MSK3 Flashcards
(143 cards)
1
Q
spinal deformity determined in degrees and usually found in pediatrics
A
Scoliosis
2
Q
exaggerated lumbar curve
A
lordosis
3
Q
curved back that can be a sequele form compression fracture
A
kyphosis
4
Q
why don’t we xray lumbar spine anymore
A
CT test of choice
but you can still get them in practice
5
Q
special lumbar views
A
Special views:
lumbosacral spot- locate a specific area of concern
oblique
6
Q
ABCs of lumbar XRAY
A
ABC’S (alignment, bones, cartilage, soft tissue)
7
Q
what four things are you looking at in an AP of the spine
A
○ Spinous process alignment (AP)
○ Intrapedicular distance (AP)
○ Transverse processes (AP)
○ Vertebral body width (AP)
8
Q
what are you looking at in a lateral of the spone
A
○ Vertebral body height, width, cortex of the bone around the vertebral body (Lateral)
○ Posterior vertebral line (Lateral)
b/c the spinal cord is behind here
○ Disc spaces (Lateral)
9
Q
what are you looking at in both of the AP and the lateral of the spine
A
○ Soft tissue (Both)
○ Free stuff (Both)
10
Q
big bulky bodies on the side of the spine
A
lamina
11
Q
in between the vertebral bodies we have the
A
discs
these should be the same
12
Q
in the lateral view or money shot what should we see
A
curved back lordosis
not exact height in between each but pretty simlar
p
13
Q
calcifications near the lumbar spine
A
aorta sitting adjacent
14
Q
most common fractures of the spine
A
wedge
15
Q
MOA of wedge
A
Hyperflexion, fall
Osteoporosis, pathologic
stable!
16
Q
Loss of height of ______- vertebral body only
seen with wedge compression fractures
A
Loss of height of anterior vertebral body only
anterior column
17
Q
what do we see posteriorly with a wedge fracture
A
Posterior body height and posterior vertebral line
are INTACT
if you have retropulsion it is NOT a wedge fracture if comminuted you have a burst
18
Q
MOA of burst fracture
A
Axial load – jump, fall
19
Q
what do we typically see with a burst fraction
A
Comminuted, entire vertebral body, both anterior and middle columns are disrupted
● Posterior vertebral line is VIOLATED
● Inter-pedicle space disruption
20
Q
RETROPULSION
A
no good
associated with burst fractures
into the canal
21
Q
what do we need if suspecting a wedge compression fracture
A
plane film and CT to rule out burst
22
Q
what determines the severity of a wedge fzx
A
> % loss height = >severity
23
Q
another name for chance fx and associated MOA
A
A.k.a. “Seatbelt fx” – hyperflexion, and propulsion of body forward
force
all the way throguh
usually at the thracolumbar junction
24
Q
chance fractures are stable or unstable?
A
Ligamentous injury
● Unstable → get a CT scan
25
Bony defect of the pars interarticularis
Spondylolysis
26
Flexion-distraction injury of spine that extend to involve all 3 spinal columns
Chance Fracture
27
what type of fx is spondylolysis
Non-displaced fracture
fracture at the neck of the scotty dog
● L4-L5, L5-S1
28
what view do we normally see spondylolysis
Seen on Lateral Oblique view (not AP or Lateral)
need to order this separately
29
what population do you normally see spondylolysis
common in children gymnists
can be congenital
or repetitive stress
30
how do you remember spondylolysis
how to remember it
Yvonne & Yvette have a dog (2 Y’s → spond Y lol Y sis)
31
Anterior slippage of the vertebral column relative to an adjacent inferior vertebrae
Spondylolisthesis
32
what is the fx in spondylolosthesis
Fracture of pars interarticularis with displacement
Usually a result of bilateral spondylolysis
33
MC reason for spinal stenosis ? in older pop
spondylolisthesis
34
TRUE
spondylolitsthesis
TRUE
spinous process step-off is just above the
subluxed vertebral body with pars interarticularis defect
35
Pseudospondylolisthesis
tep off is below subluxation, pars
| interarticularis is intact
36
Spondylosis =
DJD, Osteoarthritis
37
Characteristic with DJD
○ Characteristics: cortical sclerosis, disc space narrowing, spurs
38
also considered a spondylosis
Usually men <35yo
○ Sacroiliitis, HLA-B23 positive, bamboo spine
Ankylosing Spondylitis is also considered a spondylosis
39
standard view of the pelvis XR
special views
Single AP view is common
● Judet views - supine, inlet and outlet views, largely replaced by CT if fx suspected
40
2/3 of all pelvis fx’s are.... stable or unstable?
