Ortho Final Xrays Flashcards
Associated with acute anterior cervical cord syndrome (instant, complete quadriplegia, loss of pain, touch and temperature sensations but retention of posterior column sensations, position, motion, vibration).
MOI: Extreme hyperflexion
Flexion Teardrop Fracture
What type of fracture
Flexion Teardrop Fracture
What type of fracture
Hangman’s Fracture
MOI: hyperextension or rebound hyperflexion.
Pathology: In all 3 types, the fracture involves the pars interarticularis – that piece of bone between the superior and inferior facets of C2 (red arrows).
What type of fracture
Jefferson fx
MOI: vertical compression
Pathology: bilateral fractures of both the anterior and posterior arches of C1.
What are the most common upper Cervical Spine fractures.
Odontoid fractures
MOI: Flexion loading is the cause in the majority of patients, and results in anterior displacement of the dens. Or, an extension loading force (forward fall onto forehead), which occurs in a minority of patients, and results in posterior displacement of the dens.
MOI: Flexion loading is the cause in the majority of patients, and results in anterior displacement of the dens. Or, an extension loading force (forward fall onto forehead), which occurs in a minority of patients, and results in posterior displacement of the dens.
Odontoid fracture
What Disease
Ankylosing Spondylitis
“Bamboo lumbar spine”
History: Pain in low back radiating down leg, +/- hx of trauma, worsened with sitting (tripod sign).
Lumbar Herniated Disk/Herniated Nucleus Pulpusus (HNP)
Physical Exam: Use the motor and sensory exams to determine nerve root affected. A L5-S1 HNP causes S1 radiculopathy, which may reveal ankle plantar flexion weakness (foot drop) and decreased sensation at the bottom of the foot.
Commonly with a (+) SLR (straight leg raise)
Lumbar Herniated Disk / Herniated Nucleus Pulpusus (HNP)
Tx of lumbar herniated disk/herniated nucleus pulpusus (HNP)
NSAIDS–> epidulra steroids injections–> traction–> lumbar discetcomty/laminectomy if no improvement
Prognosis: Over 70-80% have significant relief of pain and some resolution of other symptoms.
Tx of Cauda Equina syndrome
Emergency Surgical decompression
What Disease
Spondylolysis
“Scotty dog sign w/ collar”
What Disease
Spondylolysis
Location of pain
- Anterior thigh (____).
- Lateral hip (____).
- Inquinal (____).
- Medial thigh (____).
- Anterior thigh (Lateral Cutaneous nerve syndrome).
- Lateral hip (Greater Trochanter bursitis or Snapping Hip Syndrome).
- Inquinal (Oestearthritis and Avascular Necrosis).
- Medial thigh (fractured femur)
Things to conside witha hip dislocation
- ortho emergency- reduce ASAP to decrease risk of osteonecrosis
- NV status before and after reduction
- Possible sequelae of early OA and osteonecrosis secondary to cartilage damage of femoral head and acetabulum
*most are posterior dislocations
Pelvic fractures commonly cause injury to what nerves?
- Must asses NV status stat
- Common injuries to periphearl nerve and sometimes damage to spinal nerve roots
What Fracture
Open Book Pelvis fracture
Complications of femur shaft fracture
- possible mulit-system injury
- Bleeding
- Compartment syndrome
**Assess NV status and ipsilateral knee
This Injury is associated with what complication
Intra-capsular (Femoral neck): Usually associated with a high risk for non-union secondary to AVN.
Extra-capsular (intertrochanteric or above the lesser trochanter): requires a stronger fixation and has a better chance of healing.
What Fracture
compression side (inferior-medial neck)
tension side (superior-lateral neck)
Symptoms: Restricted range of motion (ROM), antalgic gait, inquinal pain and stiffness (initially with activity) that may lead to decreased ambulation and functional independence (AODLs).
OA of the hip
Tx of OA
- Total hip arthroplasty for pts w/ persistent pain after failure of conservative therapy including meds, cortisone injection, activity modification and use of assistive devices
What people are poor surgical candidates for THA for OA?
- Morbid obese (BMI of 33 or higher)
- Poorly controlled DM (A1c of 7 or higher)
- Unstable co-morbidities
Exam: Pain and tenderness over the GT area that could radiate to the knee, but not to the foot. Pain worse when first rising from a sitting position.
What disease and tx?
Trochanteric Bursitis
*Tx: NSAIDs, activity modifcaiton, short term cane, local cortisone injection (Inject at the point of maximal tenson and inject in the painful area), long term PT
**STRETCH IT BAND!!
Name these deformities
Top: Claw toe
Middle: Hammer toe
Bottom: Mallet toe
prominent superior process of Calcaneus with common atrophy of Achilles tendon at the insertion point into Calcaneus and with Achilles bursitis.
