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Imaging (clinical anatomy) > Practical 2: MSK XRs > Flashcards

Practical 2: MSK XRs Flashcards

1
Q

Who do greenstick fractures occur in?

A

children

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2
Q

What might you see in long bones of children on XR?

A

growth plates visible

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3
Q

How do you describe XRs in terms of brightness?

A

Radiolucent and radio-opaque

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4
Q

What are the standard views for the C spine?

A

AP, Lateral and Peg (open mouth)

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5
Q

Why might you request a swimmer’s view in someone?

A

To assess the C7/T1 junction that may not be visible on lateral view

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6
Q

What 3 lines do you look at on lateral C spine view?

A

Anterior vertebral line*
posterior vertebral line*
spinolaminar line

*correspond to the longitudinal ligaments

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7
Q

What 3 columns might the C-spine might be described as? If one of these columns is disrupted what does this indicate?

A

Anterior (ant long. ligament –> ant 1/2 vertebral body)
middle (post. 1/2 vertebral body –> post. long. lig)
posterior (posterior elements of vertebra)

indicates instability

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8
Q

What is special about the role of the anterior longitudinal ligament?

A

Only ligament to Prevents hyperextension of the spine

others resist hyperflexion

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9
Q

Where do the posterior and anterior longitudinal ligaments run from and to?

A

posterior: C2 (posterior to body) –> sacrum [n.b. runs w/in the vertebral canal w/ the spinal cord]
anterior: occipital bone base –> sacrum

both are posterior or anterior to the vertebral body

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10
Q

What soft tissue spaces should you look at on a lateral c spine view?

A

nasopharyngeal
Retropharyngeal
retrotracheal

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11
Q

What would you do if one of the soft tissue spaces on the lateral C spine is >7mm above C5 or > than the width of one vertebral body below C5?

A

Suggests fracture –> CT scan

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12
Q

What should you look for on a Peg view?

A

the spaces between the C1 lateral masses and C2 peg/dens should be equidistant and small

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13
Q

what lies anterior to the dens? Why is it important?

A

The transverse ligament of C1/atlas. Prevents dens fracture affecting the spinal cord

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14
Q

what type of joint is between the dens and C1 anterior arch?

A

Synovial (therefore affected in RA pts)

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15
Q

is the dens anterior or posterior?

A

ANterior (don’t get confused by pics)

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16
Q

What is special about the vertebral foramen of the C vertebra?

A

Wide therefore subluxation may not compress the spinal cord

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17
Q

How are the superior and inferior articular facets of the C vertebra directed?

A

Superior: supero-posteriorly
inferior: infero-anteriorly

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18
Q

What is special about the spinous processes of the C vertebra?

A

Bifid

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19
Q

What is a clay shoveler fracture? Why is it called this?

Who can it be seen in acutely?

A

Fracture of the spinous process (lower c-spine [usually c7])

Clay is sticky –> as you shovel upwards there is a sudden flexion force

Acutely: motor vehicle accident, sudden onset muscle contraction (clay), direct blows to the spine

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20
Q

Are clay shoveler fracture injuries recognised at the time?

A

No, picked up incidentally when imaging C spine for ther reasons

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21
Q

What is an extension teardrop fracture?

A

Associated w/ whiplash / read end collision

hyperextesnion of the neck causes the anterior longitudinal ligament to be torn –> fracture of the vertebral body

in severe cases: a vertebral body dislocates posteriorly + compresses spinal cord

(n.b. you can get a flexion teardrop fracture)

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22
Q

What does the ligamentum flavum do?

A

Binds the lamina of the adjacent vertebrae

23
Q

What is the special role of the posterior longitudinal ligament (other than preventing hyperflexion)?

A

prevents posterior disc herniation (protecting the spinal cord)

24
Q

What does unequal distance of the C1 lateral masses from the peg/dens suggest?

A

Fracture of the C1 ring

can be equal distance but large also suggesting fracture

25
Q

What is a hangman fracture? What is interesting about its aetiology?

