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MSK3 Flashcards

1
Q

spinal deformity determined in degrees and usually found in pediatrics

A

Scoliosis

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2
Q

exaggerated lumbar curve

A

lordosis

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3
Q

curved back that can be a sequele form compression fracture

A

kyphosis

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4
Q

why don’t we xray lumbar spine anymore

A

CT test of choice

but you can still get them in practice

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5
Q

special lumbar views

A

Special views:

lumbosacral spot- locate a specific area of concern

oblique

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6
Q

ABCs of lumbar XRAY

A

ABC’S (alignment, bones, cartilage, soft tissue)

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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)

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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)

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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)

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10
Q

big bulky bodies on the side of the spine

A

lamina

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11
Q

in between the vertebral bodies we have the

A

discs

these should be the same

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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

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13
Q

calcifications near the lumbar spine

A

aorta sitting adjacent

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14
Q

most common fractures of the spine

A

wedge

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15
Q

MOA of wedge

A

Hyperflexion, fall
Osteoporosis, pathologic

stable!

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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

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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

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18
Q

MOA of burst fracture

A

Axial load – jump, fall

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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

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20
Q

RETROPULSION

A

no good
associated with burst fractures
into the canal

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21
Q

what do we need if suspecting a wedge compression fracture

A

plane film and CT to rule out burst

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22
Q

what determines the severity of a wedge fzx

A

> % loss height = >severity

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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

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24
Q

chance fractures are stable or unstable?

A

Ligamentous injury

● Unstable → get a CT scan

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25
Q

Bony defect of the pars interarticularis

A

Spondylolysis

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26
Q

Flexion-distraction injury of spine that extend to involve all 3 spinal columns

A

Chance Fracture

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27
Q

what type of fx is spondylolysis

A

Non-displaced fracture

fracture at the neck of the scotty dog

● L4-L5, L5-S1

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28
Q

what view do we normally see spondylolysis

A

Seen on Lateral Oblique view (not AP or Lateral)

need to order this separately

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29
Q

what population do you normally see spondylolysis

A

common in children gymnists
can be congenital
or repetitive stress

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30
Q

how do you remember spondylolysis

how to remember it

A

Yvonne & Yvette have a dog (2 Y’s → spond Y lol Y sis)

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31
Q

Anterior slippage of the vertebral column relative to an adjacent inferior vertebrae

A

Spondylolisthesis

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32
Q

what is the fx in spondylolosthesis

A

Fracture of pars interarticularis with displacement

Usually a result of bilateral spondylolysis

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33
Q

MC reason for spinal stenosis ? in older pop

A

spondylolisthesis

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34
Q

TRUE

spondylolitsthesis

A

TRUE

spinous process step-off is just above the
subluxed vertebral body with pars interarticularis defect

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35
Q

Pseudospondylolisthesis

A

tep off is below subluxation, pars

interarticularis is intact

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36
Q

Spondylosis =

A

DJD, Osteoarthritis

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37
Q

Characteristic with DJD

A

○ Characteristics: cortical sclerosis, disc space narrowing, spurs

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38
Q

also considered a spondylosis

Usually men <35yo
○ Sacroiliitis, HLA-B23 positive, bamboo spine

A

Ankylosing Spondylitis is also considered a spondylosis

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39
Q

standard view of the pelvis XR

special views

A

Single AP view is common

● Judet views - supine, inlet and outlet views, largely replaced by CT if fx suspected

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40
Q

2/3 of all pelvis fx’s are…. stable or unstable?

A

stable

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41
Q

Avulsions are common in

A

athletes

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42
Q

MC avlusion site of the pelvis

A

(MC at ASIS)

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43
Q

4 types of stable pelvis fx

A

avulsion
duverney’s
ramus
sacral

coocyx also stable

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44
Q

Duverney’s fx

A

● Illiac wing (Duverney’s) – blunt, MVA

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45
Q

Isolated ischium, pubic ramus occurs in

A

fall, osteoporosis

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46
Q

Sacral fx occurs with

A

– fall, direct blow

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47
Q

5 types of unstable pelvic fx

A 
malgaigne-all one side
straddle-symphysis pubis
bucket handle -opposite sides
dislocation
open book-holy shit everything
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48
Q

