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*Orthopaedic Surgery > Orthopedic Radiology > Flashcards

Orthopedic Radiology Flashcards

1
Q

Reasons for radiographic testing in orthopedics

6

A
  1. History of blunt trauma
  2. Deformity of bone or joint following injury
  3. History of pain, swelling, or loss of motion of a joint, sense of instability
  4. Infection
  5. Foreign body
  6. Night pain
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2
Q

MRI provides good contrast between the different soft tissues of the body, which make it especially useful in imaging the what? 4

A
  1. brain,
  2. muscles,
  3. the heart
  4. cancers compared with other medical imaging techniques
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3
Q

Uses of MRI in orthopedics

6

A
  1. Evaluate soft tissue injury as apposed to bony injury. Example is ligament injury, tendon injury, muscle
  2. Better evaluate soft tissue mass
  3. R/O fluid collection in the body
  4. Define abnormalities within bone seen on x-ray
  5. R/O stress fracture or infection
  6. Evaluate spinal injury
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4
Q

Ligament, tendon, soft tissue evaluation with MRI

  1. Knee? 6
  2. Shoulder? 3
  3. Elbow? 4
  4. Wrist? 2
  5. Ankle and foot? 4
  6. Hip? 1
A
  1. Knee:
    - ACL,
    - MCL,
    - PCL,
    - LCL,
    - meniscus,
    - loose body
  2. Shoulder:
    - Rotator cuff,
    - biceps tendon,
    - labrum
  3. Elbow:
    - Ulnar and radial collateral ligaments,
    - Extensor and flexor tendon insertion for epicondylitis,
    - biceps tendon rupture,
    - loose body
  4. Wrist:
    - Extensor Carpi Ulnaris injury,
    - TFCC tear
  5. Ankle and foot:
    - Anterior tibial tendon injury,
    - peroneal,
    - tibial tendon,
    - achilles tendon partial tear
  6. Hip: Labral tear
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5
Q

Soft tissue mass with MRI

4

A
  1. Lipoma
  2. Hematoma
  3. Osteosarcoma
  4. Ganglion cyst
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6
Q

Use MRI to rule out fluid collection?

4

A
  1. Effusion of a joint, shoulder, hip
  2. No need to MRI, olecrenon bursitis, patellar bursitis
  3. Infection fluid collection within soft tissue compartments
  4. Baker’s cyst in the knee
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7
Q

Bone abnormalities

seen on MRI

6

A
  1. Stress fracture
  2. Lytic or blastic lesions seen on x-ray
  3. Bone contusion (you may find it but dont order one for it)
  4. R/O occult fracture, scaphoid
  5. Avascular necrosis
  6. Osteomylitis
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8
Q

Where are the common stress fracture locations?

4

A
  1. tibia,
  2. metatarsals,
  3. tibial plateau,
  4. femoral neck
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9
Q

Spine pathology on MRI? 6

A
  1. Herniated disc
  2. Bulged disc
  3. Spinal stenosis
  4. Compression fracture, acute vs chronic
  5. Neoplasm
  6. Pars defect
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10
Q

What is this an MRI of?

A

ACL

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11
Q

What is this an MRI of?

A

Lipoma

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12
Q

What is this an MRI of?

A

Bone edema

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13
Q

What is this an MRI of?

A

HNP

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14
Q

Reasons for ordering CT-scan

4

A
  1. Cervical injury, due to multiple overlaping shadows and images on x-ray, CT-scan better r/o cervical fracture after trauma
  2. Reconstructing and better defining comminuted fractures such as; acetabular fracture, calcaneous fracture, articular fractures
  3. Evaluating joints for preoperative evaluation for surgery
  4. CT myelogram of spine for individuals that cannot undergo MRI due to pacemaker or other metal objects. Myelogram is a CT with radiographic dye injected into the dura.
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15
Q

What is this a CT of?

A

CT Calcaneous Fx

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16
Q

What is this a CT of?

