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Musculoskeletal System X-Ray Flashcards

1
Q

MSK X-Ray Systematic Approach (6 Steps)

A
  1. Bone structure alignment
  2. Joint space eval
  3. Bone cortex integrity
  4. Medullary bone texture
  5. Soft tissues
  6. Visible abnormalities
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2
Q

Joint Alignment considerations (2)

A
  1. Smooth cortical outline (if jagged, fx)
  2. Typical bone articulation (if unaligned, dislocation)
  3. Joints c adequate space (if uneven or narrowed, arthritis. if widened, dislocation)
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3
Q

Cortex Evaluation

A
  • Follow cortical outline around the edge of each bone, including in joint space
  • Cortex continuity directly relates to bone integrity
  • Cortical outline disturbances can indicate fracture
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4
Q

Identify Pathology

A

Osteoporosis or Osteopenia

Significant Findings

  • Relatively transparent bone density (compare c picture here)
  • More likely to fx
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5
Q

Identify pathology (present in both pictures)

A

Widened Joint Space (consistent c potential dislocation or fx)

  • Significant Findings*
  • Abnormal separation between joints (R image is too posterior, L image is completely disarticulated)
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6
Q

Soft Tissue Observations on X-ray (4)

A
  1. Sprain
  2. Bursitis
  3. Infection
  4. Bleeding into joint
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7
Q

Identify Pathology

A

Olecrenon Bursitis

  • Significant Findings*
  • Congruous transparent tissue shadow around elbow joint c regular edges
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8
Q

Comparison View (explaination, 2 examples)

A

Explanation: Since each body has normal varients, comparing against self is the best basis for identifying normal varient vs pathology

Examples:

  1. Right vs. Left; Cortical abnormality of injured side will appear differently than uninjured side
  2. New vs. Old; This is great to show progress of conditions like stress fx or lytic lesions
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9
Q

Lytic Lesion (def, eval method)

A

Definition: Malignant process where lesions eat away at bone

Evaluation: Comparison of new and old films is a good indicator of disease progression

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10
Q

Long Bone Fractures (4 types, descriptions)

A
  1. Transverse: fx line perpendicular to long bone direction
  2. Oblique: fx line passes at an angle to long bone direction
  3. Comminuted: fx in >2 segments, fragmented
  4. Spiral: fx line spirals/twists around long axis of bone
    • Often indication of abuse
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11
Q

Identify Pathology

A

Transverse Tibial Fracture

  • Significant Findings:*
  • Fx crossing perpendicular to cortical outline
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12
Q

Explain Pathology (not letting you get away that easily)

A

Fibula: While fibula does not have a straight fracture line transversing the bone, there are only two pieces of bone. Therefore, this is a transverse fx

Tibia: There are multiple bone fragments in the distal portion of the bone. This is best noted on the highly irregular right cortical border in Film B.

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13
Q

Identify Pathology

A

Oblique Femural Fx

  • Significant Findings:*
  • Singular fx at an angle to the cortical border
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14
Q

Explain Pathology

A

Femoral shaft is in >2 fragments. All fragments are limited to mid-upper femoral shaft

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15
Q

Identify Pathology

A

Spiral Tibia and Fibula Fractures

Significant findings

  • Twisting oblique fracture lines on both tib and fib (fibula is most noted on the left-most picture)
  • Decreased ankle mortise
  • ​*Note
  • Often result of limb-twisting. This is almost exlusively restricted to physical abuse MOIs
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16
Q

Identify Pathology

A

Spiral Tibia Fracture

  • Significant findings*
  • Twisting oblique fracture lines on tibia

​Note

Often result of limb-twisting. This is almost exlusively restricted to physical abuse MOIs

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17
Q

Displacement (define, describe in context of long bone fx)

A

Definition: Loss of bone alignment

Description: Usually a result of angulation, bone will not “fit” appropriately into joint. There is a high liklihood for associated dislocation

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18
Q

Shortening (describe in context of long bone fx)

A

When a full-thickness fx occurs, the bone displacement may create overlap between disconnected segments, making the bone appear shorter. The distal fragment will migrate