Unstable pelvic fxs are characterized by

A

pelvic ring is disrupted in ≥ 2 places

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49
Q

Diastasis

A

= separation at SI joints or pubic symphysis

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50
Q

why is unstable pelvis high risk

A

High-risk injury - hemorrhage, pelvic organ injury

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51
Q

standard views for hip fx

A

AP and Frog-leg views (abd external rotation) – standard

need AP pelvis for other type of injury

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52
Q

AP of hip

what position what does it show

A

AP: toes touching → exposes greater and lesser trochanter

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53
Q

how common are hip fxs

and CC

A

250k/yr in US, 20% mortality in elderly

Trauma, osteoporosis, steroids

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54
Q

high risk of AVn with these fxs

A

Displaced neck, subcapital fx’s

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55
Q

tippy top femoral head fx

A

capital

fxs because of the way the bones develop

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56
Q

whole rounded area off at surgical neck

A

subcapital

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57
Q

transcervial

A

middle of the neck

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58
Q

70% of trochanter fxs are

A

interrochanteric

59
Q

when is it subtronchanteric vs femur fx

A

if it involves the lesser trochanter that is subtrochanteric

60
Q

when do you get a MRI for hip fx

A

for occult fxs

61
Q

when would you get a CT for hip fx

A

pre-surg, occult

62
Q

don’t replace the acetabulum with this hip hardware

A

hemiarthroplasty

total hip is with replacement of acetabulum

63
Q

femoral head is lateral and superior with the LE internally rotated and shortened dislocation of the hip

A

posterior

64
Q

externally rotated and shortaned leg

A

very rare 10% anterior

65
Q

how do you get hip dislocation

A

axial force along flexed hip and knee

66
Q

femoral shaft fx what are we worried about

A

high risk of bleeding and compartment syndrome

WAS IT PATHOLOGIC?
this is the biggest bone in the body

67
Q

Intercondylar Notch or “Tunnel View”

A

highlights tibia with femur bent

not really done so much anymore

68
Q

bumper fractures

A

Tibial Plateau

69
Q

MOA in tibial plateau

A

Axial load, valgus force - seen in jumpers
Direct blow “fender fx”

High risk of ligamentous injury
● Order CT scan
● Most require ORIF

70
Q

how can you tell if their is a problem

A

Tibial Plateau - Compression Fx

or femur and plateau don’t line up

usually lateral

71
Q

Segond fx

A

avulsion fx of the lateral tibial condyle

little tiny fx seen with ACL fxs

72
Q

Segond fx best seen on

A

Best seen on Tunnel View

73
Q

*Bipartite Patella

A

NOT a fracture

very smooth
look at 33

74
Q

MC patella fx MOA

A

Direct blow mechanism most common

75
Q

majority of patellar dislocations are

A

lateral

30% w/ ligamentous, meniscus injury

76
Q

two views for patellar dislocations

A

Seen laterally on AP

● Also seen on Sunrise Vie

77
Q

how to test patellar tendon rupture

A

can you kick me flexes

78
Q

patellar tendon rupture will be see with

A

High-riding patella
● Effusion
● Check anterior tibia for avulsion fx

79
Q

MOA of patellar tendon rupture

A

sudden muscle contraction (direction change) or direct blow

80
Q

Butterfly” fracture

A

fragment midshaft of the tibia

81
Q

Ankle views

A

AP
Lateral
oblique (MORTIS)

82
Q

mortis view

A

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
Q

Ankle fxs AABC

A

AABC’S = Adequacy, Alignment, Bones/Periosteum, Cartilage (joint space), Soft

84
Q

3 bones of the ankle

A

Tibia, fibula, talus (special guy)

85
Q

little nobs you need to check on the side of the ankle

A

Check all 3 – medial, lateral, posterior (posterior tibia)

86
Q

Mortise need to look at

A

these space will determine ligament disruption and stability

○ Check width, symmetry

in the spaces
difference between a splint and a surgical ankle

87
Q

sprained ankle could be a break of the

A

distal fibula

surgery mot necessary

88
Q

Bimalleolar Fracture

A

Lateral and medial malleoli fractures. Posterior malleolus INTACT.

unstable goes to surgery

89
Q

spiral fx of the proximal fibula that aka the fracture of necessity

A

Maisonneuve Fracture

90
Q

how does maisonneuve fx

A

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
Q

what do we see with a maisonneuve fx

A

Wide medial mortise (big clue!)
○ MEDIAL malleolar fx
○ Tibiofibular joint widening (syndesmosis disruption)
○ With or without distal fibula fx (classic)

92
Q

what should you do to rule out maisonneuve before film

A

Check proximal leg tenderness in ALL ankle injuries!