A

Pelvic fx

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17
Q

What is this a CT of?

A

Tibial Plateau fx

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18
Q

What are these CTs of?

A

CT Cervical Fx

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19
Q

Reasons for ordering CT-scan

Reconstructing and better defining comminuted fractures such as?

3

A
  1. acetabular fracture,
  2. calcaneous fracture,
  3. articular fractures
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20
Q

What is a myelogram?

A

Myelogram is a CT with radiographic dye injected into the dura.

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21
Q

Bone Scans

  1. What is it?
  2. Over what areas can this scan?
  3. What will the scans show? 2
  4. What will it not show?
  5. Bone scans are used best for what?
A
  1. Nuclear medicine study in which the patient is injected into a vein with a small amount of radioactive material such as 600 MBq of technetium-99m-MDP and then scanned with a gamma camera, which is sensative to the radioactive material.
  2. The scan may be a full body study or localized to a body part called a SPECT which will look at smaller lesions.
  3. The scan will show
    - bone turn over and
    - osteblastic activity.
  4. It however will not show osteclastic activity.
  5. Bone scans are used best for bone metastatic disease
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22
Q

What kind of mets disease usually show up on bone scans? 2

Other reasons for use? 3

A

1.

  • prostate cancer and
  • less for lytic such as multiple myeloma.
    2. Other reasons for scans include,
  • stress fracture,
  • infection,
  • occult fractures
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23
Q

What is this bone scan showing?

A

Bone scan infection

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24
Q

What is this showing on the scan?

A

Stress Fx

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25
Q

What is the following Xray called?

A

Cervical Lateral

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26
Q

Whats the name of the following xray?

A

Shoulder AP

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27
Q

Whats the name of the following xray?

A

Shoulder Axillary

Looking at lesser tuberosity

28
Q

Whats the name of this xray?

A

Shoulder Y-view

-When you cant get the axillary view

29
Q

Xray of?

30
Q

Xray of?

A

Lumbar spine

31
Q

Xray of?

A

Lumbar spine oblique

Scotty Dog Fracture!- pars defect/fracture

32
Q

Whats this xray?

33
Q

What is this an Xray of?

A

Hip Lateral

34
Q

What is this?

A

Knee sunrise view

35
Q

What is this an xray of?

A

Tibia and fibula

36
Q

What is this an xray of?

A

Tibia and Fibula lateral

37
Q

What are these xrays of?

A

Ankle mortis and lateral

38
Q

What is this an X ray of?

A

AC separation

grade 3

2 times the width

39
Q

Name the different ways to describe fractures on an Xray that were given?

A
  1. Displacement
  2. Angulation (where is the apex of the fracture)
  3. Avulsion
  4. Impaction

5 .Intra-articular

  1. Comminuted
  2. Spiral
  3. Greenstick
  4. Buckle
  5. Transverse vs oblique
40
Q

Be wary of intra-articular fractures.

What should you do to not miss a fracture? 2

A
  1. Get at least 2 views of XRs 90 degrees to each other
  2. Re-XR in about a week
41
Q

What do the following mean:

  1. Displacement
  2. Angulation (where is the apex of the fracture)
  3. Avulsion
  4. Impaction
  5. Intra-articular
  6. Comminuted
  7. Spiral
  8. Greenstick
  9. Buckle
A
  1. The term ‘displacement’ is often used as a specific term to describe loss of bone alignment along its long axis.
  2. Angulation: To describe fracture angulation the direction of the distal bone and degree of angulation in relation to the proximal bone should be stated. Medial angulation can be termed ‘varus’, and lateral angulation can be termed ‘valgus’.
  3. An avulsion injury arises when a bone fragment is pulled away by a ligament or tendon
  4. In some cases, one serious injury can cause the bone to break to various fragments. It is referred to as comminuted impacted fracture. If these broken bone fragments are driven to other bone fragments, it results in impacted fracture.
  5. Intraarticular fractures are those in which the break crosses into the surface of a joint.
  6. A comminuted fracture is a break or splinter of the bone into more than two fragments. Since considerable force and energy is required to fragment bone, fractures of this degree occur after high-impact trauma such as in vehicular accidents.
  7. A spiral fracture (a.k.a. torsion fracture) is a bone fracture occurring when torque (a rotating force) is applied along the axis of a bone. Spiral fractures often occur when the body is in motion while one extremity is planted.
  8. a fracture of the bone, occurring typically in children, in which one side of the bone is broken and the other only bent.
  9. It is a compression fracture on one side of a bone that causes the bone to bend or buckle toward the damaged side. Buckle fracturesare more common in children because their bones are softer and more able to bend.
42
Q

