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Orthopaedics > Radiology > Flashcards

Radiology Flashcards

1
Q

Label picture 6 in trauma section - shenton line, iliopectineal, ilioischial and teardrop

A

See picture 7

Blue = shenton
Green = iliopectineal
Yellow = ilioischial
Red = teardrop
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2
Q

Label picture 8 in trauma section with the lines used to interpret C spine X-ray (5)

A

See picture 9

Pink= prevertebral soft tissue shadow : between c2-c4 shouldn’t be > 3-5 mm
Blue = anterior vertebral body line :must be in lordosis, smooth, parallel.
Green = posterior vertebral body line
Yellow - spinolaminar line
Black = posterior spinous line. Must converge at 1 point.

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3
Q

Label picture 70 in trauma section

A

See picture 71

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4
Q

Identify pathology picture 39 in trauma section

A
  1. Details: lateral xray of the Thoracolumbar spine of Mr x on date y
  2. Adequacy - adequate.
    •t11/t12 - sacrum with vertebral bodies, facet joints, pedicles and transverse processes clearly visible. Good penetration.
  3. Alignment
    • Anterior vertebral line disrupted from l1 to L3 indicating fracture
    . Posterior vertebral line intact

4 loss vertebral height of l2 = compression fracture associated with osteoporosis or burst #

  1. Vertebral spaces normal
  2. Vertebral end plate superior and inferior continuity.
    • superior end plate of l2 disrupted
    • end plate sclerosis and osteophytes formation = spondylosis
    • no fragments seen so unlikely burst #
  3. Posterior elements
    • pedicles: normal so unlikely burst #
    • laminae normal
    • spinous processes: normal

Pathology: compression # of l2 with spondylosis

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5
Q

Identify pathology picture 40 in trauma section

A
  1. Details: ap and lateral xray of the lumbar spine of Mr x on date y
  2. Adequacy = adequate
    •t11/t12 - sacrum with vertebral bodies, facet joints, pedicles and transverse processes clearly visible. On ap, spinous processes central and transverse processes equal distance.
  3. Alignment
    . Ap: vertebral bodies alignment disrupted at l2. spinous processes aligned
    • lateral: disruption of ant and post vertebral body lines
    • therefore fracture

4 loss vertebral height at L2 = compression fracture associated with osteoporosis or burst #

  1. Vertebral spaces
    • narrowed at L1/L2
  2. Vertebral end plate superior and inferior continuity.
    .L2 superior end plate disrupted
    • end plate sclerosis = spondylosis
  3. Posterior elements
    • pedicles: normal
    • laminae normal
    • spinous processes: normal

Pathology: Compression #

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6
Q

Identify pathology picture 41 in trauma section

A

Burst #

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7
Q

Identify pathology picture 42 in trauma section and describe

A
  • Sagittal View CT scan of lumbar spine of Mr X on the date of y
  • Alignment: anterior and posterior Vertebral lines continuous and in lordosis
  • loss of vertebral height seen therefore a fracture is present
  • vertebral spaces increased
  • vertebral end plates not continuous
  • multiple fragments of the vertebral body seen
  • fracture of posterior half of vertebral body
  • no soft tissue abnormality seen

Pathology: burst #

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8
Q

Identify pathology picture 44 in trauma section

A
  1. Details: Sagittal CT scan of the lumbar spine of patient X on date Y
  2. Adequacy = adequate
    •t11/t12 - sacrum with vertebral bodies, facet joints, pedicles and transverse processes clearly visible. On ap, spinous processes central and transverse processes equal distance.
  3. Alignment
    posterior vertebral line disruption at L1
    • disruption = fracture
  4. loss vertebral height at L4 and l1 vertebral body fragments seen projecting anteriorly
  5. Vertebral spaces normal
  6. Vertebral end plate superior and inferior continuity.
    • superior end plate of l1 disrupted
  7. Posterior elements
    • pedicles:widened distance normal
    • spinous processes: increased distance = flexion distraction injury

Pathology= Flexion distraction injury lumbar

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9
Q

Identify pathology picture 47 in trauma section

A

•Sagittal View MRI scan of spine of Mr X on the date of y
. Alignment: anterior and posterior Vertebral lines disrupted and neither in kyphosis nor lordosis
• loss of vertebral height seen between 2 vertebrae therefore a fracture is present
• vertebral space increased
• vertebral end plates not continuous
• multiple fragments of the vertebral body seen
• spinal cord compression seen

