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Clinical Medicine I > Musculoskeletal Imaging > Flashcards

Musculoskeletal Imaging Flashcards

1
Q

What is the hard outer surface of bone that provides skeletal support and is the site of attachment for tendons and ligaments?

A

Cortical Bone

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2
Q

What is the “spongy”/trabeucular bone found at the ends of long bones, pelvis, ribs, skull, and vertebrae and contains red and yellow bone marrow?

A

Cancellous Bone

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3
Q

What does the Axial Skeleton consist of?

A 
Bones of the Head and Trunk:  Skull Bones
Ossicles of Middle Ear
Hyoid Bone
Rib cage
Sternum and Vertebral Column
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4
Q

What are the six regions of the appendicular skeleton?

A 
Pectoral Girdles
Arms and Forearms
Hands
Pelvis
Thigh/Legs
Feet/Ankles
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5
Q

What type of bone marrow are precursors to RBC’s and are found in the axial skeleton after 30?

A

Red Bone Marrow

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6
Q

What type of bone marrow contains fat and is found in the appendicular skeleton after 30?

A

Yellow Marrow

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7
Q

What are fibrous cords of tissue that attach muscles to bone?

A

Tendons

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8
Q

What are fibrous cords of tissue that attach bone to bone?

A

Ligaments

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9
Q

What is the best clinical guideline criteria recommended by Professor Smith?

A

The American College of Radiology Appropriateness Criteria

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10
Q

What is the initial imaging study of choice following skeletal trauma?

A

XRAY

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11
Q

What are xrays used to evaluate?

A 
Cortical Integrity
Articular Surface Congruity
Joint Space
Osseous lesions
Bone Density (not as commonly used)
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12
Q

What questions should you ask when interpreting?

A 
Trauma?
Overuse Injury?
Acute/Insidious Injury?
Mechanism of Injury?
General Health of Patient?
Injury Pattern?
Compare prior studies
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13
Q

What are three types of Mechanism of Injury?

A

FOOSH
Rotational Injury
Deceleration Injury

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14
Q

What are three types of Injury Patterns?

A

Traumatic/Atraumatic
High/Low Velocity
Acute/Chronic

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15
Q

The location and appearance of fracture depend on what three factors?

A

Mechanism of Injury
Age of the Patient
Predisposing Factors

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16
Q

What should you always do before getting an xray?

A

Examine the patient first

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17
Q

When ordering xrays, how many views should you order?

A

at least 2 orthogonal views; typically AP/Lateral

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18
Q

What should you do if a patient is symptomatic and high clinical suspicion of fracture but a negative xray?

A

Treat as fracture and splint
Have patient follow up with ortho in 7-10 days
Repeat xrays may show cortical changes

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19
Q

What is a comminuted fracture?

A

any fracture with more than 2 fragments

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20
Q

What types of fractures are the least common?

A

Spiral fractures

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21
Q

What is a butterfly Fracture?

A

subtype of comminuted fracture with wedge shaped fragment along the shaft of bone

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22
Q

When interpreting an xray what should you make sure is correct?

A 
patients Name, gender, DOB
Correct patient
Correct date
Correct region of Body part
Correct side
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23
Q

What do you look for when interpreting an xray?

A 
Open vs. Closed
Anatomic Location
Morphology of Fracture Line
Displacement
Distraction
Angulation
Rotation
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24
Q

What do most fractures appear as on xray?

A

radiolucent lines

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25
Q

Where is the most common site for Mach Bands?

A

ankle radiographs where tibia overlaps the fibia

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26
Q

What types of fractures appear as sclerotic fracture lines?

A

compression fractures

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27
Q

Where are sclerotic fracture lines most common?

A

vertebral bodies

Distal radius

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28
Q

Where is cortical buckling often seen?

A

distal radius

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29
Q

What are the three aspects of displacement?

A

Translation
Angulation
Rotation

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30
Q

What does translation (displacement) describe?

A

direction of translation of the distal fracture component compared to proximal

The amount of translation in %

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31
Q

What does the AP view show in regards to displacement?

