RAD-MSK-LE Flashcards
What’s the most common fracture in the thoracic spine?
Compression fractures from a significant mechanism
What percentage of thoracic spine fractures/dislocations involve a spinal cord injury?
60-70%– get an MRi. CT -FX
What’re the standard films for lumbar spine?
-standard: AP + lateral
-special: lumbosacral spot and oblique.
LS NOT Common ordered plain films
What’s the approach to reaching lumbar films?
ABC's: alignment, bones, cartilage and soft tissue AP-1. spinous process alignment 2. intrapedicular distance 3. traverse processes 4. vertebral body width
LATERAL 5. vertebral body height, width and cortex
- posterior vertebral line
7. disc spaces
- posterior vertebral line
BOTH-
- soft tissue
- freebies
What’s that cause of a wedge compression fracture?
hyperflexion from a fall, pathological, or osteoporosis
What is a wedge compression fracture?
- loss of height *anterior vertebral body only (anterior column)
- **posterior body height and post vertebral line intact
- greater loss of height = greater severity
- 25% 75yo
- CT to r/o burst fracture
What is a burst fracture?
Axial load like a jump or fall
- comminuted both anterior and middle columns -***posterior vertebral line disruption
- inter-pedicle space disruption
- **unstable=posterior column fx
- fx fragment *retropulsion into spinal cord -CT, MRI if neuro deficit
What is a chance fracture?
seatbelt fracture hyperflexion at the thoracolumbar junction
- Horizontal fx thru body, post arch, spinous process Ligamentous injury retropulsion of fragments
- unstable.
What is spondylolysis?
- bony defect of the pars interarticularis
- non-displaced fracture
- MC L4/L5 + L5-S1
- repetitive stress, congenital
- FX results in a collar around pars/neck of the scotty dog in an LATERAL oblique view
What is spondylolisthesis?
- anterior slippage of the vertebral column relative to the vertebral body below it
- usually a result of bilateral spondylolysis
- MC occurs at L3/4, L4/L5 or L5-S1
- results in spinal stenosis
What’s a true spondylolisthesis?
UNSTABLE Fracture of pars interarticularis *with displacement
w. Step off ABOVE slippage level
What’s a pseudo-spondylolisthesis?
*no pars interarticularis fx present
w/ STEP off BELOW slip level
What is DJD?
Degenerative joint disease aka spondylosis- cortical sclerosis(outer edges white irreg), disc space narrowing, spurs
What is seen with Ankylosing Spondylitis?
VB narrowed towards edges,
long oval, with bulge.
Fusing together
Bamboo spine
What’s the judet view, special view w/ AP?
It’s supine, hip at 45 deg.
viewing the acetabulum.
What’s the inlet view?
40d caudad to see the pelvic ring
What’s the outlet view?
40d cephal to see the sacroiliac. Ideal POST op
What’re the stable pelvis fractures?
-avulsion(ASIS),
-Ramus
-Duverney-iliac wing,
-sacral
Coccyx -2/3
ARDS
What’re the unstable pelvic fractures?
M-algaigne- 1 side SI dislocation FX 1 side
O-PEN BOOK–diastasis (separation) of the SI joint or pubic symphysis
Bucket handle-1 SI jt and ramus opp side
-pelvic ring dislocated in 2+ places
Straddle-B/L FX rami
Dislocation
What causes of hip fractures?
Trauma, osteoporosis, steroids. High risk bleeder to nearby vessels and nerves
If one hip hurts what should you order?
*AP to compare.
Toe touching- IR see Great troch.
Frog Leg- ER absent greater troch
What line is drawn from Less troch of hip to superior rami?
Shenton’s line- if shortent or neck w/in line, +Femoral neck FX
What are the types of Proximal Femur FX with AVN risk?
Capital-top of femur,
Subcapital-below capital,
Transcervical-neck*
Displaced femoral neck FX
Are hip dislocations usually posterior or anterior?
90% are posterior
Describe posterior hip dislocations.