Example: Identifying quality of hip fx is that affected leg will appear shorter than unaffected leg, both on x-ray and phys examination

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19
Q

Identify Pathology

A

Displaced Oblique 4th Metatarsal Shaft Fx

Signifiant Features:

  • discontinuity of cortical border
  • loss of alignment; movement of distal fragment
  • ​*Note
  • Little to no shortening, likely due to muscular and ligamentus integrity of the foot in addition to lack of repeated pressure application. (That is my guess, at least. History will reveal more)
20
Q

Identify Pathology

A

Transverse Tibial and Spiral Fibular Fractures

Significant Findings:

  • Incongruous cortical borders
  • Displacement of distal fragments
  • Shortening of long bones
  • ​*Note
  • Fxs stabalized c a locked reamed intramedullary nail, shown
21
Q

Pathological Fractures (definition, most common example)

A

Definition: Fractures that arise in bones weakened by disease

Most Common: Osteoperosis-based fractures

22
Q

Identify Pathology and Explain Pathogenesis

A

Left Medial Midshaft Humeral Pathological Fx

Pathogenesis

  • Pt presented with metastatis cancer (in this case, prostate)
  • Metastses migrated to internal L humerus (via lymphatic metestatic disease), where it created moddled diaphyseal appearance c irregular cotical erosion (A and B)
  • 2 mo later, pt presented c complete transverse pathological fx thru midshaft humerus (C and D)

​Significant Findings

  • Mottling and fx noted above
  • Decrase in longbone opacity between A/B and C/D, a sign of osteoporsosis/osteopenia
23
Q

Avulsion Fracture (Definition, X-Ray Landmarks)

A

Definition: Bone fragment that is pulled off by a tendon

Landmarks: Change in color beyond line of avulsion fx, even without displacement. Think about tendonous attachment points and look there carefully, especially with corresonding history