Pathology: bifacetal Fracture dislocation and spinal cord compression

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10
Q

Identify pathology picture 48 in trauma section

A

Fracture dislocation of the Thoracolumbar spine

• anterior and posterior vertebral line disruption

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11
Q

Identify and classify pathology picture 55 in trauma section

A

Tile pelvic fracture type c: rotationally and vertically unstable

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12
Q

Identify pathology picture 58 in trauma section

A

• ap X-ray of Mr x’s knee taken on date y
. Adequacy: adequate . No rotation: slight overlap of lateral tibia and head of fibula. Patella visible in midline. Adequate penetration. would like joint above or below To assess for any other abnormalities.
• effusion: need lateral view to determine.
• bones: no visible fracture. Significant overlap of femur over tibia and fibula, suggesting dislocation
• tibio-femoral alignment: normal, thus no tibial plateau fracture
• patellar tendon: assess on lateral view

pathology: Knee dislocation

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13
Q

Identify pathology picture 61 in trauma section

A

Ant dislocation knee

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14
Q

Identify pathology picture 63 in trauma section

A

• lateral X-ray of Mr x’s left/right knee taken on date y
. Adequacy: adequate . No rotation: fibulae head overlaps tibia and femoral condyles superimposed. Adequate penetration. would like joint above or below To assess for any other abnormalities.
• effusion: suprapatellar recess between prefemoral and suprapatellar fat pad not enlarged, thus no effusion.
• bones: no visible fracture. Posterior dislocation of the knee joint visible.
• tibio-femoral alignment: to be assessed on AP view
• patellar tendon: possible rupture as this distance is longer than the patellar length

pathology: Post knee dislocation

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15
Q

Identify pathology picture 50 in trauma section

A

Lisfranc injury
• tarsometatarsal fracture dislocation with traumatic disruption between articulation of medial
Cuneiform and base of second metatarsal
• discontinuity of line from medial base 2nd metatarsal to medial side of middle cuneiform on ap- diagnostic
• widening interval between 1st and 2nd ray on ap view. May see bony fragment (fleck sign) in 1st metatarsal space representing avulsion of lisfranc ligament from base of 2nd metatarsal - diagnostic.

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16
Q

Label picture 56 in trauma section

A

See picture 57

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17
Q

Identify pathology picture 59 in trauma section

A

Salter Harris type 1 # (physis separation) of the proximal tibia, with minimal shortening, dorsal angulation and 15% apposition

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18
Q

Identify pathology picture 68 in trauma section

A
  1. Details: lateral xray of left/right ankle joint of Mr X on date y
  2. Adequacy: inadequate.
    Can see distal 1/3 of tibia and fibula
    should also see calcaneus and base of fifth metatarsal.
  3. Bones:
    •cortical outlines of tibia disrupted dorsally on metaphysis and intra-articular on epiphysis
    • intra-articular fracture of distal tibia extending from metaphysis through epiphysis. Minimally displaced.
  4. Cartilages
    No abnormalities seen
  5. Soft tissues
    No swelling or effusion seen

Pathology: Salter Harris #type 4 (through epiphysis to metaphysis) (intra-articular)

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19
Q

Identify pathology picture 67 in trauma section

A

Salter Harris #type 5 (crush) of the distal tibia

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20
Q

Identify pathology picture 66 in trauma section

A

• This is an ap xray of the left/right elbow of Mr x on date y
• adequacy: inadequate. Wrist joint must be included
• No gross soft tissue swelling visible
• Joint effusion and fat pads: need lateral view to discern.
• bones and alignment: radiocapitellar line disruption, indicating dislocation of radius.
Anterior humeral line to be assessed on lateral view for supracondylar #.
Humerus appears normal.
Ulnar bowing.
• ossification centres by order of appearance (CRITOE): all present up to internal/medial epicondyle, so this child is probably 5 -7 years old

Pathology: Plastic ulna deformity (bowing) with radial head dislocation

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21
Q

Identify pathology picture 65 in trauma section

A

Torus/ buckle # of the distal radius

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22
Q

Identify pathology picture 73 in trauma section

A

1 details: lateral xray of the left / right elbow of Mr x taken on date y
2. Adequacy: inadequate

