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Differential Diagnosis/Imaging > Radiologic Eval of Bone Fx & Pathological Fx > Flashcards

Radiologic Eval of Bone Fx & Pathological Fx Flashcards

1
Q

Describe alignment

A
  • General skeletal architecture: size, #, congenital anomalies, absence of bones, deformities
  • Contour of bone: IN/EX irregularities, cortical outline of bone, bony outgrowth of spurs, breaks in continuity of cortex
  • Alignment of bones to adjacent bones: fx, dislocation, subluxation
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2
Q

Describe bone density

A
  • General bone density: assess the shade of grey, look for sufficient contrast b/w bone & soft tissue, look for sufficient contrast within the bone
  • Textual abnormality: fluff, smudge, coarsening
  • Local density changes: sclerotic changes (normal, excessive, reactive)
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3
Q

Describe cartilage space

A
  • Cartilage is full of water, images on radiograph are radiolucent
  • Evaluate the joint space width: decreased space implies cartilage or disk is thinned down due to degenerative process
  • Subchondral bone: increased sclerosis = OA, erosions = RA/gout
  • Epiphyseal plates: position, size, & smooth margins
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4
Q

Describe soft tissue

A
  • Muscles: wasting
  • Fat pads/fat lines (wrist/elbow)
  • Joint capsule
  • Periosteum: solid = fx healing, chronic OM; laminated = repetitive or Ewing Sarcoma; speculated/sunburst = malignant bone
  • Gas, foreign bodies, calcification
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5
Q

What is the radiologic report

A
  • Attempts to link radiologic signs with pt Hx & exam
  • Provides a standard of comparison with previous exam
  • Permanent record
  • Provides important indications & contraindications for medical intervention
  • Research
  • Communication b/w healthcare professionals
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6
Q

Describe the primary trauma survey: Protocol Series

A
  • Performed in ER
  • CT often utilized to screen for major organ injury & Fx (time saving practice)
  • Examples: Cross table lateral views of cervical spine (assess gross instability/Fx/dislocations); Anteroposterior (AP) chest (assess for hemothorax, pneumothorax, pulmonary contusion); AP pelvis (assess for Fx, hemorrhage)
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7
Q

Radiographic signs of fracture

A
  • Cortical disruption
  • Change in shape of bone
  • Double density sign: 2 densities instead of 1
  • Avulsion fragment
  • Lucent line
  • Abnormal fat pad signs
  • Linear region of sclerosis
  • Alteration of smooth surfaces
  • Displaced bone
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8
Q

Categories of fractures

A
  • Traumatic
  • Stress/fatigue fracture
  • Insufficiency fracture: deficient elastic resistance or weakened by decreased mineralization
  • Pathologic fracture: bone abnormally fragile by neoplastic or disease
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9
Q

Other conditions besides fractures that can be seen on radiograph

A
  • Accessory bones: found in the foot>wrist>shoulder
  • Epiphysis/epiphyseal plates
  • Juxta-articular calcification: calcium deposits near joint
  • Multipartite conditions: bipartit patella/scaphoid
  • Nutrient foramina: oblique radiolucency in shafts of long bones
  • Sesamoids: metacarpal & tarsal heads, fabella, pisiform
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10
Q

Elements of fracture description

A
  • Anatomical site & extent of fracture
  • Type of fracture: complete/incomplete
  • Alignment fracture fragments
  • Direction of fracture line
  • Presence of special features (impact/avulsion)
  • Associated abnormalities (dislocation)
  • Articular involvement
  • Classification schemes/labels
  • Physician name/other name
  • Typically will be a combination of terms with non standard
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11
Q

Define a comminuted fracture

A
  • multiple fragments
  • more than the normal two pieces from a fracture
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12
Q

Long bone fracture biomechanics Force = Pattern

A
  • Tapping = transverse fx
  • Crushing = comminuted fx
  • Penetrating = comminuted fx
  • Bending = transverse fx
  • Torsion = spiral fx
  • Compression + bending = oblique/transverse or butterfly fx
  • Compression +bending + torsion = oblique
  • Traction = avulsion
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13
Q