A

fracture of C2’s pars interarticularis (bilaterally) due to high-velocity hyperextension injury

Never seen in hangings –> more associated w/ high speed motor vehicle accidents

26
Q

What might be at risk in a Hangman fracture? How?

A

Vertebral artery if the fracture extends to the transverse foramina

27
Q

Where does the pars interarticularis lie?

A

between the superior and inferior articular processes of the facet joints

28
Q

What is a Jefferson fracture? What is it caused by? What should you request?

A

C1 burst fracture (fracture of both posterior and anterior arches) due to axial load to head (e.g. diving)

CT!!!

29
Q

What is an oblique view of the T/L spine good for?

A

Shows you the scotty dog appearance –> useful in examination of pars interarticularis

30
Q

what do the spinal nerves come out of?

A

The intervertebral foramen

31
Q

How does the rib articulate with the T vertebra?

A

The transverse process has a costal facet for tubercle of the rib

The vertebral body has sup/inf costal facet for head of the rib

32
Q

What might you see in a lateral T/L spine view in someone older?

A

Calcification of the aorta

concave vertebral bodies

33
Q

What 3 lines make up the y view in a shoulder?

A

coracoid, acromion, scapula blade/body

34
Q

how is the patient positioned in a XR Y view of the shoulder?

A

arm extende

35
Q

how is the patient positioned in a XR axial of the shoulder?

A

arm abducted

36
Q

Why do a Y view of the shoulder?

A

differentiate ant. from post. humeral head dislocations

37
Q

Why do an axial view of the shouldeR?

A

dislocations, visualisation of the humeral head + glenoid fossa

38
Q

What is a supracondylar fracture? Who is it seen in?

A

Fracture of the distal humerus

Children/young teens

39
Q

What structures are at risk in a suracondylar fracture?

A

Median nerve and brachial artery

40
Q

What is the mechanism of injury for posterior elbow dislocation? What structure is at risk?

A

Fall onto flexed elbow, hyperextension (causes posterior displacement of ulnar)

ULNAR NERVE

41
Q

What are the scaphoid views?

A

PA, PA w/ ulnar deviation, oblique and lateral

42
Q

What is the use of a lateral view of the wrist?

A

sees if capitate, lunate and radius are in line –> may show luneate dislocation

43
Q

What is a boxer’s fracture?

A

Punch –> fracture of distal/neck of 4th and/or 5th MCs

44
Q

What are the 4 types of intracapsular fractures? What is at risk?

A

head of femur
subcapital
transcervical
basicervical (can be extracapsular)

Middle circumflex artery (from deep femoral a.) supplying proximal femur

45
Q

What are the 3 types of NOF fractures?

A

subcapital
transcervical
basicervical

46
Q

What are the (3) types of extracapsular fractures

A

basicervical (can be intracapsular too)
trochanteric
subtrochanteric

47
Q

How will the leg look in a NOF#?

A

Short and externally rotated

48
Q

how do you classify NOF#s?

A

Garden classification system

49
Q

What is special about garden II fractures?

A

The trabecular lines are normal (interrupted in I, III and IV)

50
Q

What is there a Hx of in Lisfranc fracture-dislocation? What may you need to request?

A

Midfoot trauma

request CT (XR may be equivocal)

51
Q

On a C spine lateral view, what should the widths be of the soft tissue spaces? What if they’re greater than this?

A

<7mm above C5

< width 1 vertebral body below C5

If greater –> CT

52
Q

What are the pedicle + lamina of vertebra?

A

Lamina connects the transverse process w/ the spinous process (ligamentum flavum connects lamina of adjacent vertebrae)

Pedicle connects the vertebral body w/ the transverse process

53
Q

What is at risk of a posterior elbow dislocation?

A

Ulnar nerve

54
Q

Why are elbow dislocations rare? What do they most usually occur from?

A

Elbow joint one of the most stable joints

sports activities (50%)

Imaging (clinical anatomy) (19 decks)

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