, elderly, post-menopause, ETOH, steroids, smokers, renal failure, GI Dz, debilitation

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48
Q

what should you order in a pt with suspected osteoperosis

A

Plain film, BMD (bone mineral density test / DEXA (dual energy xray absorptiometry), CT

● Risk for pathologic fracture

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49
Q

story behind hyperparathyroidism

A

○ Stones, bones, abdominal groans

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50
Q
A

classic finding with hyperparathyroidism

hour glass

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51
Q
A

“brown tumors”, “salt & pepper skull”

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52
Q

_________ respond to periosteal insult - localized ○ Fx is a periosteal insult

A

Osteoblasts respond to periosteal insult - localized ○ Fx is a periosteal insult

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53
Q

non aggressive solid periosteal reaction

Fx healing, repetitive trauma (child abuse)

○ Neoplasms (usually benign)

○ Osteomyelitis, indolent infections

A

periosteal insult

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54
Q
A
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55
Q
A

Codman’s Triangle

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56
Q

Codman’s Triangle

A

Characteristic of aggressive periosteal reaction

Usually d/t malignancy ; also seen with osteomyelitis

Spicule of bone at edge of lesion, lifts periosteum

Forms a triangle with bone cortex

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57
Q
A

heel bone spur

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58
Q

4 Characteristics of Osteoarthritis (DJD)

A

Narrowed joint spaces

Osteophytes & Spurs (early OA)

Subchondral sclerosis (late OA)

Subchondral bony cysts

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59
Q

3 characteristics of charcot’s joint and who get’s them

A

○ Denervation of joint

○ Micro fx’s, bone fragmentation

○ Joint destruction

○ DM’s most common

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60
Q

CCPD

A

CPPD = Calcium Pyrophosphate Deposition Dz Two Types:

■ Chondrocalcinosis

■ Pseudogout – red, swollen joint

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61
Q
A

CPPD

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62
Q

2 types of DJD and MC

A

Osteoarthritis (DJD)

○ Primary most common

○ Secondary

Usually after trauma

Young, unilateral

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63
Q

what should you always say about joint issues

A

could be septic! but probably not b/c …

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64
Q

Risks for Septic - pyogenic

A

IVDU, trauma, prosthesis, steroids

65
Q

fast septic joint

A

Septic - pyogenic

66
Q

charcateristics of pyogenic septic joint

A

Monoarticular - knee, hip, hands - any joint

● Staph, GC

● Articular cartilage destruction

● Rapid progression

67
Q

cc of Septic - non-pyogenic joints

A

M. tuberculosis, fungus

68
Q

risks for non-pyogenic spetic joint

A

: IVDU, DM, steroids, TB risks

69
Q

ulnar deviation classic finding in

A

RA

70
Q

RA charcteristics

A

○ Narrowed joint spaces

○ Periarticular erosions

○ Osteopenia ○

○ Subluxation

○ Also radiocarpal erosion and ulnar deviation

71
Q

● Psoriatic arhtritis charcateristics

A

○

At DIP, spares PIP
Subchondral erosions
Terminal phalanges narrow “pencil in cup”

72
Q

Bamboo spine ”

A

syndesmophytes fuse anteriorly

seen in Ankylosing Spondylitis

73
Q

order of fusion in Ankylosing Spondylitis

A

SI joint fuses first - ascends spinal column

74
Q

three classic findings with Ankylosing Spondylitis

A

Sacroiliitis is hallmark

HLA-B27 positive

bamboo spine

75
Q

what do we measure to tract Ankylosing Spondylitis

A

measure distance angle

76
Q

Ankylosing Spondylitis seen most commonly in

A

young men

77
Q

what to ask with bone tumors

A

○ Where? Joint violated? ( tumors don’t cross joints )

○ Margin? Sclerotic/thin, well-defined vs. irregular, ragged

○ Shape? Longer than wide (w/in medullary) or wider than long (burst through cortex)?

○ Characteristics? Geographic, permeative, “moth-eaten”, expansile, “soap bubbly”

○ Bony reaction? Lytic, sclerotic

○ Periosteal reaction?

