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Diagnostic Imaging II > Part 1 > Flashcards

Part 1 Flashcards

1
Q

Should we take xrays of the skull?

A

No, less than 10% of skull fractures are detected on xray
skull anatomy is very complex
interpretation is very difficult

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2
Q

what does the patient need if you suspect a skull fracture?

A

CT

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3
Q

tripod fracture

A

when all 3 major attachments of the zygoma are separated from the rest of the face

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4
Q

what are the requirements for spine trauma xrays?

A

xrays must be of diagnostic quality
need appropriate views
old films can be helpful

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5
Q

what are the different mechanisms of trauma?

A 
hyperflexion**
hyperflexion and rotation
hyperextension
hyperextension and rotation
vertical compression
lateral flexion
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6
Q

what are the different types of hyperflexion injuries?

A 
compression fracture
bilateral interfacial dislocation
flexion teardrop fracture
clay shoveler's fracture
anterior subluxation
dens fracture
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7
Q

what are the types of hyperflexion and rotation injuries?

A

unilateral interfacetal dislocation

unilateral interfacetal fracture-dislocation

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8
Q

hyperextension fractures

A 
avulsion of anterior tubercle of C1
hyperextension fracture-dislocation
hyperextension dislocation
posterior arch fracture of C1
extension teardrop fracture
hangman's fracture
lamina fracture
dens fracture
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9
Q

hyperextension rotation fractures

A

pillar fracture

pedicolaminar fracture

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10
Q

vertical compression fractures

A

jeffersons fracture of C1

bursting fracture of lower cervical spine

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11
Q

lateral flexion fractures

A

unilateral fracture, lateral mass of C1
transverse process fracture
uncinate fracture

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12
Q

where are the most common spinal traumas?

A

C1-2
C5-7
T12-L1

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13
Q

what percentage of cervical traumas end up with neurological injury?

A

40%

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14
Q

what percent of spinal traumas end up with spinal cord injuries overall?

A

10-14%

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15
Q

what percent of thoracolumbar traumas end up with neurological injury?

A

10%

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16
Q

if you suspect cervical spine trauma, what should you do?

A

take a 7 view cervical spine series

“Davis series”

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17
Q

what is included in the 7 view cervical spine series?

A 
lateral
APOM
AP cervical
right and left obliques
flexion and extension
swimmers
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18
Q

what should you do if you have a diagnosis before you finish the entire 7 view cervical series?

A

stop and take care of it

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19
Q

when is a fracture stable or unstable?

A

unstable: middle column, 2 or more columns
stable: anterior column only, posterior column only

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20
Q

what if you have a new spinal fracture?

A

orthopedic consult

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21
Q

how do you treat a stable injury?

A

more conservatively

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22
Q

retropharyngeal space

A

7mm

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23
Q

retrotracheal space

A

22mm

24
Q

signs of spine trauma (abnormal vertebral alignment)

A 
misalignment
loss of lordosis
acute kyphotic angulation
widened interspinous spaces
vertebral rotation
torticollis
25
Q

signs of spine trauma (abnormal joints)

A

increased ADI
abnormal disc height
widened apophyseal joints

26
Q

other signs of spinal trauma

A

vacuum cleft disc
an angle of 11 degrees or more of flexion compared to adjacent levels
greater than 3.5mm body offset maybe a clue to instability

27
Q

radiographic features of severe sprain

A

widening of interspinous distance
loss of parallelism between facet joints
horizontal displacement
angular displacement of greater than 11 degrees compared to adjacent interspaces

28
Q

antero/retrolisthesis can be due to:

A 
fracture
dislocation
ligamentous laxity
DJD
anatomic
physiologic
29
Q

how fast can spinal fractures heal?

A

3-6 months

30
Q

body fractures heal more with..

A

fibrosis

31
Q

arch fractures heal more with

A

callus

32
Q

posterior arch fracture

A

MC fracture of atlas
usually bilateral and vertical in orientation
hyperextension mechanism

33
Q

other name for jefferson’s fracture

A

bursting fracture of C1

34
Q

what is jefferson’s fracture?

A

axial compression injury
bilateral fracture of anterior and posterior arches
bilateral lateral mass offset

35
Q

when is a jefferson’s fracture definitely unstable?

A

when the transverse ligament is torn (>7mm)

36
Q

when is ADI most common

A

RA

37
Q

traumatic rupture is ___in ADIs

A

rare

38
Q

ADIs are considered..

A

unstabile

39
Q

what do you do when you find an increased ADI?

A

DON’T adjust

orthopedic consult

40
Q

what are the max ADIs for children and adults?

A

children: 5mm
adults: 3mm

41
Q

what are some etiologiesfor ADIs

A 
normal variant
trauma
down's syndrome
major UC anomaly
inflammatory arthropathies
42
Q

what should you do if there is an increase in ADI

A

take flexion and extension films

43
Q

which film is better for seeing ADIs, flexion or extension?

A

flexion

44
Q

steele’s rule of thirds

A 
ring of atlas is
1/3 cord
1/3 odontoid
1/3 potential space
anterior displacement may be asymptomatic
45
Q

40-50% of axis fractures are..

A

dens fractures

46
Q

name the types of odontoid fractures and how common they are

A

type I: oblique fx of the tip (4%)
type II: fx at the base (66%)
type III: fx into the body 30%)

47
Q

type I dens fractures are stable or unstable?

A

stable and rare

48
Q

type II dens fractures are stable or unstable?

A

unstable and most common

49
Q

type III dens fractures are stable or unstable?

A

unstable when broken

stable when healed

50
Q

which dens fracture are non unions common?

A

type II

51
Q

what is disrupted with type III dens fractures?

A

Harris’ ring

52
Q

describe type I dens fx

A

uncommon
avulsion of the tip
distraction by apical or alar ligament

53
Q

describe type II dens fx

A

transverse or oblique fx through base
best seen on APOM
nonunion very cmmon
unstable

54
Q

if the dense is more than 5mm displaced in a type II dens fx, what does that mean?

A

100% nonunion

55
Q

T/F: most os odontoideum are old ununited dens fx

A

true

56
Q

T/F: most old ununited dens fx are os odontoideums

A

false

57
Q

describe type III dens fractures

A 
below junction of dens and C2 body
mechanically unstable
may disrupt Harris' ring
altered body contour "fat C2 body"
best seen on lateral
may need specialized again

Diagnostic Imaging II (19 decks)

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