stable
41
Avulsions are common in
athletes
42
MC avlusion site of the pelvis
(MC at ASIS)
43
4 types of stable pelvis fx
avulsion
duverney's
ramus
sacral
coocyx also stable
44
Duverney’s fx
● Illiac wing (Duverney’s) – blunt, MVA
45
Isolated ischium, pubic ramus occurs in
fall, osteoporosis
46
Sacral fx occurs with
– fall, direct blow
47
5 types of unstable pelvic fx
```
malgaigne-all one side
straddle-symphysis pubis
bucket handle -opposite sides
dislocation
open book-holy shit everything
```
48
Unstable pelvic fxs are characterized by
pelvic ring is disrupted in ≥ 2 places
49
Diastasis
= separation at SI joints or pubic symphysis
50
why is unstable pelvis high risk
High-risk injury - hemorrhage, pelvic organ injury
51
standard views for hip fx
AP and Frog-leg views (abd external rotation) – standard
need AP pelvis for other type of injury
52
AP of hip
what position what does it show
AP: toes touching → exposes greater and lesser trochanter
53
how common are hip fxs
and CC
250k/yr in US, 20% mortality in elderly
| Trauma, osteoporosis, steroids
54
high risk of AVn with these fxs
Displaced neck, subcapital fx’s
55
tippy top femoral head fx
capital
fxs because of the way the bones develop
56
whole rounded area off at surgical neck
subcapital
57
transcervial
middle of the neck
58
70% of trochanter fxs are
interrochanteric
59
when is it subtronchanteric vs femur fx
if it involves the lesser trochanter that is subtrochanteric
60
when do you get a MRI for hip fx
for occult fxs
61
when would you get a CT for hip fx
pre-surg, occult
62
don't replace the acetabulum with this hip hardware
hemiarthroplasty
total hip is with replacement of acetabulum
63
femoral head is lateral and superior with the LE internally rotated and shortened dislocation of the hip
posterior
64
externally rotated and shortaned leg
very rare 10% anterior
65
how do you get hip dislocation
axial force along flexed hip and knee
66
femoral shaft fx what are we worried about
high risk of bleeding and compartment syndrome
WAS IT PATHOLOGIC?