Haglund Deformity (hindfoot pain)
Midfoot pain
Dorsal Osteophytes
MC site of OA on the foot
What Fracture
Avulsion (Dancer’s) fracture
*most distal, Zone 1
What Fracture
Jone’s fracture, zone 2
What Fracture
Lisfranc fracture dislocation
MOI: riding a horse and fell, Motorcycle, high mechanism injury
Tender over 2nd metatarsal jointà if tender around there (RED FLAG)à get weight baring xray
What Fracture
Lisfranc fracture-dislocation
High ankle sprain aka
Syndesmosis ligament (Intraosseous membrane)
What Disease
Talus OCD (osteochondral defect)
The floating piece is attached to scar tissue
- can be painful with walking
- go in scrap it out or keep an eye on in if it on the outside
What disease
Charcot’s Foot
Presentation: hot, red, infection, but no pain due to neuopathy
What Fracture
Maisonneuve Fracture
What Fracture
Pilon fx
Unstable– straight force through the tibia and the bones explode
VERY communited, very unstalbe
Swelling a LOT In 24 hrsà need to wait for swelling to go down before surgeryà go into external fixaton
What Fracture
Massonneuve fx
What Fracture
Talus fracture
What Fracture
Osteochondroma
What Disease
Enchondroma
What Disease
Giant Cell tumor
*Most often occur after skeletal bone growth is completed and they account for 20 percent of benign bone tumors.
What Disease
Non-Ossifying Fibroma
*MC benign bone lesion in children
*Results from a defect of periosteal cortical bone development, which leads to failure of ossification.
*When the tumor occupies more than 50% of the diameter of bone, there is much greater risk for a pathological fracture.
Osteosarcoma usually develops where?
the knee or in other long bones, particularly in the bone metaphyses.
*can prevent an amputation by segmental arthroplasty
What Disease and tx?
Osteosarcoma
*Sunburst appearance
TX: amputation or segmental resection
What Disease
Ewing’s sarcoma
*Onion skin
Chondrosarcoma is a cancer of ___cells and often develops in ___, but it can be found in any portion of any bone and in surrounding soft tissues.
cartilage
flat bones (eg, pelvis, scapula)
What Disease
Chondrosarcoma
Xray: starts growing out of the cartilage
What Disease
Multiple myeloma
Right MRI: bite out of the bone (take the cortex and blow it out)
Bowing of the tibia can be caused by
Paget’s and neurofibromatosis
What Disease
Paget’s Diease
What Disease
Fibrous Dysplasia
*It is characterized by expanding fibro-osseous tissue within affected bones and predominantly is a lesion of the growing skeleton.
What disease
Osgood Schlatter
*In children, these injuries are more common at the bone-tendon junction (adults: muscle-tendon)
____ sign is when able to dislocate an unstable neonatal hip.
___ is to reduce an unstable neonatal hip.
Limb-leg discrepancy: measure from the __ to __, or request full extremity x-rays
Barlow’s: the Barlow’s (Bad)
Ortolani’s (gOOd):
anterior superior iliac spine (ASIS) to the prominence of the medial malleolus
Low back pain red flags
- Persistent or increasing pain
- Pain with systemic symptoms such as fever, malaise and wt loss.
- Neurologic symptoms
- Bladder or bowel dysfunction
- Age 4 or younger
- Painful thoracic scoliosis
What disease
Diskitis
What Disease
Spina Bifida
What disease
SCFE
What Disease and tx
Osgood Schlatter
*activity modification and ST immobilizaiton for 4-8 weeks
What disease
(considered waht until proven otherwise)
Pes Cavus deformity
An abnormally high arched foot is usually secondary to an underlying neuromuscular disorder, until proven otherwise, with up to 60% found to be from a neurological etiology.
What disease and tx
clubfoot/talipes equinovarus
Treatment: Sequential manipulation and casting and may require 2-4 months of treatment and splinting for up to another 5-7 years.
Surgery when non-operative treatment failed and usually after 3-4 months of treatment.
*Physical exam: a true idiopathic clubfoot can not be corrected with passive manipulation
What disease
Child abuse
*Also look for avulsion-type or “corner chip” fractures
The most common complication after a physeal injury is
Premature partial arrest of growth (growth disturbance)
What type of Salter-Harris fracture
Type 2
Type II fracture is when there is a fracture across the physis which extends into the metaphysis
What type of salter harris fx
Type III fracture is when there is a fracture across the physis which extends into the epiphysis
What type of fracture
buckle/torus
What Fracture
Greenstick
Tx of femur fractures in peds
- Most fractures involve the femoral shaft and heal without incident in 6 to 12 weeks.
- Closed treatment, such as traction or spica casting, was used more commonly in the past but is giving way to surgical fixation in children older than 6 years and adolescents to enable early mobility and improved outcome.
Non-displaced tibia and fibula fractures are treated with
a long leg cast for six to eight weeks.
*Repeat x-rays weekly to check fracture position.
