Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OSCE examinations > Orthopedic Xray Presentation > Flashcards

Orthopedic Xray Presentation Flashcards

1
Q

Introduction

A

Patient details - name, age, DOB, date of Xray
Projection - AP, lateral?
Technical adequacy
-is the entire area of concern covered?
-adequate exposure => differentiation between soft tissue and bone
-rotation?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Xray interpretation approach

A

ABCS

Alignment and joint space
Bone texture
Cortices
Soft tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Alignment and joint space

A

Fracture
Subluxation (partial dislocation)
Dislocation

When describing displacement -Position of the fragment distal to fracture site

Joint space narrowing

  • cartilage loss
  • cartilage calcification
  • osteophytes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Bone texture

A

Altered density/disruption in trabeculae and cortex => pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Cortices

A

Trace around the outline of each bone

  • steps - fracture/pathology
  • bony destruction - infection, tumours
  • periosteal reaction - new bone formation in response to injury or periosteal stimulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Soft tissues

A

Swelling, foreign bodies, effusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describing fractures

A

Bone involved
Location within bone - proximal, middle, distal
Articular involvement

Complete fracture types

  • transverse
  • oblique
  • spiral
  • comminuted
  • impacted

Incomplete - more common in children

  • torus/buckle
  • bowing
  • greenstick
  • SalterHarris - involvement of growth plate

Open or closed

Displacement?
-dorsal/volar angulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cervical spine

  • views
  • what are you assessing in A
A 
Lateral - C1-T1
4 curves
-ant vertebral line
-post vertebral line
-spinolaminar line
-spinous processes

AP - C1-7
2 lines lateral to vertebral bodies
Spinous process line

Open mouth/peg view
Alignment of lateral masses of C1-2
Alignment of space between peg and C1 lateral mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Cervical spine

  • B
  • C
  • S
A

Cortex of each bone

Intervertebral discs roughly similar in height

Prevertebral tissue
Above C4 - 1/3d of vertebral body width
Below C4 - 1 vertebrae wide
-if abnormal => prevertebral hematoma from cervical fracture?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Thoracolumbar spine

-A

A 
Lateral
3 column model
-Ant - ant half of vertebral body
-Middle - post half of vertebral body
-Post - post ligament, bone arch

AP

  • 2 lines lateral to vertebral bodies
  • Spinous process line

Thoracic spine - kyphosis
Lumbar spine - lordosis

If 2 of 3 columns disrupted => instability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Thoracolumbar spine

  • B
  • C
  • S
A

B

  • cortex of each vertebrae
  • pedicles - if not visible => bony destruction?
  • height of vertebrae should be equal

C
-intervertebral discs similar in height - reduced => degenerative disease?

S
-can be difficult to assess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Shoulder

-A

A

AP - glenoid fossa and humeral head visible

Lateral/scapula Y - Y intersection coming out of humeral head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Possible shoulder pathologies

  • anterior shoulder dislocation
  • post shoulder dislocation
  • acromioclavicular joint
  • humeral shaft fracture
A

Ant dislocation MORE COMMON
AP - humeral head medially inferior to glenoid
Lateral - humeral head out of line from Y

Post dislocation
AP - lightbulb, widened joint space
Lateral - humeral head post to glenoid

Acromioclavicular joint dislocation
AP - misalignment/widened gap of clavicle and acromion
Coracoclavicular joint dislocation
AP - widened gap of clavicle and coracoid

Humeral shaft fracture

  • often spiral
  • radial nerve often involved
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Shoulder

  • B
  • S
A

Outline of cortex

  • clavicle
  • scapula
  • ribs

Soft tissue

  • dark areas - blood, fat => hidden fracture
  • white areas - calcification of tendons?
  • lungs - Pancoast, pneumothorax?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Elbow

-A

A

AP
Radiocapitellar line
-if not => radial head dislocation (Monteggia?)