Describe osteomalacia

A
  • a disease that weakens bones & can cause them to break more easily
  • a disorder of decreased mineralization which results in bone breaking down faster than it can re-form
  • occurs in adults
  • in children inadequate concentrations of Vit D may cause rickets
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14
Q

Describe an impaction fracture

A
  • compression forces in axial loading
  • predominately occurs in cancellous bone
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15
Q

Describe an avulsion fracture

A
  • tensile loading of the bone Ie. ligaments, tendons
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16
Q

Describe compression fracture

A
  • compression of vertebrae between inferior & superior adjacent vertebrae
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17
Q

Describe a depression fracture

A
  • surface of one bone driven into another Ie. tibial plateau fracture
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18
Q

Fractures in children growth plates (Salter Harris Fractures)

A
  • Normal: epiphysis (top), epiphyseal growth plate (middle), metaphysis (below the growth plate)
  • Type I = fracture straight across the growth plate (horizontal)
  • Type II = fracture starts in the growth plate and exits at the metaphysis
  • Type III = fracture starts in epiphysis and exits through the growth plate
  • Type IV = fracture goes through the epiphysis, epiphyseal growth plate, and metaphysis
19
Q

Clinical exam for slipped capital femoral epiphysis (SCFE)

A
  • Pediatric pathology
  • restricted IR with PROM
  • increased hip ER PROM
  • limping
  • vague pain in the hip, knee, or thigh
  • knee pain can be referred
  • groin pull is rare in children
20
Q

Describe a greenstick fracture

A
  • Seen in children <10 y/o
  • Incomplete fracture
  • Mid-diaphyseal
  • Forearm/lower leg
  • Bone is bent/curved
21
Q

Describe nursemaid’s elbow

A
  • subluxation of the radial head into the annular ligament, which usually spontaneously or easily reduces
  • pull on extended pronated arm
22
Q

Describe reduction of closed fractures

A
  • No surgical incision is made
  • Bones are guided back into position via manipulation, traction, or both
  • Tissue tingle allows fracture to be reduced & when tensioned wll help to stabilize the fracture
  • Non-displaced will require no reduction
23
Q

How to name fracture displacements

A
  • you name it by the distal piece
24
Q

When is open reduction required

A
  • Closed methods have failed
  • Closed methods are known from experience to be ineffective
  • Articular surfaces are fractures & displaced, & perfect alignment is necessary for joint function
  • Fracture is secondary to metastasis
  • There is an associated arterial injury
  • Multiple injuries are present
25
Q

Stages of fracture healing

A
  • Cellular stage: hematoma & granulation tissue
  • Vascular stage: revascularization & bony resorption
  • Primary callus: fibrocartilage proliferation (soft callus)
  • Bony callus: hard callus
  • Mature callus: compact bone at fracture site
26
Q

Describe creeping substitution

A
  • direct osteoblastic activity at the fracture site with no callus formation if fragments are in close contact
  • termed primary bone union
  • Ex: surgically compressed bone healing
27
Q

Factors that effect healing

A
  • Age
  • Degree of local trauma or bone loss
  • Type of bone involved
  • Degree of immobilization
  • Infection
  • Local malignancy
  • Radiation or avascular necrosis
  • Hormones
  • Exercise/modified tension along the line of stress
28
Q

Complications in fracture healing

A
  • Delayed union: pathological/adverse factors
  • Slow union: non-pathological/age/location
  • Nonunion (bone repair has stopped): delayed union can create nonunion
  • Malunion: angular or rotary deformity persists
  • Pseudoarthrosis (false joint)
  • Osteomyelitis (infection)
  • Avascular necrosis
29
Q

Complications in adjacent tissues

A
  • Soft tissue injury
  • Arterial injury
  • Nerve injury
  • Compartment Syndrome (5 P’s)
  • Fat embolism (similar to a pulmonary embolism)
  • Hemorrhage (especially in pelvic fractures)
30
Q