■ Codman’s, mixed, onion skin

78
Q
A
79
Q
A

BAMBOO SPINE (AS)

80
Q

“moth-eaten”, expansile, “soap bubbly” all describe

A

bone tumors

81
Q

bone tumors seen in 0-10 yrs

A

Ewing’s sarcoma

○ Neuroblastoma

82
Q

● 10-20yo , long bones tumors ddx

A

○ Ewing’s sarcoma (shaft)

○ Osteosarcoma (epiphysis: growth areas)

83
Q

20-40 ddx bone tumor

A

○ Osteosarcoma
○ Giant cell tumor (epiphysis)

84
Q

>40 yrs ddx for bone tumors

A

Chondrosarcomas

■ (hips, pelvis, humerus 75%)

Consider metastases from distant primary

85
Q
A

osteosarcoma of distal femur

86
Q

Description of Fractures

A

oepn or closed

location

number of fragmnets

direction

alignment

special fractures

87
Q

open fracture means

A

compound (bone out through the skin of wound over broken bone)

gunshot wound breaking femur

88
Q
A

depressed

89
Q

how to describe the location of a fx

A

Which bone(s)?

○ Where in the bone?

○ “Head” proximal (usually)

○ Proximal, middle, distal third of shaft, neck

○ Intra-articular or not?

90
Q

direction of fx

A

Transverse, oblique spiral, longitudinal

91
Q
A

transverse spiral fracture

92
Q
A

oblique

93
Q
A

longitudinal fx

94
Q
A

greenstick

95
Q
A

spiral fx

96
Q
A

vaLgus

forms an L

97
Q
A

Varus

98
Q
A
99
Q

how to talk about alighnment

A

descirbe the movement of the distal piece

100
Q

angulation

A

NOT DISPLACEMENT

forms an angle

still touching althoguh displacement can also still be touching

can have both

describe angulation in degrees and displacement %

101
Q
A
102
Q

movement away from

mid-diaphyseal axis line

A

Displacement

103
Q

how to describe angulation

A

Posterior (dorsal) or Anterior (ventral/volar)

Medial (varus) or Lateral (valgus

104
Q

dorsal

A

can bet the back of the dog

105
Q
A

Closed oblique fracture of the right distal 5th metatarsal shaft with medial displacement (of 5th metatarsal)

medial displacement of the DORSAL segment

106
Q
A
107
Q
A

Right humerus with a spiral fracture at the mid-shaft with 90% medial displacement, 1-2cm shortening and internal rotation of distal segment

still touching but hooked on an edge

108
Q
A

Spiral fracture of the left distal tibia that is intra-articular and comminuted (many pieces), with a comminuted oblique fx of the distal fibula with ~1cm shortening. Both with varus angulation.

109
Q
A
110
Q
A
111
Q
A

Greenstick fx of the right mid-clavicle with 60 degree volar angulation. There is disruption of the AC joint w/ inferior displacement of the distal clavicle

112
Q
A

Complete POSTERIOR (describes foot) dislocation of the right tibio-talar joint. There is also a spiral fx of the distal fibula with shortening and lateral displacement of the distal fragment

113
Q
A

comminuted (multiple) fx of the left proximal tibia and tibial plateau (all the way up) , with an intra-articular fx extending through the lateral tibial spine. There is an opacified area medially – likely an area of impaction.

goes to CT

114
Q
A

seaweed taken a piece of the rock

AVULSION beach

nondisplaces avulsion fx at tge base of the 5th metatarsal left foot

115
Q
A
116
Q

avulsion fx’s are caused by

A

caused by sudden torque on the ligaments

igament stays intact but pulls a piece of bone away. If small piece of

bone pulled off, commonly called a “chip fracture.”

117
Q
A

nutrient vessel doesn’t break through the cortex and is not compliteley longitudinal

FAKE OUT

118
Q
A

acessory ossicle fakeout

119
Q

esamoid bones/ Accessory Ossicles typically found in

A

Feet, hands, elbows, wrists, knees

120
Q
A

growth plate fakeout wiht kids

121
Q
A

normal pelvis of a child

122
Q

complications with compound fx

A

Any fracture complicated by breach in the adjacent skin

● High incidence of infection , osteomyelitis (later)

123
Q

what are we worried about wiht crush injuries

A

Crush injury: vascular complications, infection

124
Q

what needs to happen with open practures

A

Irrigated and repaired in OR < 8 hrs (orthopedic emergency!)