  • need wrist too, to visualise entire ulna and radius
  • hourglass/figure of 8 sign present thus no rotation
  1. Effusion and soft tissue injury
    None visible, no fat pads
  2. Bones:
    • radial head dislocation
    • proximal 1/3 transverse fracture of the ulna with shortening, volar angulation, rotation to be assessed clinically, 10% apposition.
  3. Alignment
    • anterior humeral line intact

• radio capitellar linedisplaced thus radial head dislocation

5.ossification centres not present. Adult xray

Pathology: fracture dislocation, Monteggia # type because radial head dislocation with proximal ulnar #

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23
Q

Identify pathology picture 74 in trauma section

A

Galeazzi #
• distal radioulnar joint dislocation
• displaced radial mid shaft fracture with shortening, ulnar angulation , zero apposition

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24
Q

Identify pathology picture 76 in trauma section

A

1.details: ap xray of right hemipelvis of Mr X on date y

  1. Adequacy - inadequate
    • not taken from above iliac crests
  2. Alignment - can’t comment on only hemipelvis
  3. Bones
    • femur: Shenton’s line Disruption- intertrochanteric femur #
    . Pelvic brim continuity
    • obturator foramen continuous
    • Ischium normal
    • ilium can’t comment without full view
    . Pubis normal
    • sacrum can’t comment without full view.
    . Acetabulum: iliopectineal line intact, ilioischial line intact, teardrop sign present
  4. Cartilaginous joints
    • acetabular joint: femoral head articulated ,joint space normal 3-5 mm
    • pubic symphysis width can’t comment without full view
    • sacroiliac joint: cant comment
6. Soft tissue and other
• no effusion
•no Periosteal reaction
. No Calcification soft tissues
• no foreign bodies

Pathology: Displaced intertrochanteric femur # that is shortened, angulated, rotation to be assessed clinically, 0% apposition

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25
Q

Identify pathology picture 79 in trauma section

A

Greenstick # of distal radius with minimal change in length, volar angulation and 90% apposition

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26
Q

Identify pathology picture 80 in trauma section

A

Osteogenesis imperfecta

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27
Q

Identify pathology picture 81 in trauma section

A

Supra condylar # completely displaced Gartland type 3
No change in length, slight volar angulation, bayonet apposition.
(most common # around elbow)

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28
Q

Identify pathology picture 82 in trauma section

A

Posterior fat pad sign and enlarged elevated anterior fat pad (sail/flag sign)
Pathology:
occult Supracondylar # Garland type 1 (non-displaced)

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29
Q

Identify pathology picture 83 in trauma section

A

Fracture of the distal 1/3 of the radius and ulna with shortening of the radius, bayonet apposition, and volar angulation.

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30
Q

Identify pathology picture 84 in trauma section

A

Osgood schlattler disease (osteochondrosis-patellar tendon insert onto prox tibia growth plate. Ossicles )

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31
Q

Identify pathology picture 85 in trauma section

A

AcromiOclavicular joint dislocation of the right shoulder with Ac and cc ligament tear
• widened gap between acromion and clavicle > 8 mm (ac ligament)
• widened gap between clavicle and coracoid 713 mm (coracoclavicular ligament)

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32
Q

Identify pathology picture 86 in trauma section

A

Gartland type 1 Undisplaced supracondylar #

(flag sign) - post fat pad

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33
Q

Identify pathology picture 116 in trauma section

A
  1. Details: lateral view of cervical spine of Mr X on date y
  2. Adequacy: c1-c7/t1 visible therefore adequate
  3. Alignment
    . Lateral:anterior and posterior longitudinal line and spinous process line intact,
    . spinolaminar line disrupted at c5 c6 indicating anterior dislocation
    . Lordosis present
  4. Bones
    • superior cortices of vertebrae c4 and c5 disrupted
    • odontoid peg normal
    . Lateral mass of c5 and C6 disrupted
    • bowtie sign seen at c5 c6: unifacetàl dislocation
    •facet joints disrupted at c5 c6 - dislocation /subluxation
  5. Cartilage / disc spaces normal and symmetrical
  6. Soft tissue normal

Pathology: Unifacetal dislocation: bow tie sign
Anterior dislocation vertebral bodies

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34
Q

Identify pathology picture 117 in trauma section (3)

