Musculoskeletal Radiology Flashcards
How many and what type of views do you order for conventional radiographs of bone?
At least 2 views at 90degree angle to each other (orthogonal views)
If a trauma patient comes to see you, what is the first thing that you do?
Stabilize the patient
What is the dense portion of the bone?
The outer cortex
What is the less dense portion of the bone?
The inner medullary cavity
Where is cancellous/trabecular bone located?
The medullary cavity
How does the cortex appear in radiographs?
A smooth white shell, dense white band
How does the medullar cavity appear in radiographs?
A core of gray material
What views would you order for a sternoclavicular injury?
PA and oblique of the manubrium
What views would you order for a rib injury?
PA and oblique CXR
What views would you order for a thoracic spine injury?
AP and lateral C7-L1
What views would you order for a lumbar spine injury?
AP and lateral T11-distal sacrum
What view would you order for a pelvis injury?
AP from L5/pelvic girdle - greater trochanter of femur
What views would you order for an acetabulum injury?
Upside and downside (Judet method)
What views would you order for a femur injury?
AP and lateral
What views could you order for a patella injury?
PA, lateral, oblique, or “sunrise”
How does the physis appear on a radiograph?
Dark
What defines a dislocation?
Bones that used to form a joint are no longer in apposition to each other
What defines a subluxation?
Bones that used to form a joint are in partial contact with each other
Define a complete fracture.
Broken completely through the cortex.
Define an incomplete fracture.
Only a part of the cortex is fractured.
How do fracture lines appear in a radiograph?
Blacker, more lucent
What does a posterior “sail sign” suggest?
An occult fracture of the humerus near the elbow joint.
What does an anterior “sail sign” suggest?
It’s normal.
Where and how do pathologic fractures occur?
In bone with a preexisting abnormality with minimum or no trauma
What is a local cause of pathologic fracture?
Metastasis
What is a diffuse cause of pathologic fracture?
Rickets
Where are pathologic fractures most common?
Ribs
Spine
Proximal appendicular skeleton (humerus, femur)
How will pathologic fractures present in radiographs?
Bone surrounding the fracture will be abnormally dense (radiopaque)
How would you treat a pathologic fracture?
Treat the underlying condition.
What 4 descriptors are used when referring to fractures?
Number
Direction of line
Relationship of fragments to each other
Communication with outside environment
Define a simple fracture.
Two fragments
Define a comminuted fracture.
> 2 fragments
What is a segmental fracture?
A portion of the shaft is an isolated fragment.
What is a butterfly fragment?
A central fragment that has a triangular shape.
A force was applied perpendicular to the long axis of a bone, and a fracture occurred at the point of impact. What direction is the fracture line?
Transverse
A force was applied to the long axis of bone, and a fracture occurred somewhere along the shaft. What direction is the fracture line?
Diagonal/Oblique
A twisting or torque injury occurred. What direction is the fracture line?
Spiral
In what population are spiral fractures most common?
Kids
What term does this describe: “The amount by which the distal fragment is offset”
Displacement
What term does this describe: “The angle between the distal and proximal fragments”
Angulation
What term does this describe: “How much, if any, overlap there is of the ends of the fracture fragments”
Shortening
What is the most common type of fracture: Closed or Compound/Open?
Closed
What communication does a closed fracture have with the outside environment?
No communication
What implications must be addressed by deeming a fracture closed or open?
The way the fracture is treated in order to avoid osteomyelitis
What type of fracture involves only one part of the cortex?
Greenstick fracture
In what population are Greenstick fractures most common?
Kids
What type of fracture is caused by longitudinal compression of the soft bone, characterized by localized bulging?
Torus/buckle fracture
What type of fracture occurs when a fragment is pulled from its parent bone by contraction of a tendon/ligament?
Avulsion fracture
What is a Type I Salter-Harris fracture?
Straight across
What is a Type II Salter-Harris fracture?
Above, in the metaphysis
What is a Type III Salter-Harris fracture?
Lower, in the epiphysis
What is a Type IV Salter-Harris fracture?
Two/Through, in the metaphysis and epiphysis
What is a Type V Salter-Harris fracture?
ERasure of the growth plate
What type of fracture involves a dorsal angulation of the distal radial fracture fragment?
Colle’s fracture
What causes a Colle’s fracture, and what is an associated fracture?
FOOSH
Fracture of the ulnar styloid
What fracture involves a palmar angulation of the distal radial fragment?
Smith’s fracture
What causes a Smith’s fracture?
A fall on the back of a flexed hand
What type of fracture involves a fracture of the head of the 5th metacarpal with palmar angulation of the distal fragment?
Boxer’s fracture
What type of fracture is characterized by tenderness int he anatomic snuffbox?
Scaphoid fracture
What type of fracture involves a fracture of the radius (dorsal angulation) with shortening and dislocation of the distal ulna?
Galeazzi fracture
What causes a Galeazzi fracture?
FOOSH with elbow flexed
What type of fracture involves anterior dislocation of radial head with dorsally angulated ulna fracture?
Monteggia fracture
What causes a Monteggia fracture?
Direct blow to the forearm
What is the most common fracture of the elbow in a child?
Supracondylar fracture of distal humerus
What characteristics are produced by a supracondylar fracture of the distal humerus?
Posterior displacement of distal humerus
Anterior humeral line (in lateral view)
What type of fracture is a transverse fracture of the 5th metatarsal near the base?
Jones fracture
What causes a Jones fracture?
Plantar flexion of the foot and inversion of the ankle
What type of fracture is caused by repeated microfractures to the foot from trauma?
March fracture
What bones are affected by a March fracture?
Most often the shafts of the 2nd and 3rd metatarsals
What fracture is frequently related to osteoporosis?
Hip fracture
What view do you order when suspecting a hip fracture?
Radiograph of femoral neck with leg internally rotated
What fracture involves the tarsometatarsal joint?
Lisfranc fracture
What causes a Lisfranc fracture?
Excessively loading the mid-foot