A

medial to lateral displacement

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32
Q

What does the lateral view show in regards to displacement?

A

anterior to posterior displacement

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33
Q

What does angulation describe?

A

direction of angulation of distal facture component as compared to proximal

Amount of angulation in degrees

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34
Q

How is rotation seen easiest?

A

when looking at orientation of joints above and below fracture

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35
Q

What commonly causes distraction?

A

transverse fractures the results from tension force

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36
Q

What is distraction?

A

when a fracture is separated by a gap with no overlap

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37
Q

What is tension force and examples?

A

pulls or stretches two objects apart

medial malleolar and pattela fracture

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38
Q

What is alignment?

A

proximal femur fractures that are subtle and appear as misalignment of trabeculae across the femoral neck

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39
Q

What type of injury is most missed by inexperienced readers?

A

Anterior dislocation of 5th metacarpal base

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40
Q

What is impaction?

A

bones are wedged into each other

stable fracture

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41
Q

What is an avulsion fracture?

A

caused by abnormal tensile stress on ligaments of tendons and occurs at hands, feet, and pelvis

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42
Q

What is associated with dorsal distal phalanx avulsion?

A

extensor tendon

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43
Q

What is associated with base of fifth metatarsal avulsion?

A

peroneous brevis

44
Q

What is associated with ischial tuberosity avulsion?

A

hamstring tendon

45
Q

What helps in identifying an underlying fracture?

A

soft tissue swelling especially trauma to metacarpals and phalanges

46
Q

What are joint effusions?

A

blood or inflammatory fluid or both near the joint which may be due to intra-articular injury to either the soft tissues or adjacent bone

47
Q

Joint effusion in acute setting in patient with no underlying arthritis is presumptive sign of what?

A

hemarthrosis

48
Q

What tendons should you check on a lateral ankle and lateral knee view?

A

quad and patella tendons

Achilles tendon

49
Q

What may be present near ruptured tendons?

A

large effusions

50
Q

What is beignet apposition?

A

comminuted fracture of the clavicle in which the distal end comes underneath the proximal end

51
Q

What is normal to see in a shoulder xray?

A

the humerus head overlapping the glenoid

52
Q

What two xray views help us to view how the shoulder is dislocated?

A

scapular Y and axial

53
Q

What does the scapular Y view show if shoulder is dislocated?

A

the humeral head will be somewhere in the chest

54
Q

What does an axial view show?

A

whether the shoulder is dislocated anteriorly or posteriorly

55
Q

What is a proximal humerus fracture and how is it treated?

A

unstable fracture of the neck of the humerus

Treat with open reduction and internal fixation

56
Q

What would be visible if the shoulder is dislocated anteriorly?

A

the corocoid process will protrude

57
Q

Where do you see the Sail Sign and what does it suggest?

A

Sail Sign is seen on lateral view of elbow as fluid near joint

Suggests a radial head fracture

58
Q

What is a common elbow fracture and its treatment?

A

Fracture of the lateral condyle of the humerus

treated by open reduction internal fixation

59
Q

What does a Nightstick Fracture occur from?

A

Direct force on forearm; its a defensive injury

60
Q

What is a Buckle Fracture known as (often seen on PANCE)?

A

Torus Fracture

61
Q

What is a Colles Fracture?

A

fracture of the distal radial metaphysis with dorsal angulation and impaction

Common

Extra-articular

62
Q

What is a Colles fracture caused by?

A

FOOSH

63
Q

What type of fracture accounts for 10% of all fractures and 40% of hand fractures?

A

metacarpal fractures

64
Q

What fractures make up 25% of all metacarpal fractures and 10% of hand fractures?

A

Fractures of 5th metacarpal which is usually the results of direct trauma

65
Q

What is the treatment for 5th metacarpal fractures?

A

Nothing, they are stable and function will remain the same without treatment

66
Q

What does SCFE stand for?

A

Slipped Capital Femoral Epiphysis

67
Q

What causes a transverse distal femoral shaft fracture?