93
Q

plafond

A

ornatly decorated ceiling

most distal part of the tibia ceiling of the ankle joint

94
Q

tibial plafond
type
stable or nah
what do you need

A 
Comminuted
● Intraarticular
● Impacted
● Vertical load - jumpers
● Unstable
● Get CT scan right away
95
Q

Talus fx

what are we worried about

A 
Uncommon – but serious
● High force mechanism
● Fracture/dislocation common
● High risk AVN, malunion (doesn’t heal)
● ORIF
96
Q

navicular

A

on top of tallus underneath the 1st cuneiform

97
Q

MC tarsal bone fx

A

Calcaneus Fracture

98
Q

MOA of calcaneus fx

A

Jumpers, axial load or fall from height

99
Q

what will we see with calcaneus

what view

A

lateral or axial

Decreased Bohler’s Angle,
increased Gissane Angle

Can be subtle! CT ALL

100
Q

what do we commonly see associated with calcaneus fxs

A

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
Q

Bohler’s Angle-what does it mean if it is narrow

A

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
Q

Base 5th metatarsal shaft at least 1.5cm from styloid

A

Jones Fx

103
Q

why do you care about a jones

A

○ High incidence non-union - Cast, ORIF

104
Q

Jones Fx MOA

A

○ Direct blow, repeated activity, stress

105
Q

Styloid avulsion fx @ tuberosity of 5th metatarsal

A

○ Walking cast

● These do not require a surgical repair

106
Q

“Dancer’s Fx”

A

Styloid avulsion fx

pseudojones

107
Q

Lisfranc Fracture

A

Midfoot slide-dragged by the horse

Often mechanism is extreme dorsiflexion at
MTP joints – tip-toe position.

108
Q

how to assess for a lisfranc

A

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
Q

what would you do for a lisfranc

A

● Unstable - must refer to podiatrist right away!

● ORIF

110
Q

cartilaginous (it’s not bone yet); looks black on x-rays of kids AKA (3 names)

A

epiphyseal plate is also called the physis or growth plate

111
Q

● Used for pediatric fxs that involve the growth plate

A

Salter-Harris Fracture Classification

112
Q

Salter-Harris Fracture Classification

how many are there

A

● I-V for us,

I-IX for pediatric orthopedists

Higher number = worse prognosis

113
Q

Fx through epiphyseal plate + fx of metaphysis

○ *MC type (up to 75%)

A

Type II

like you tried to rip your pants off but took a corner of your shirt

114
Q

Type IV

A

Fx through epiphyseal plate + fx of epiphysis AND metaphysis

looks like a sword slash

115
Q

Fx through epiphyseal plate + fx of epiphysis

A

Type III

like a little corner

116
Q

Type I :

A

Fx through epiphyseal plate
○ With or without displacement of the epiphysis
○ Difficult to detect w/o displacement

117
Q

Type V :

A

impaction fx involving all/part of the epiphyseal plate

○ Most serious growth consequences

118
Q

What should you do if you suspect a type V

A

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
Q

Tillaux Fx

A

Salter-Harris III fx through anterolateral aspect of distal tibial epiphysis

120
Q

Pediatric Elbow Ossification

acronym

A

○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
Q

first bones to ossify in the hand of child

A

Capitate/hamate first to ossify
everyone gets them

Roughly 1 carpal per year age up
to age 7

122
Q

Radial head epiphysis is seen

A

> age 3

123
Q

Pisiform ~ is seen

A

age 12 – the last one Spiral order

124
Q

Medial epicondyle fuses at

A

fuses at 15-18yrs

125
Q

Growth plates close

A

at 14-17yrs

126
Q

ncomplete break in cortex

A

greenstick fx

127
Q

buckle, bulge, impaction along cortex =

A

torus fx

128
Q

(SCFE)

A

Slipped Capital Femoral Epiphysis

Capital femoral epiphysis slips - posterior/lateral

129
Q

SCFE MC seen in

A

10-15yo obese boys : complain of hip/knee pain

130
Q

SCFE risky because

A

Salter-Harris Type I injury

● Risk for AVN

131
Q

what type of injury is a SCFE

A

Salter-Harris Type I injury

132
Q

Legg-Calve-Perthes (LCP) Dz

A

Avascular necrosis of femoral head, epiphysis

Boys : 4:1 predominant
● Age 4-9 most common

133
Q

knee pain that can progressively worsen to not being able to walk

A

Legg-Calve-Perthes

LCP is idiopathic
● ”Growing pains”
● Limp, hip pain, often knee
pain; usually unilateral
● Seen on AP pelvis
● Tx: hip replacement
134
Q

what is a malleolus tertius fx

what’s another name

A

trimalleolar fx

when all three malleoli are fx including posterior

135
Q

maisonneuve fx occurs where

A

medial malleolar with tibufibular

136
Q

why is the base of the lateral 5th metatarsal at risk

A

shaft

1.5 cm from the styloid
jones

we care about this because of the high incidence of non-union

137
Q

normal gissane’s angle

A

120-140

helps measures calcaneous
if too long then it is broken

138
Q

pseudojones

A

avulsion fx at the tuberosity

139
Q

at the age of three you get which wrist bone

A

Triquetrum

140
Q

at the age of 4 you get which wrist bone

A

lunate

141
Q

when you’re fiver you get the

A

scaphoid

142
Q

at 6 years old which wrist bone develops

A

trapezium

143
Q

wrist bone to develop at sseven

A

trapezoid

radiology (13 decks)

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