A

Hangman # c2 (red = fracture) (subluxation, traumatic # of bilateral pars interarticularis of C2)
Disruption anterior line, pre-vertebral soft tissue swelling (orange)
Anterior dislocation c2 (blue)

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35
Q

Approach to Knee X-ray? (8)

A
  1. Details: patient, date, view, side
  2. Adequacy:
    • AP centered on joint space with slight overlap lateral tibia and head fibula. Patella in midline.
    • Lateral fibulae head overlap tibia and femoral condyles superimposed.
    • Ideally 2 joints with 2 views.
  3. effusion and soft tissues: suprapatellar recess between prefemoral and suprapatellar fat pad should be <5mm. Effusion indicate occult fracture or significant ligamentous/cartilaginous injury.
  4. bones: fibular head, femur, tibia, patella, tibial plateau, intercondylar eminence
  5. Joint articulation: dislocations
  6. tibio-femoral alignment: to be assessed on AP view. Line along lateral femoral condyle- tibia should be within 0,5cm of this line otherwise suggest tibial plateau fracture.
  7. patellar tendon: Insall-Salvatti ratio, ideally measured with knee flexed at 30 degrees. If patellar tendon length (inferior pole patella to tibial tuberosity ) more/less than 20% of patellar length, indicate patellar tendon rupture.
  8. Name pathology
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36
Q

Approach to Elbow X-rays? (5)

A

1 details: name, date, side, view
2. Adequacy:
• preferably 2 joints
• lateral: check for rotation with hourglass/figure of 8 sign (normal)
3. Effusion and soft tissue injury
• anterior fat pad: small is normal but large (sail sign) = intra-articular injury
• posterior fat pads: always abnormal = fracture occult
5. Bones: obvious fractures humerus, radius, ulna.
4. Alignment
• anterior humeral line: down anterior border humerus on lat view, should go through middle 1/3 of capitellum. Displacement = fracture (usually supracondylar)
• radio capitellar line: through middle of prox end radius, should bisect capitellum in both views. Displace = radial head dislocation
• angulation radial head- fracture
5.ossification centres: CRITOE in order of appearance by age- capitellum (1), radial head (3), internal/medial epicondyle (5), trochlea (7), olecranon (9), external epicondyle (11)

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37
Q

Approach to Thoracolumbar X-rays? (7)

A
  1. Details: name, date, view,
  2. Adequacy
    • lumbar: t11/t12 - sacrum with vertebral bodies, facet joints, pedicles and transverse processes clearly visible. On ap, spinous processes central and transverse processes equal distance.
    • thoracic: c7/t1 - t12/l1 with all aspects clearly visible.
  3. Alignment
    . Ap: vertebral bodies and spinous processes aligned
    • lateral: alignment vertebral bodies anterior (disrupted with burst # ) and posterior lines
    • disruption = fracture

4 loss vertebral height = compression fracture associated with osteoporosis or burst #

  1. Vertebral spaces
    • should gradually increase from top to bottom
    • narrow = spondylosis
  2. Vertebral end plate superior and inferior continuity.
    • multiple fragments = burst #
    • end plate sclerosis = spondylosis ( also osteophytes formation)
  3. Posterior elements
    • pedicles:widened distance = burst fracture
    • laminae
    • spinous processes: increased distance = flexion distraction injury
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38
Q

Approach to pelvic X-rays? (6)

A

D ABCs

1.details: name, date, view

  1. Adequacy
    • above iliac crests to 1/3 down femoral shaft
    •Penetration
3. Alignment
• coccyx tip and pubic symphysis in midline
• Shenton's line
• iliopectineal line
•Ilioischial line
• roof and medial wall acetabulum
• anterior wall acetabulum
• posterior wall acetabulum
  1. Bones
    • femur: Shenton’s line along medial femoral neck and inferior edge of superior pubic ramus. (Disruption- neck femur #adults, DDH children)
    . Pelvic brim continuity for # -if see one #, look for the other. Rarely only in 1 place.
    • obturator foramen
    • Ischium
    • ilium
    . Pubis
    • sacrum
    . Acetabulum: iliopectineal line (disruption = anterior column fracture), ilioischial line (post column), teardrop sign (displace = occult acetabular #)
  2. Cartilaginous joints
    • acetabular joint: location femoral head (dislocation), joint space typically 3-5 mm (reduced = osteoarthritis )
    • pubic symphysis width (wide =pelvic ring fracture or diastasis)
    • sacroiliac joint: joint space 2-4 MM, joint end plates smooth and regular (wide = pelvic ring # or sacroiliitis )
  3. Soft tissue and other
    • effusion: hyperdensity, fluid level ( eg inflammatory joint disease)
    •Periosteal reaction:nonspecific radiographic finding that indicates periosteal irritation eg healing fracture, bone tumour
    . Calcification soft tissues eg phleboliths, panniculitis, atherosclerotic vascular calcifications )
    • foreign bodies eg total hip replacement
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39
Q

approach to C spine xray? (6)

