Orthopedics-NM

Question 1

Views for Shoulder

Answer 1

AP / Grashey

Tip: dont forget clavicle, often ordered seperate series.

Question 2

Views for Humerus

Answer 2

internal and external rotation

unless you DEFINITELY know there is a fracture/dislocation

Question 3

Fat pad sign

Answer 3

(or sail sign) means there is a dark area displacing the fat pad indicating blood and injury

Question 4

elbow views

Answer 4

Should try to have them lay the arm as flat as possible to get proper view on AP

Question 5

Radiocapitellar line

Answer 5

Question 6

forearm views

Answer 6

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

Question 7

Wrist lines

Answer 7

3 lines (actually should be 4)

Question 8

wrist views

Answer 8

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

Question 9

Hand views

Answer 9

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)

Question 10

Hip views

Answer 10

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

Question 11

Femur views

Answer 11

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

Question 12

knee views

Answer 12

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!)

Question 13

Answer 13

sunrise view of patella

Question 14

Answer 14

tunnel view of knee

Question 15

Tib/Fib views

Answer 15

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)

Question 16

Ankle views

Answer 16

AP, lateral and mortise for injuries
AP and lateral for arthritis
Don’t ignore the posterior ankle; will often see lots of problems there

Question 17

foot views

Answer 17

AP, lateral and oblique are the most common views

Question 18

simple fracture

Answer 18

2 fracture fragments

Question 19

Subtle fractures may become visible in how many days

Answer 19

7-10 days after the injury

Question 20

Compound fracture

Answer 20

also called open fracture. Skin is broken

Question 21

comminuted fracture

Answer 21

also called complex fracture

more than 2 bone fragments

Question 22

transverse fracture

Answer 22

straight across

Question 23

oblique fracture

Answer 23

Question 24

spiral fracture

Answer 24

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

Question 25

angulation of fractures

Answer 25

Terms like dorsal, radial, ulnar, valgus, and varus are also used to describe the direction of the angulation.

Question 26

displacement of fracture

Answer 26

Displacement is named according to the distal fragment. Can be full displacement or side-to-side movement of fragments.

Question 27

describe this fracture

Answer 27

A: A medially displaced transverse midshaft fracture of the humerus

Question 28

Fracture Terminology: Distraction & Overriding

Answer 28

Question 29

Fracture Terminology: Impaction

Answer 29

Question 30

stress fracture

Answer 30

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

Question 31

pathologic fracture

Answer 31

Fracture through a bone abnormality, benign or malignant; can occur with minimal or no trauma | due to osteoporosis, cancer, infection so on..

Question 32

Answer 32

This patient also had metastatic renal cell carcinoma, with a **pathologic** humerus fx

Question 33

Avulsion Fracture

Answer 33

Fracture of a bony fragment that is produced by the pull of a ligamentous or tendinous attachment

Question 34

Answer 34

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)

Question 35

Pediatric Fractures: Normal physis

Question 36

Question 37

Answer 37

type 2 salter harris

Question 38

Answer 38

type 3 salter harris

Question 39

Answer 39

type 5 salter harris

Question 40

Answer 40

type 4 salter harris

Question 41

Pediatric Fractures: Greenstick Fracture

Answer 41

Question 42

Pediatric Fractures: Torus fracture

Answer 42

Torus fractures (buckle fractures) are also incomplete fractures. The buckled cortex creates a “bump” without an obvious fracture line.

Question 43

Fracture Healing: Callus formation

Answer 43

Question 44

Fracture Healing: Nonunion (nonhealing)

Answer 44

Causes of fx nonunion: infection, inadequate immobilization, inadequate blood supply, and inadequate nutrition

Question 45

Fracture Healing: Malunion

Answer 45

Fx has healed in an unacceptable position

Question 46

Common Fractures: Scaphoid Fracture

Answer 46

Most commonly fractured carpal bone – have a high suspicion for this! Always refer these to ortho – this one was surgically repaired

Question 47

Scaphoid fx complications

Answer 47

5% of scaphoid fractures have complications Nonunion Osteoarthritis Avascular necrosis

Question 48

Common Fractures: Colles Fracture

Answer 48

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)

Question 49

Common Fractures: Smith Fracture

Answer 49

: 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!)

Question 50

Common Fractures: Radial Head Fracture

Answer 50

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

Question 51

orthogonal views.

Answer 51

two views at 90° angles to each other (AP/Lateral)

Question 52

Answer 52

radial head fx

Question 53

Common Fractures: Boxer Fracture

Answer 53

Fracture of the head of the 5th metacarpal Usually a result of punching a solid object

Question 54

Common Fractures: Hip Fractures RF

Answer 54

OSTEOPOROSIS (and all of its risk factors) Age (incidence doubles with each decade beyond 50) High energy trauma or pathologic fractures in the young

Question 55

Common Fractures: Hip Fractures

Answer 55

Most hip fractures are in the femoral neck or the intertrochanteric region Fx line may be difficult to see in a patient with osteoporosis

Question 56

Joint Injury Terminology: Subluxation

Answer 56

Incomplete loss of contact between articular surfaces

Question 57

Joint Injury Terminology: Dislocation

Answer 57

Complete loss of contact between articular surfaces

Question 58

Joint Injury Terminology: Dislocation position

Answer 58

Dislocations are described by the position of the distal bone(s)

Question 59