Lateral
Anterior humeral line intersects middle 1/3 of capitellum on distal humerus
-if not => distal humeral fracture
Radiocapitellar line intersects radius and capitellum
-if not => radial head dislocation (Monteggia?)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Possible elbow pathology

  • supracondylar humerus fracture
  • radial head dislocation
  • radial head fracture
  • Monteggia
  • olecranon fracture
A

Supracondylar humerus fracture - V COMMON IN PAEDS

  • post fat pad
  • displaced ant humeral line
  • ant humeral line
  • broken champagne flute

Radial head dislocation
-disrupted radiocapitellar line

Radial head fracture
-post fat pad with no obvious fracture

Monteggia - paeds
-proximal ulnar fracture + radial dislocation

Olecranon fracture
-Highly avulsed due to attachment to triceps

17
Q

Elbow

  • B
  • S
A

Bone cortex especially

  • radial head
  • distal humerus
  • coronoid
  • olecranon

Champagne flute sign - humerus not fractured
-flute broken => supracondylar fracture (Gartland)

Effusion
Ant fat pad - small
-if massive => effusion
Post fat pad - not visible
-if visible => effusion
If any effusions are present => look for fracture
If no fracture found => radial head fracture likely

18
Q

Wrist

-A

A

Distal ulnar and radius with NO OVERLAP

PA - radius, capitate, 3rd MC in a line
-2 smooth arcs in proximal and distal rows of carpal bones

Lateral - radius, lunate, capitate in a line
-slight palmar tilt in radius

19
Q

Wrist pathologies

A

Colles - EA, distal radial
-dorsal radial angulation

Smith - distal radius
-volar radial angulation

Bartons - IA, distal radius
-dorsal or volar angulation

Galeazzi - distal radial fracture, ulnar dislocation

Distal radioulnar joint dislocation
-increased joint space between radius, ulnar

Scaphoid fracture - scaphoid series to comprehensively assess
-proximal - poorest prognosis

20
Q

Wrist

  • B
  • C
  • S
A

B - cortical margin, trabecular pattern

  • radius
  • ulnar
  • carpal bones
  • metacarpals

Joint spaces - should all be similar

Soft tissue - assess for overt abnormalities

21
Q

Pelvic and hip

  • A
  • B
A

AP - 1/3d femoral shaft <=> ilium
-coccyx tip inline with pubic symphysis

Bones

  • cortical outline
  • bony texture
  • symmetry

Femur
-proximal, head, NOF, greater trochanter, lesser trochanter
Shenton’s line - disrupted => fracture

Pelvic bones
-ischium, ilium, pubis, sacrum
Pelvic brim
Obturator foramen
-if 1 fracture found => look for 2nd
22
Q

Types of hip fracture

-classification

A

Intracapsular - above intertrochanteric line
-risk of AVN, nonunion

Extracapsular - below intertrochanteric line

Garden
-3, 4 unstable displaced

23
Q

Pelvic and hip

  • C
  • S
A

Cartilage and joint space
Acetabular joint
-reduced - OA?
-increased - dislocation?

Pubic symphysis
Sacroiliac joint - joint space and end plates
-sacroilitis - sclerosis of iliacs, irregular end plates, wide joint spaces

Soft tissue and others
Effusion - hyperdense fluid level (inflammatory joints)
Periosteal reaction - irritation from healing or tumour
Calcification of tissue
Foreign bodies - THRs

24
Q

Knee

  • A
  • B
  • C
  • S
A

AP
-lateral femoral line passes through midline of fibula, next to tibia

Lateral

Bones
Tibial plateau
-lateral plateau fracture
Patella
Fibula 
Femur

Cartilage, joint space
Knee joint
-decreased => OA?

Soft tissue
Suprapatellar fat pad
-effusion => patella displaced

25
Q

Ankle

-A

A

Penetration adequate, clear distinction between bone and soft tissue

AP - distal 1/3 tibia, fibula, talus

Lateral - distal 1/3 tibia, fibula, talus, calcaneusm 5th MC

26
Q

Ankle

  • B and classification of fractutures
  • C
  • S
A

Bones
Cortical outline of fibula, tibia, talus, calcaneus
-thinner cortex - OP?
Top of talus should be smooth

Weber
A-fibula fracture below syndesmosis
B-fibula fracture at syndesmosis
C-fibula fracture above syndesmosis

Cartilage and joint space
Ankle joint space should be equal all around talus
Tibiofibula overlap
-loss => syndesmosis injury?

Soft tissue
-swelling, effusion => fracture

27
Q

Salter Harris classification

-types and mnemonic

A 
1 - straight across
2 - above
3 - lower
4 - through
5 - erasure of growth plate or crush

OSCE examinations (142 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions