MSK - Trauma

Question 1

Tillaux fracture

Answer 1

Salter Harris III fracture of the lateral tibial epiphysis, avulsion of the anterior inferior tib-fib ligament; occurs because physis fuses medial to lateral (so lateral weaker)

Question 2

Triplane fracture

Answer 2

Vertical epiphyseal fracture, horizontal physical fracture, oblique metaphyseal fracture

Question 3

Wagstaffe-Lefort fracture

Answer 3

Avulsion of ant distal fibular at site of insertion of ATFL (from the fibular attachment); Tillaux-Chaput involves the tibial insertion

Question 4

Maisonneuve fracture

Answer 4

High fibular fracture with interosseous membrane tear or medial malleolar fracture; look for subtle medial joint space widening on the AP radiograph

Question 5

Pilon fracture

Answer 5

Comminuted vertically oriented fracture of distal tibia involving the tibial plafond

Question 6

Segond fracture is associated with

Answer 6

Avulsion fracture at insertion of lateral capsular ligament
ACL injury and IT band injury
NB: IT band inserts on Gerdy’s tubercle of the tibia

Question 7

Imaging findings Tennis leg

Answer 7

Tear at medial gastroc myotendinous junction

Rupture of plantaris tendon

Question 8

Avulsion sites in pelvis

Answer 8

ASIS - sartorius
AIIS - rectus femoris
Greater trochanter - gluteus medius/minimus
Lesser trochanter - iliopsoas
Ischial tuberosity - hamstrings

Question 9

Fracture classification for acetabular #

Answer 9

Judet-Letournel

Question 10

Fracture classification system for femoral head?

Femoral neck?

Answer 10

Pipkin - femoral head

Garden - sub capital femoral neck (based on degree of valgus displacement)

Question 11

Classic location of stress fracture in femur

Answer 11

Inferomedial femoral neck, less commonly in superior femoral head

Question 12

Classification system for AC joint injury

Answer 12

Rockwood

Question 13

What is laxation erecta

Answer 13

Inferior shoulder dislocation
Often association with cuff tear and GT fracture
Injury to axillary nerve or artery

Question 14

List the anterior-inferior instability lesions of the shoulder

Answer 14

• HAGL - humeral avulsion of the glenohumeral ligament ( presents with fluid/edema in axillary recess, avulsion of ligament from surgical neck)
• BHAGL - same as above but have bony avulsion
• Bankart
• ALPSA - labral tear still attached to periosteum
• Perthes - same as above, but flipped under and heals with bulky appearance
• Floating AIGHL

*Note - GLAD lesions do not tend to be associated with instability

Question 15

List the posterior inability lesions of the shoulder

Answer 15

• PHAGL
• Reverse bankart
• Congenital hypoplastic posterior glenoid

Question 16

What is the Bennett lesion? (seen in baseball players)

Answer 16

Ossification posterior band IGHL - associated with posterior labral injury, and tears of infraspinatus and teres minor

Question 17

What is Essex-Lopresti fracture?

Answer 17

Radial head # + ulnar dislocation at DRUJ

Question 18

Monteggia versus Galeazzi

Answer 18

“GRUM” (which bone is fractured)
Monteggia - ulnar shaft fracture, prox radial head dislocation
Galeazzi - radial shaft fracture, distal ulna dislocation

Question 19

Types of distal radial fractures

Answer 19

Colles
Smith
Barton
Reverse Barton
Chauffeur (intra-articular involving the radial styloid)

Question 20

Kienbock disease

Answer 20

NEGATIVE ulnar variance predisposing factor
Usually involves the whole lunate (edema –> sclerosis)

DDx: ulnar impaction syndrome - POSITIVE ulnar variance (changes seen along proximal aspect of lunate)

Question 21

What is a Stener lesion

Answer 21

Complication of UCL injury, complete disruption with interposition of adductor aponeurosis
Results in mass like area proximal to joint line, adjacent to metacarpal head which (ball on yo-yo sign)

Question 22

Which muscle is involved in ischiofemoral syndrome?

Answer 22

Quadratus femoris

Question 23

What is distal intersection syndrome? proximal intersection syndrome?

Answer 23

Distal: When the tendons in the 2nd and 3rd compartment “cross over”, EPL tendon (3rd compart) crosses over ECRB/ECRL (2nd compart), usually happens at the joint, Listers tubercle plays a role

Proximal: Proximal to distal radius, when APL& EPB (1st compart) crosses over tendons in second compart approx. 5 cm proximal to joint

Question 24

Difference in sublabral foramen versus recess in shoulder (SLAP tear mimics)

Answer 24

• Foramen: in the FRONT, from 1-3 o’clock

- Recess: in the ROOF, from 11-1 o’clock (at biceps insertion)

Question 25

What is a Bennett lesion in the shoulder?

Answer 25

Traction injury, usually in throwing athletes (thrower’s exostosis) - curvilinear band of calcification/ossification along posterior IGHL

Question 26

Imaging findings in posterior interosseous nerve syndrome

Answer 26

• Entrapment neuropathy, branch of radial nerve i.e. PIN
• Cause: Multiple sites of compression (orthobullets); Arcade of Frohse, b/w brachialis and brachioradialis
• Can also occur post trauma to radial head
• Involves supinator and proximal forearm extensor muscles - edema or atrophy depending on acuity

Question 27

Impingement syndromes around the knee

Answer 27

• Suprapatellar: inflamed quadriceps FP

- Infrapatellar: Hoffa’s disease (diffuse involvement) and patellar maltracking /PT-LFCFS (superolateral FP)