-Femoral head lateral, superior to the acetabulum
-LE IR and shortened
-Axial force along flexed hip and knee
-Sciatic nerve injury 10%
Hiden hip
Describe an anterior hip dislocation.
-External rotation
-Shortened
-Femoral head is inferior, medial
Open hip
What’s the mechanism of a femoral shaft fracture?
High energy/force Often a pathologic fracture. Shortened d/t MSK contraction
Why are femoral fractures at high risk for bleeding?
Femoral artery. high risk for compartment syndrome
What’re standard views of the knee? Special views?
- standard: AP and lateral
- special: sunrise and intercondylar notch (“tunnel view”)
What’s the intracondylar notch/tunnel view?
Knee flexion
Describe a tibial plateau fracture.
- axial load, valgus force
- jumpers
- high risk of ligamentous injury
- CT scan for all tibial plateau FX - ORIF
Describe a tibial plateau compression fracture.
- subtle and easy to miss
- MC lateral plateau
- localized increase in density
- tibia appears lateral to femur
- joint wide on affected side
What’re patella fractures?
- direct blow mechanism most often
- the patella is the largest sesamoid
- ex: horizontal, vertical, stellate-star or marginal- margin piece
What can be seen in AP OR TUNNEL view of Knee jt?
Proximal fib FX.
Tibia condyle fX-Segond avulsion >75% ACL. ACL tear
What is thought to be a FX in the patella, but isn’t bc/ smooth cortical, and eval. Pt?
Bipartite Patella
Describe a patellar dislocation.
Sunrise view- axial. from a sudden quad contraction
- majority are lateral
- will self reduce
- x-ray for patella fx post-reduction
- 30% w/ ligamentous or meniscus injury
Describe a patellar tendon rupture.
- pt cannot extend knee
- high-riding patella
- effusion
- mechanism: sudden muscle contraction (direction change) or direct blow
What is a butterfly FX?
Triangular fragment in long bones
What is ordered for Ankle injury?
AP, Lateral and Mortise-20deg angle,
Width<4mm,
Tib-fib space <5mm, slight distal tib fib overlap. .
What should be noted in ankle injury?
Mortise jt of stability. Wide, Narrow-determine ligamentous disruption
What should be noted in bimalleolar FX?
Tri malleoli. Follow the cortex. Med and Lat and Post-UNSTABLE
What is Maisonneuve FX?
Spiral FX of proximal fibula;
Widened mortise.
Wide syndesmosis-
+/- distal fib. Check above and below
What FX occurs at the roof of the mortise jt?
Plafond FX- distal tibia/joint talus- comminuted- intraarticulur-impacted-
UNSTABE- CT
What are risk with Talus fX?
Missed- Chronic pain if note treated d/t AVN, malunion. CT!- ORIF
What are seen posteriorly and thought to be FX?
Ossicle- os trigonum talus, Os
What is MC tarsal FX and require CT or MRI of LS?
Calcaneus FX- high force
Draw Bohler’s angle and what does it indicate?
Line A- sup posterior to subtalar articulation Line B- Inf talus tip of subtalar jt to ANT process of calcaneus. Ant Angle= 20-40deg. DEC angle= compression FX. BUT normal does not R/O FX still CT
Gissane angle?
N- 120-140 INC= FX. Line btwn navicular and calcaneus+ talus and navicular
What is a FX btwn base and shaft of 5th MT?
Jones FX- slight more distal from styloid. CAST- ORIF. Risk NOn union
What is avulsion of 5th MT at base?
Pseudo Jones- Dancers.
Peronus brevis tendon-
Walking cast.
STRESS FX- MC shaft of 5th
What is a LIsfranc FX?
- Midfoot slide laterally d/t FX and dislocation
- Check 1-2MT alignment with/ 1st and 2nd cunieform
- 5th MT w/ cuboid
- FX at proximal 2 MT
- MT cuboid space on AP obligue.
- MOA DF -
7 UNSTABLE ORIF - ligament is 1st cuneiform and medial 2nd MT