this is the biggest bone in the body
67
Intercondylar Notch or “Tunnel View”
highlights tibia with femur bent
not really done so much anymore
68
bumper fractures
Tibial Plateau
69
MOA in tibial plateau
Axial load, valgus force - seen in jumpers
Direct blow “fender fx”
High risk of ligamentous injury
● Order CT scan
● Most require ORIF
70
how can you tell if their is a problem
Tibial Plateau - Compression Fx
or femur and plateau don't line up
usually lateral
71
Segond fx
avulsion fx of the lateral tibial condyle
little tiny fx seen with ACL fxs
72
Segond fx best seen on
Best seen on Tunnel View
73
*Bipartite Patella
NOT a fracture
very smooth
look at 33
74
MC patella fx MOA
Direct blow mechanism most common
75
majority of patellar dislocations are
lateral
| 30% w/ ligamentous, meniscus injury
76
two views for patellar dislocations
Seen laterally on AP
| ● Also seen on Sunrise Vie
77
how to test patellar tendon rupture
can you kick me flexes
78
patellar tendon rupture will be see with
High-riding patella
● Effusion
● Check anterior tibia for avulsion fx
79
MOA of patellar tendon rupture
sudden muscle contraction (direction change) or direct blow
80
Butterfly” fracture
fragment midshaft of the tibia
81
Ankle views
AP
Lateral
oblique (MORTIS)
82
mortis view
the space between these three bones
talus
tibia
and fibula
the space between
this is more important than the bones because it is the ligamentus connection and the way in which the bones relate to each other
83
Ankle fxs AABC
AABC’S = Adequacy, Alignment, Bones/Periosteum, Cartilage (joint space), Soft
84
3 bones of the ankle
Tibia, fibula, talus (special guy)
85
little nobs you need to check on the side of the ankle
Check all 3 – medial, lateral, posterior (posterior tibia)
86
Mortise need to look at
these space will determine ligament disruption and stability
○ Check width, symmetry
in the spaces
difference between a splint and a surgical ankle
87
sprained ankle could be a break of the
distal fibula
| surgery mot necessary
88
Bimalleolar Fracture
Lateral and medial malleoli fractures. Posterior malleolus INTACT.
unstable goes to surgery
89
spiral fx of the proximal fibula that aka the fracture of necessity
Maisonneuve Fracture
90
how does maisonneuve fx
force tears the fibula at the syndysmosis of the tibia seen with a rotational force followed all the way up the interosseous membrane with a fracture of the proxima fibula
Associated with injury to the medial side of the ankle and disruption of the distal tibiofibular syndesmosis
91
what do we see with a maisonneuve fx
Wide medial mortise (big clue!)
○ MEDIAL malleolar fx
○ Tibiofibular joint widening (syndesmosis disruption)
○ With or without distal fibula fx (classic)
92
what should you do to rule out maisonneuve before film
Check proximal leg tenderness in ALL ankle injuries!
93
plafond
ornatly decorated ceiling
most distal part of the tibia ceiling of the ankle joint
94
tibial plafond
type
stable or nah
what do you need
```
Comminuted
● Intraarticular
● Impacted
● Vertical load - jumpers
● Unstable
● Get CT scan right away
```
95
Talus fx
what are we worried about
```
Uncommon – but serious
● High force mechanism
● Fracture/dislocation common
● High risk AVN, malunion (doesn’t heal)
● ORIF
```
96
navicular
on top of tallus underneath the 1st cuneiform
97
MC tarsal bone fx
Calcaneus Fracture
98
MOA of calcaneus fx
Jumpers, axial load or fall from height
99
what will we see with calcaneus
what view
lateral or axial
Decreased Bohler’s Angle,
increased Gissane Angle
Can be subtle! CT ALL
100
what do we commonly see associated with calcaneus fxs
Compression fx of lumbar spine is common w/ these fx’s b/c axial load is transferred → get plain films L-spine too
need to examine the spine
101
Bohler’s Angle-what does it mean if it is narrow
If decreased Bohler’s angle → suspect compression fx of the calcaneus → get a CT scan of calcaneus
Normal Bohler’s angle does NOT rule out a fracture
20-40 is normal
if less it is too short
102
Base 5th metatarsal shaft at least 1.5cm from styloid
Jones Fx
103
why do you care about a jones
○ High incidence non-union - Cast, ORIF
104
Jones Fx MOA
○ Direct blow, repeated activity, stress
105
Styloid avulsion fx @ tuberosity of 5th metatarsal
○ Walking cast
| ● These do not require a surgical repair
106
“Dancer’s Fx”
Styloid avulsion fx
pseudojones
107
Lisfranc Fracture
Midfoot slide-dragged by the horse
Often mechanism is extreme dorsiflexion at
MTP joints – tip-toe position.