A

DabCs

  1. Details: name, date, view
  2. Adequacy: c1-c7/t1 must be visible
  3. Alignment
    . Lateral:anterior and posterior longitudinal line, spinolaminar line, spinous process line
    • ap: 2 lateral lines down each side of vertebral bodies and spinous process line
    • odontoid view: alignment of lateral masses of c1 and c2, alignment of odontoid peg with lateral masses of c2
    . Lordosis
4. Bones
• cortices of vertebrae
• odontoid peg
. Lateral mass of c2
• examine each vertebra for fracture/collapse/avulsion
• parallel facet joints
  1. Cartilage / disc spaces
    • loss height, herniation, symmetry etc
  2. Soft tissue
    • prevertebral soft tissue line on lateral view: widening = prevertebral haematoma with fracture suspicion. Above c4 no larger than 1/3 of adjacent vertebral body (<7mm); from c4 onwards no larger than width of one whole vertebral body (<22mm)
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40
Q

Xray findings of osteomyelitis? (5)

A

May be normal first 10 days! Technetium bone scan most sensitive.

  • Soft tissue swelling - early sign (and suppuration)
  • osteolysis / lytic bone distruction/necrosis/ osteopenia/ sequestra ! (Trapped necrotic bone) after 2 weeks
  • new periosteal bone formation / thickening/ periosteal reactions !, especially in response to #, /involucrum after 1 week - appear “hazy”/ “moth eaten” appearance!
  • metaphyseal rarefaction (reduction in bone density) after 2 weeks- late sign
  • Brodie ‘s abscess! (Chronic)
  • subperiosteal abscess!
  • pot puffy tumour
  • sclerosing osteomyelitis of Garre
  • endosteal scalloping
  • Cloaca! (Chronic, cortical defect that drains pus from medulla to surrounding soft tissues)
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41
Q

What does disruption Shenton line indicate?

A

Adults: neck of femur #
Paediatrics: DDH

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42
Q

What does disruption Illopectineal line indicate?

A

Anterior column acetabular #

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43
Q

What does disruption Ilioischial line indicate?

A

Posterior column acetabular #

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44
Q

What does disruption Of teardrop sign indicate?

A

Occult acetabular #

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45
Q

What does widened interpedicle distance indicate on xray?

A

Burst #

46
Q

What does widened Spinous process distance indicate on xray?

A

Flexion distraction injury

47
Q

Identify pathology picture 18

A

Peri- implant fracture of the middle 1/3 of the femur with shortening, angulation and 20% apposition. Rotation to be assessed clinically.

48
Q

Identify Pathology picture 19

A

Minimally displaced Peri- implant fracture of the femoral midshaft extending distally.

49
Q

Name 3 radiological signs of slipped upper femoral epiphysis

A
  • Trethowan’s sign on lateral view = Klein’s line displaced: should go from superior aspect femoral neck and intersect epiphysis of femoral head.!
  • epiphysis has “woolly” appearance
  • posterior and medial slip of epiphysis
50
Q

Name 3 radiological signs septic arthritis

A
  • joint space widening
  • vacuum phenomenon- collections of gas
  • soft tissue swelling
51
Q

Approach to ankle X-ray? (5)

A
  1. Details: name, date, view, side
  2. Adequacy:
    • should see distal 1/3 of tibia and fibula
    • mortise views: should also see talus
    . Lat view: should also see calcaneus and base of fifth metatarsal.
  3. Bones:
    • trace cortical outlines in all views of all bones
    • mortise views: trace mortise and talar dome surface
    • lateral view: assess medial, lateral and posterior malleoili, calcaneus, base of 5th metatarsal
    • internal architecture bone eg thin cortex and increased lucency= osteopenia or osteoporosis
  4. Cartilages
    • mortise: joint space loss (osteoarthritis), widening (fracture or dislocation)
    • medial clear space (mortise): widest distance between medial border talar bone and lateral border medial malleolus should be = to superior clear space (between articular surfaces of tibia and talus).
    Widening (lateral talar shift) = syndesmosis disruption therefore joint instability
    • tibiofibular overlap loss (syndesmosis injury)
    • joint widening with no obvious #on this xray may indicate more proximal #eg maisonneuve #
  5. Soft tissues
    • swelling, effusion
52
Q

How describe angulation of fracture on XR?

