MSK radiology

Question 1

What important features of the clinical history are useful in relation to radiology?

Answer 1

High/low velocity injury
Mechanism of injury (impaction, rotation, etc)
Site of bone tenderness
Presence/absence of deformity 
Age

Question 2

Most fractures only require two x-ray views. Name these and the views that they require

Answer 2

Cervical spine (AP, lateral and odontoid peg)
Scaphoid (AP, lateral and two obliques)

Question 3

In relation to fracture which features must you assess?

Answer 3

Site of fracture along bone
Spiral?
Transverse?
Comminution?
Extra or intra-articular?
Angulation?
Displacement?
Impaction?
Avulsion?
Bony alignment
Soft tissue abnormality

Question 4

Which three structures can mimic avulsion fractures?

Answer 4

Sesamoid bone of the thumb
Accessory ossification centres (children)
Old non-united fractures

Question 5

What is the posterior fat pad sign?

Answer 5

Fat pad normally sitting anterior to the distal humerus is displaced posteriorly by an elbow effusion

Question 6

The posterior fat pad sign can be normal in obese patients. T/F

Answer 6

False - never normal

Question 7

Children’s soft tissues commonly avulse. T/F

Answer 7

True

Question 8

Which three fracture types are unique to children?

Answer 8

Greenstick
Buckle
Bowing

Question 9

What is a physis? Why is this important in relation to imaging?

Answer 9

Growth plate! Space between physis and epiphysis can mimic a fracture

Question 10

Describe the Salter-harris classification of growth plate fractures

Answer 10

type 1 - S - straight across 
type 2 - A - above
type 3 - L - lower
type 4 - T - through/two
type 5 - ER - erasure of growth plate (cRush)

Question 11

Bones, soft tissues and bony alignment must all be checked even when an abnormality is found in one area. T/F

Answer 11

True - multiple problems common

Question 12

If a bony ring is ruptured expect to see more than one fracture/soft tissue injury. T/F

Answer 12

True - examples include forearm, vertebrae and pelvis

Question 13

When might you suspect pathological fracture?

Answer 13

When fracture seems out of proportion to injury velocity

Question 14

How do scaphoid fractures present? Which sex more commonly gets them?

Answer 14

Pain in the anatomical snuff box

Male

Question 15

Where is the most common site for a scaphoid fracture? What is the risk?

Answer 15

Scaphoid waist (mid-scaphoid)
Avascular necrosis

Question 16

Surgical neck of the humerus fractures pose an injury to which nerve?

Answer 16

Axillary (badge patch injury)

Question 17

A supracondylar fracture poses a risk to which artery?

Answer 17

Brachial

Question 18

What part of x-ray assessment is most important with regard to detecting a supracondylar fracture?

Answer 18

Alignment

Question 19

If a scaphoid fracture is suspected clinically but not seen on x-ray what is done?

Answer 19

Repeat x-ray after 10 days

Question 20

What is a bennett’s fracture?

Answer 20

Intra-articular fracture of the first metacarpal bone