Orthopedics-NM Flashcards
Views for Shoulder
AP / Grashey
Tip: dont forget clavicle, often ordered seperate series.
Views for Humerus
internal and external rotation
unless you DEFINITELY know there is a fracture/dislocation
Fat pad sign
(or sail sign) means there is a dark area displacing the fat pad indicating blood and injury
elbow views
Should try to have them lay the arm as flat as possible to get proper view on AP
Radiocapitellar line
forearm views
Just changing from pronation to supination does not give you 2 proper views of the radius and ulna
Make sure the entire unit moves together (left films are correct; right films are not perfect)
Bones should mostly overlap on lateral view
MUST include the wrist and elbow to be considered adequate
Wrist lines
3 lines (actually should be 4)
wrist views
Does not have to include the fingers
Does not have to include the shaft of the radius and ulna
Too much radius and ulna sometimes indicate inadequate films (won’t be centered on the wrist)
Scaphoid view is specially ordered and not typically part of a wrist series
Hand views
Lateral should have fingers in the “Okay” position
Should include an oblique to better view metacarpals
Don’t accept if fingers are cut off! (this oblique was done properly but I cropped it)
Hip views
AP, frog leg and pelvis are most common
Cross table lateral is not very common
Very common to get a pelvis with any type of injury
Don’t forget to look at the pubic rami!
Bilateral hip vs pelvis- different things
Femur views
AP should include knee and hip to be considered adequate
Difficult to accomplish lateral because of lead in groin and overlap of pelvic structures
only time it is ok to not include top joint
knee views
Several views needed for different knee problems
AP, lateral, sunrise, tunnel, oblique
Don’t forget to look at the fibula and tibial tubercle
Should be weight bearing unless there is a fracture or patient cannot stand (other than sunrise & tunnel- not possible to do those while standing!)
sunrise view of patella
tunnel view of knee
Tib/Fib views
Often angled on the film because the leg is too long for the cassette
MUST include knee and ankle joints to be considered adequate
Typically only performed for fractures and tumors (if tib or fib fxs seen on ankle or knee x-rays, you should get a long bone aka tib/fib series to check for more fractures)
Ankle views
AP, lateral and mortise for injuries
AP and lateral for arthritis
Don’t ignore the posterior ankle; will often see lots of problems there
foot views
AP, lateral and oblique are the most common views
simple fracture
2 fracture fragments
Subtle fractures may become visible in how many days
7-10 days after the injury
Compound fracture
also called open fracture. Skin is broken
comminuted fracture
also called complex fracture
more than 2 bone fragments
transverse fracture
straight across
oblique fracture
spiral fracture
Spiral fractures are caused by rotational forces and are usually seen in children if in the femur; aging females if in humerus
A spiral fx in a child who is not walking is suspicious for child abuse
angulation of fractures
Terms like dorsal, radial, ulnar, valgus, and varus are also used to describe the direction of the angulation.
displacement of fracture
Displacement is named according to the distal fragment. Can be full displacement or side-to-side movement of fragments.
describe this fracture
A: A medially displaced transverse midshaft fracture of the humerus
Fracture Terminology:
Distraction & Overriding
Fracture Terminology:
Impaction
stress fracture
Summation of microfractures caused by unusual or excess stress; frequently seen in athletes
The tibia is a common site of stress fx in all age groups
pathologic fracture
Fracture through a bone abnormality, benign or malignant; can occur with minimal or no trauma
due to osteoporosis, cancer, infection so on..
This patient also had metastatic renal cell carcinoma, with a pathologic humerus fx
Avulsion Fracture
Fracture of a bony fragment that is produced by the pull of a ligamentous or tendinous attachment
Segond fracture
This is an avulsion fx of the knee (lateral tibial condyle), highly associated with ACL injury
(specifically referred to as a Segond fracture)
Pediatric Fractures: Normal physis
type 2 salter harris
type 3 salter harris
type 5 salter harris
type 4 salter harris
Pediatric Fractures: Greenstick Fracture
Pediatric Fractures:
Torus fracture
Torus fractures (buckle fractures) are also incomplete fractures. The buckled cortex creates a “bump” without an obvious fracture line.
Fracture Healing: Callus formation
Fracture Healing:
Nonunion (nonhealing)
Causes of fx nonunion: infection, inadequate immobilization, inadequate blood supply, and inadequate nutrition
Fracture Healing:
Malunion
Fx has healed in an unacceptable position
Common Fractures:
Scaphoid Fracture
Most commonly fractured carpal bone – have a high suspicion for this!
Always refer these to ortho – this one was surgically repaired
Scaphoid fx complications
5% of scaphoid fractures have complications
Nonunion
Osteoarthritis
Avascular necrosis
Common Fractures:
Colles Fracture
Fracture of the distal radius with dorsal angulation of the distal fragment; sometimes with ulnar styloid fx
More common in children and older adults (scaphoid fractures are more common in 15-40 y/o)
Common Fractures:
Smith Fracture
: fracture of the distal radius with palmar angulation of the distal fragment
Injury – fall on the back of a flexed hand (holding something, like my beer!)
Common Fractures: Radial Head Fracture
Most common elbow fracture in adults
Easily missed on radiograph: look for the “posterior fat-pad sign”
Caused by a fall on an outstretched arm or direct blow to the elbow
orthogonal views.
two views at 90° angles to each other
(AP/Lateral)
radial head fx
Common Fractures:
Boxer Fracture
Fracture of the head of the 5th metacarpal
Usually a result of punching a solid object
Common Fractures: Hip Fractures
RF
OSTEOPOROSIS (and all of its risk factors)
Age (incidence doubles with each decade beyond 50)
High energy trauma or pathologic fractures in the young
Common Fractures:
Hip Fractures
Most hip fractures are in the femoral neck or the intertrochanteric region
Fx line may be difficult to see in a patient with osteoporosis
Joint Injury Terminology: Subluxation
Incomplete loss of contact between articular surfaces
Joint Injury Terminology:
Dislocation
Complete loss of contact between articular surfaces
Joint Injury Terminology: Dislocation position
Dislocations are described by the position of the distal bone(s)