108
how to assess for a lisfranc
1st and 2nd MT alignment w/ 1st and 2nd cuneiform respectively
4 and 5th MT alignment w/ cuboid
Fx at proximal 2nd or 3rd MT
MT/cuboid spacing on AP/oblique
109
what would you do for a lisfranc
● Unstable - must refer to podiatrist right away!
| ● ORIF
110
cartilaginous (it’s not bone yet); looks black on x-rays of kids AKA (3 names)
epiphyseal plate is also called the physis or growth plate
111
● Used for pediatric fxs that involve the growth plate
Salter-Harris Fracture Classification
112
Salter-Harris Fracture Classification
| how many are there
● I-V for us,
I-IX for pediatric orthopedists
Higher number = worse prognosis
113
Fx through epiphyseal plate + fx of metaphysis
| ○ *MC type (up to 75%)
Type II
like you tried to rip your pants off but took a corner of your shirt
114
Type IV
Fx through epiphyseal plate + fx of epiphysis AND metaphysis
looks like a sword slash
115
Fx through epiphyseal plate + fx of epiphysis
Type III
like a little corner
116
Type I :
Fx through epiphyseal plate
○ With or without displacement of the epiphysis
○ Difficult to detect w/o displacement
117
Type V :
impaction fx involving all/part of the epiphyseal plate
| ○ Most serious growth consequences
118
What should you do if you suspect a type V
Most serious growth consequences
○ Really difficult to diagnose Salter-Harris 5 on plain x-rays
○ If you suspect a S-H 5 → call the radiologist (first) or get a CT
119
Tillaux Fx
Salter-Harris III fx through anterolateral aspect of distal tibial epiphysis
120
Pediatric Elbow Ossification
acronym
○C apitellum 1 yr (1-8mo)
○ R adial head 3 yr (3-6yr)
○ I nternal (medial) epicondyle 5 yr (3-7yr)
○ T rochlea 7 yr (7-10yr)
○ O lecranon 9 yr (8-10yr)
○ E xternal (lateral) epicondyle 11 yr (11-12y)
121
first bones to ossify in the hand of child
Capitate/hamate first to ossify
everyone gets them
Roughly 1 carpal per year age up
to age 7
122
Radial head epiphysis is seen
>age 3
123
Pisiform ~ is seen
age 12 – the last one Spiral order
124
Medial epicondyle fuses at
fuses at 15-18yrs
125
Growth plates close
at 14-17yrs
126
ncomplete break in cortex
greenstick fx
127
buckle, bulge, impaction along cortex =
torus fx
128
(SCFE)
Slipped Capital Femoral Epiphysis
Capital femoral epiphysis slips - posterior/lateral
129
SCFE MC seen in
10-15yo obese boys : complain of hip/knee pain
130
SCFE risky because
Salter-Harris Type I injury
| ● Risk for AVN
131
what type of injury is a SCFE
Salter-Harris Type I injury
132
Legg-Calve-Perthes (LCP) Dz
Avascular necrosis of femoral head, epiphysis
Boys : 4:1 predominant
● Age 4-9 most common
133
knee pain that can progressively worsen to not being able to walk
Legg-Calve-Perthes
```
LCP is idiopathic
● ”Growing pains”
● Limp, hip pain, often knee
pain; usually unilateral
● Seen on AP pelvis
● Tx: hip replacement
```
134
what is a malleolus tertius fx
what's another name
trimalleolar fx
when all three malleoli are fx including posterior
135
maisonneuve fx occurs where
medial malleolar with tibufibular
136
why is the base of the lateral 5th metatarsal at risk
shaft
1.5 cm from the styloid
jones
we care about this because of the high incidence of non-union
137
normal gissane's angle
120-140
helps measures calcaneous
if too long then it is broken
138
pseudojones
avulsion fx at the tuberosity
139
at the age of three you get which wrist bone
Triquetrum
140
at the age of 4 you get which wrist bone
lunate
141
when you're fiver you get the
scaphoid
142
at 6 years old which wrist bone develops
trapezium
143
wrist bone to develop at sseven
trapezoid