Antibiotics, Tetanus

125
Q

exception to OR rule for compound fractures

A

Open tuft fx (exception to OR repair) → wash out, close f/u

126
Q
A
127
Q

what are Stress Fractures

A

Small breaks, repetitive stress, exercise or impact

128
Q

stress fracture most common in

A

Most common in the foot (usually at 2nd metatarsal), lower leg

129
Q

who gets stress fractures

A

elderly, gymnasts, athletes, new marine recruit, ballerina, goalies

130
Q

what do you normally see with a stress fracture XRAY

what are alternative iimaging options

A

○ Plain xray may show findings in 10-14 days (or longer)

○ Repeat xray - solid periosteal reaction in 10-14 days

● Bone scan - may be positive in 6-72 hours

● MRI

131
Q

a fracture arising within abnormal bone is termed

A

pathologic fx

132
Q

processes associated with pathologic fractures

A

○ Bone tumor

○ Bone cyst

○ Metastasis

○ Lytic or sclerotic changes

133
Q

Intra Articular Fractures

A

● Fracture enters joint

● Important distinction

● Cartilage damage

● Ligamentous injury

● Joint is now at risk for degenerative arthritis

SEE ONE SAY IT BECAUSE THEY GET SPECIAL TREATMENT

134
Q
A

intra articular Barton’s

135
Q

fx that are easy to miss

A

Stress fracture (March fx)

● Scaphoid, elbow, radial head, midfoot, tibial plateau, hip; supracondylar and torus fractures in kids

● Non-displaced and impacted fractures

● Non-displaced growth plate fractures (SALTER 1)

136
Q

Suspect fracture but negative x-ray?

A

○ Dx: Probable fx. Immobilize

○ Repeat x-ray in 2-3 weeks – look for callous

○ CT, MRI or bone scan next

blasts will show up later

137
Q

5-7 day fracture healing

A

Inflammatory Phase – 5 to 7 days, hematoma formation

138
Q

4-40 say fracture healing

A

Reparative Phase – 4 to 40 days, callus formation

139
Q

Remodeling Phase of fracture healing

A

remodeling Phase – can last up to one year, callus is converted into bone, 70% of healing time

140
Q

ORIF

A

= open reduction and internal fixation

○ Plate, screws, sutures

141
Q

Fracture Complications

● Acute (hours/days)

A

Compartment Syndrome

■ Pulselessness, pallor, pain, paresthesia, paralysis (5 P’s)

○ Local Infection - skin cellulitis

○ Fat Embolism

○ Hemorrhage

142
Q

Delayed (weeks/months) complications

A

Delayed union, Malunion, Nonunion

‘Malunion’ is a complication that arises if a fracture is allowed to heal in an abnormal position.

Failure of bone healing following a fracture is termed ‘non-union’ .

○ Osteomyelitis – bone infection

○ Avascular necrosis – the death of bone cells through lack of blood supply

○ Myositis Ossificans – after blunt trauma

143
Q

imaging and diagnostic tests for osteomyelitits

A

● MRI best , bone scan next

● Bone biopsy diagnostic

cna be acute subacute or chronic

144
Q

● Soft tissue swelling, Hx

● Focal lucent or destructive areas within the bone

● Focal periosteal reaction

A

Osteomyelitis

145
Q

AVN occurs

A

AVN occurs in 15-30% of scaphoid

fractures, almost always involving proximal pole. The more proximal the fracture line, the greater the risk of AVN.

146
Q

what would you order if trying to look at the soft tissues

A

MRI

147
Q

What would you order if you suspect a malignancy or oseomylitis

A

bone scan

148
Q

what would you order if you suspect avascular necrosis

A

MRI

149
Q

what would you order if you suspect a stress fracture

A

bone scan

150
Q

What are the four subgroups of erosive arthritis

A

rhematoid

gout

psoriatic

AS

151
Q

narrowed joint spaces

periarticular erosions

osteopenia

and subluxation

all pictures of

A

rheumatoid

152
Q

Psoriatic arthris at _____ but spares the ____

A

at DIP but spares PIP

153
Q

sharp sclerotic punched out rat bite erosion near affected joint

A

GOUT

154
Q

radioculpar erosion with ulnar deviation

A

RA

155
Q

HLA-B27 positive is a finding in

A

AS

156
Q

what test imaging is best for dx osteomyelitis (1st and then 2nd)

what is diagnostic

A

MRI

then bone scan

bone biopsy is diagnostic

157
Q

diagnostic test of choice for AVN

A

MRI

and then bone scan

plain film sensitive is late

158
Q

extra skeletal ossification in soft tissue

occurs after blunt trauma but can be after penetrating tauma this is a young kid thing

A

what is myosisitis ossification

radiology (13 decks)

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