A

a high velocity injury like a motor vehicle crash or direct force

68
Q

What is a transverse fracture?

A

fracture that is perpendicular to long axis of bone; stable fracture

69
Q

What commonly causes a transverse fracture?

A

direct force or tension force

70
Q

Where is a transverse fracture most common?

A

Forearm/leg

71
Q

What is an oblique fracture?

A

inherently unstable fracture

72
Q

What commonly causes an oblique fracture?

A

indirect forces

compression and angulation forces combine to cause shear force

73
Q

How is an oblique fracture repaired?

A

In the OR

74
Q

What type of fracture is least common?

A

Spiral Fracture

75
Q

What creates a spiral fracture?

A

twisting movement through the long bone axis creating a rotation/shear forces

76
Q

What type of fracture is a spiral fracture?

A

unstable and repaired in OR

77
Q

What is a comminuted fracture?

A

fracture that has > 2 fragments

78
Q

What type of fracture is a comminuted?

A

unstable that needs to be repaired in the OR

79
Q

What side is a butterfly fragment produced on?

A

the concave, compression side

80
Q

What causes a butterfly fragment?

A

indirect force producing a bending of bone with resultant tension vector on convex side and compression vector on concave side

81
Q

What is a greenstick fracture?

A

incomplete fracture of long bone produced on convex cortex, while concave cortex becomes bent; without a visible grack

82
Q

What side is a greenstick fracture on?

A

convex side

83
Q

Where does a greenstick fracture usually occur?

A

in the forearm of young children

84
Q

What causes a greenstick fracture?

A

bending force applied perpendicular to shaft

85
Q

What is a Buckle/Torus Fracture?

A

type of incomplete fracture that occurs at metaphyseal diaphyseal junction

86
Q

What causes a Buckle Fracture?

A

FOOSH

87
Q

Is a buckle fracture stable or unstable

A

VERY STABLE and well heal more quickly than greenstick fracture

88
Q

What is an avulsion fracture caused by?

A

abnormal tensile stress on ligaments/tendons

89
Q

What is the most important Fracture Classification System that we need to know?

A

Salter-Harris System

90
Q

What are Salter-Harris Fractures?

A

epiphyseal plate fractures in children typically 10-15 yrs old

91
Q

Why are Salter-Harris fractures so important?

A

they can result in premature closure of growth plate and they represent 35% of all skeletal injuries in children

92
Q

What is Salter Harris Type 1 fracture?

A

Fracture plane passes all the way through the growth plate, not involving bone

Cannot occur if growth plate is fused

93
Q

What is the percentage of Type 1 SHF?

A

5-7%

94
Q

What is the most common Salter Harris Fracture?

A

Type 2; 75%

95
Q

What is a Salter Harris Type 2 Fracture?

A

Fracture passes across most of the growth plate and up through the metaphysis

96
Q

Which Salter-Harris fractures have a good prognosis?

A

Type 1 and 2

97
Q

What is a Type 3 Salter Harris Fracture?

A

fracture plane passes some distance along the growth plate and down through the epiphysis

98
Q

What is the percentage of Type 3 SHF?

A

7-10%

99
Q

What is a Salter Harris Type 4 fracture?

A

fracture is continuous through the metaphysis, physis, and epiphysis

100
Q

What is the percentage of Type 4 SHF?

A

10%

101
Q

What type of SHF has a poor prognosis because the proliferative and reserve zones are interrupted?

A

Type 4

102
Q

What type of SHF has the worst prognosis?

A

Type 5

103
Q

What is a type 5 SHF?

A

crushing type injury does not displace the growth plate but damages it by direct compression

104
Q

What is the percentage of Type 5 SHF?

A

< 1%

105
Q

What will you see in a SHF type 5?

A

several fractures within calcaneus

106
Q

What helps to confirm a Type 5 SHF?

A

complete obliteration or diminished physeal distance of the affected extremity

107
Q

What is the mnemonic for Salter Harris Fractures?

A 
S = space
A = above plate
L = lower
T = through
R = really bad

Clinical Medicine I (15 decks)

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