What is this an image of?

A

Kyphosis of the cervical spine as a result of DDD

kyphosis and loss of lordosis and disc height at 3-4, 4-5

43
Q

What is this an image of?

A

broken and bayonetted clavicle

44
Q

What is this an image of?

45
Q
  1. What is the most common fracture in children and adolescents?
  2. Male of females?
  3. Whats the most common place?
A
  1. Most commonly fractured bone in children and adolescents
  2. Male>female (2.5:1)
  3. 80% middle third
46
Q

Clavicle Fractures

Dx? 3

A

Diagnosis

  1. History
  2. Exam
  3. XRs
47
Q

Clavicle Fracture

  1. Which Xray views? 2
  2. Helps to evaluate what? 2
A

1.

  • AP view: seeing both SC and AC joints
  • Zanca view (30-45 degree cephalic tilt
    2. Helps to evaluate displacement and comminution
48
Q

What is this?

49
Q

What is this?

50
Q

What is this?

A

Pec muscle pulls on this so it gets displaced aneriorly

51
Q
  1. What is the second most common upper extremity fracture?
  2. Population affected?
  3. Gender?
A
  1. Humeral head- 2nd most common upper extremity fracture
  2. >65 yo 3rd most common fracture: Usually in adults >65

1 is radius, 2 is hip

  1. Females>males
52
Q

Humeral Head Fractures

  1. XRs? 3
  2. Ct when?
A
  1. XRs
    - AP,
    - lateral, and
    - scapular Y
  2. CT if articular involvement of glenoid and humeral head
53
Q

Humeral Head Fractures

Treatment: Treat comorbidities that may increase risk of nonunion such as?

6

A
  1. Osteoporosis
  2. Alchoholism
  3. Tobacco use
  4. Mental illness
  5. Steroid use
  6. Rheum diseases
54
Q

What is this?

Worry about what nerve?

A

Usually treated conservatively unless you want to get them back moving. Need to use crutches because they have other fractures too.

WORRY ABOUT RADIAL NERVE

55
Q

Humeral Shaft Fractures

XRs? 4

What arteries are we worried about injuring?

Veins? 2

A

XRs

  1. AP and
  2. lateral
  3. Get shoulder and
  4. elbow in views
  5. Artery- brachial art,
  6. cephalic or basilic veings
56
Q

Describe the degrees/types of the following:

  1. Simple fracture?
  2. Wedge fracture?
  3. Complex fracture?
57
Q

What could this be? 2

A

AVN or osteomylitits

58
Q

What is this?

A

Anteror dislocation

sitting down further

59
Q

What is this?

A

Posterior dislocation

Not sitting down further, looks almost normal

60
Q

What is this?

A

Lateral radiograph of the elbow in a 78-year-old man who fell on his outstretched hand is shown. A displaced fracture of the olecranon was noted.

61
Q

What is this?

62
Q

What is this?

63
Q

What is this?

A

Immature epiphysis

Humeral shaft is bent backwards

Supracondylar fracture

64
Q

What is the name of the fracture?

A

Night stick fracture

65
Q

What is this a picture of?

A

Long arm cast or put a rod or a plate in it

*Orthopaedic Surgery (28 decks)

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