What are the 5 P’s of compartment syndrome

A
  • Pain: deep poorly localized
  • Paresthesia
  • Paralysis: permanent damage likely
  • Pallor: distal to the compartment involved
  • Pulselessness
31
Q

Importance of the clinical history & evaluation

A
  • Patient history & clinical exam prevent a missed fracture
  • Trauma = fracture
  • Acute point tenderness to palpation over fracture site is reliable
  • Use CDRs
  • Rule: if it acts like a fracture but radiographs are negative, treat it as a fracture (immobilize) & reevaluate with radiographs in 1-2 wks
32
Q

Commonly missed high risk fractures on radiographs

A
  • C1-C2 fx
  • C6-C7 fx
  • Vertebral body fx secondary to osteoporosis
  • Scaphoid fx
  • Triquetrum fx
  • Galeazzi fx (distal 1/3 of radius)
  • Distal radius fx + carpal injury
  • Monteggia fx (proximal ulna fx)
  • Radial head fx
  • Femoral neck fx
  • Acetabulum fx
  • Sacrum fx
  • Pelvic ring fx
  • Tibial plateau fx
  • Tibial spine fx
  • Second fx
  • Patella fx
  • Maisonneuve fx
  • Calcaneus fx
  • Talus fx
  • Thoracolumbar fx + calcaneus fx
33
Q

Describe pathologic fractures

A
  • Bone weakened by a pathological process
  • Systemic: Congenital (osteogenesis imperfect & osteopetrosis) & Acquired (osteoporosis & Paget’s disease)
  • Local: tumor, infection, disuse, sequelae or irradiation
34
Q

What are the 6 basic categories of skeletal pathology for fractures

A
  • Congenital
  • Inflammatory
  • Neoplastic
  • Metabolic
  • Traumatic
  • Vascular
  • Miscellaneous
35
Q

11 predictor variables of bone tumors

A
  • Behavior of the lesion
  • Bone/joint involved
  • Locus within a bone
  • Patient demographics: age, gender, ethnicity
  • Margin of the lesion
  • Shape of the lesion
  • Joint space involvement
  • Bony reaction
  • Matrix production
  • Soft tissue changes
  • Patient history
36
Q

Describe the behavior of a lesion

A
  • Osteoblastic: creates new bone formation
  • Osteolytic/osteoclastic: Geographic destruction (areas of bone destroyed/radiolucent areas; sharp borders = benign lesion); Moth eaten (several small holes throughout the bone; ragged boarders = metastatic); Permeative destruction (fine destruction of the Haversian system; poorly defined boarders = metastatic)
  • Mixed
37
Q

Describe margin of the lesion

A
  • sharp & clearly defined with sclerotic borders = slow growing/benign
  • poorly defined with no sclerosis = fast growing/malignant
38
Q

Describe shape of lesion

A
  • Longer than it is wide = slow growth/benign
  • Wider than it is long = fast growth/malignant
  • Cortical breakthrough = malignant
  • No cortical breakthrough = benign
39
Q

Describe joint space involvement related to bone tumors

A
  • Infections & inflammation invade the joint space
  • Bone tumors generally do not cross joint spaces
40
Q

Describe bony reaction

A
  • Sclerosis: new bone growth
  • Buttressing: osteophyte formation for stabilizing a joint
  • Periosteal reaction: interrupted suggests tumor & uninterrupted = benign
41
Q

Describe matrix production

A
  • A matrix is tissue formed by primary bone neoplasms
  • Chondroid = cartilaginous
  • Osteoid = bone
  • Mixed
42
Q

Describe osteomyelitis

A
  • Soft tissue edema, loss of tissue planes (blurring)
  • Lytic lesion = increased radiolucency = cortical & cancellous destruction
  • Sequestra = isolated bone segments of dead bone & immature periosteal bone
43
Q

Describe infectious arthritis

A
  • Soft tissue swelling
  • Radiolucency of pain at periarticular regions
  • Joint space narrowing
  • Subchondral bone erosion

Differential Diagnosis/Imaging (20 decks)

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