24
Q

Identify Pathology

A

Avulsion Fx to Ulnar Base of 1st Proximal Phalynx and MCP Joint

Significant Findings

  • Small differently colored bone fragments (not really displaced here)
  • Fx location near ulnar collateral ligament attachment
  • Thenar eminence swelling
  • ​*Note
  • This was probably due to forced hyperabduction of a flexed thumb
25
Identify Pathology
**Comminuted Clavicular Fx** *Significant Findings* * *3 bone fragments in middle third of clavicle* * *Clavicular shortening* * *No apparent shoulder dislocation!* * ​*Note * Nonoperative management due to fx nondisplacement
26
Identify Patholgoy
**Anterior Right Shoulder Dislocation** *Significant Findings* * *Medial humeral head displacement (compared to glenoid fossa)* * *Humeral head location inferior to coracoid process*
27
Identify Pathology
**Right Anterior Shoulder Dislocation** * Significant Findings* * *Glenoid inferior to its normal position in the center of the "Y" formed by the scapula* * ​*Note * This is a "scapular Y view" x-ray. Good for ID of shoulder dislocation. Glenoid should fall in center of Y
28
Identify Pathology
**Posterior Shoulder Dislocation** Note * Highly difficult to dx from AP views alone, as glenoid moves posteriorly but usually does not displace superiorly or inferiorly. Thus, bone may appear to be in place * Best view for dx: transcapular Y view (not pictured)
29
Identify Pathology
**Slightly Oblique Midshaft Humeral Fx** *Signifiant Findings* * *Fracture that is not completely perpendicular with cortical border, but is only two pieces (see chipping in medullary area)* * *+ Displacement, - Shortening* * *While overexposed, bone still seems to exhibit opacity*
30
Identify Pathology
**Displaced (2 part) Comminuted Proximal Humerus Fx** *Significant Findings* * *Complete separation at surgical neck* * *+ Shortening, + Displacement* * *No dislocation of glenoid from GF* Note * While we did not learn Neer Classification System at this time (that dictates the "2-part" of this dx, the significance of this fracture is still present
31
Fat Pad Sign (Definition, Description)
Also called "Sail Sign" _Definition_: Typical X-ray presentation due to displacement of joint fat pad from bleeding into a joint _Description_: Elevated and visible change in soft tissue coloration bordering bone. The disclorations are triangular or "sail-shaped," with the bone parallel to one of the triangular borders
32
Identify Pathology
**Radial Neck Impaction fx** *Signifiant Findings* * ***Anterior and posterior fat pad signs*** *(white arrows)* * *Sharp, angular change in cortical border near black arrow*
33
Identify Pathology
**Gartland Type II Supracondylar Fx** * Significant Findings* * *Growth plate present on humerus* Note * This pediatric fx is typical of falling on an extended elbow, usually from some height (monkey bars, beds) * Type II indicates displacement but intact cortex * The most revealing image for this fx is usually a lateral semi-flexed position. This will reveal an anterior sail sign c elevated fat pad
34
Identify Pathology
**Colles Fx** *Significant Findings* * *100% dorsally displaced distal radius and ulna* * *Volnar angulation* * *+ Shortening, + Displacement* * *Two transverse fx* Note * MOI = FOOSH (falling on outstretched hand)
35
Identify Pathology
**Distal Greenstick Radial Fx, Distal Full-thickness Ulnar Fx** *Significant Findings* * *Minimal angulation and no displacement (pediatric fx, flexible bones)* * *Greenstick fx - partial thickness - better visualized in lateral view. Bulges from dorsal aspect* * *Growth plates present*
36
Identify Pathology
**Scaphoid Fracture** * Significant Findings* * *Line through middle 1/3 of scaphoid* Note * This image was taken 2 weeks after FOOSH (fall on outstretched hand) injury. Initial xrays were normal but lack of circulation precipitating avascular necrosis caused a change in xray appearance
37
Identify Pathology
**Angulated 4th and 5th Metacarpal Neck Fxs** *Significant Findings* * *Incongruency in cortical borders in 4th and 5th metacarpals* * *Angular shape of bone fragments* * *Transverse fractures*
38
Identify Pathology
**Anterior PIP Dislocation** *Significant findings* * *Anteriorly deviated middle phalanx* * *No associated fx* Note * Dislocation direction is classified by the distal bone's location compared to the proximal bone. * Remember anatomic position puts middal phalynx distal to proximal phalynx
39
Identify Pathology
**Anterior Hip Dislocation** * Significant Findings* * *Femoral head displaced superiorly* Note * This is to confirm strong s/sx (leg shortening, external thigh rotation)
40
Identify Pathology
**Posterior Hip Dislocation** * Most common type of hip disloation * Patient will present c internally rotated and flexed hip
41
Identify Pathology
**Comminuted Distal Femoral Fx** *Significant findings* * *\>2 bone fragments in distal femur, represented by incongruous medullary color and uneven cortical borders* * *Growth plates present but not involved in fx* Note * Stabalized via plate fixation
42
Identify Pathology
**Comminuted Patellar Fx** *Significant Findings* * *Darkened line near white arrow* * *Associated soft tissue swelling* Note * This is a sunrise view of the knee
43
Identify Pathology
**Anterior Knee Dislocation** *Significant Findings* * *Anterior displacement of tibia* * *Alignment of patella and femur are not parallel* * *Close proximity of femur and tib-fib* Note * Dislocations are named for the distal bone's location in respect to the proximal bone's location * This included a bicruciate injury * Lateral radiograph
44
Identify Pathology
**Lateral Tibial Pleateau Fx** *Significant Findings* * *Horizontal fx line near yellow arrows* * *Nondisplaced lateral bone fragment*
45
Identify Pathology
**Nondisplaced Tibial and Fibular Shaft Fxs, Before/After Tx** *Significant findings* * *Minimal distrubance to cortical borders* * *Visible oblique to spiral fxs on tibia and fibula (fibula is more distal)* Note * Nonoperative tx c nonweightbearing thru week 4 and modified weighbearing weeks 5 and 6. Long leg cast and patellar-tendon bearing casts used.
46
Identify Pathology
**Bimalleolar Fx** *Significant findings* * *Transverse fx on lateral malleolus* * *Oblique, almost avulsion-looking fx on medial malleolus* * *Normally presenting ankle mortise* Note * Unstable fx, requires ortho referral

Diagnostic Studies (11 decks)

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