A

According to distal segment - volar/dorsal/ulnar etc angulation
OR according to apex (point of intersection between distal and prox segment) eg apex dorsal displacement

53
Q

What is bayonet apposition?

A

2 bone fragments aligned side-by-side rather than end-to- end.

54
Q

How interpret shoulder xrays?

A
  1. Details: name, date, view, side
  2. Adequacy: 2 views, 2 sides
  3. Alignment
    • ap: glenohumeral joint- glenoid fossa (socket) should be visible as concavity medial to humeral head
    - ant dislocation = humeral head inferomedial to glenoid; disruption Maloney’s line , increased subacromial space,
    - post dislocation - glenohumeral joint widened and numeral head has “light bulb” appearance due to forced internal rotation
    - Ac joint dislocation: widened gap between acromion and clavicle >8mm (pathology Ac lig) or between clavicle and coracoid process >13mm (coracoclavicular ligament)
    - acromiohumeral distance <7mm = supraspinatus tear >12 mm = joint widening eg effusion
    • scapular y/ lateral view: humeral head on top of glenoid fossa with coracoid process ant to it, Mercedes Benz sign
    -Ant dislocation: head anteroinferior to glenoid fossa and coracoid process
    - post dislocation: humeral head posterior to glenoid fossa
    • subacromial space 8-14 MM.!
    . Maloney’s line gothic /arch / Shenton line of shoulder intact - ap . from lateral border scapula towards glenoid neck and along medial border humerus
  4. Bones - follow cortex
    • ribs
    • humerus
    • clavicle - most common paediatric shoulder injury, especially midshaft.
    • scapula -fracture here indicate significant trauma
  5. Soft tissue
    • effusion
    • lungs
55
Q

How interpret wrist xray?

A
  1. Details: name, date, view, side
  2. Adequacy: include distal radius and ulna with no overlap
  3. Alignment ap
    • smooth distal radial contour (irreg = # )
    • distal radial articular surface should cup carpals
    • radial inclination: from distal radius to perpendicular shaft, normal 21-25° (>25= #)
    • radial length/height: between 2 lines drawn perpendicular to long axis radius from apex radial styloid and level of ulnar aspect of particular surface, normal 8-14 MM. Loss = impacted radial #
    • Gilula’s /carpal arcs (disruption = # or ligament injury)

Alignment lateral
• long axis of radius, lunate, capitate and third metacarpal should align (Apple, cup, saucer) (empty cup- perilunate dislocate )
• palmar/volar cortex of pisiform should lie between scaphoid and capitate
• radius surfaces smooth
• volar tilt of 10-25° between line along distal radial articular surfaces and line perpendicular to longitudinal axis of radial shaft.

3. Bones - margin and trabecular pattern
• radius
• ulna, ulnar styloid
• carpals esp scaphoid and prox row - most frequently injured and risk AVN
• metacarpals
  1. Cartilaginous Articulation - normal joint spaces
    • intercarpal and carpometacarpal should be 1-2mm

5-soft tissue

56
Q

Label picture 23

A

See picture 24

57
Q

Label picture 25 and name view

A

See picture 26

58
Q

Label picture 27 and name view

A

See picture 28

59
Q

Label picture 29 indicating numeral head, glenoid fossa, acromial process, distal clavide, coracoid process and name view

A

See picture 30

60
Q

Label picture 31 indicating numeral head, glenoid fossa, acromial process, distal clavide, coracoid process and name view

A

See picture 32

61
Q

Label picture 33

A

See picture 34

62
Q

How assess alignment on Pa view of wrist? How draw?

A

See picture 35 - Gilula’s carpal arcs- disruption = underlying # or ligament injury.

63
Q

Label picture 36

A

See picture 37

64
Q

Label picture 38 and name view

A

See picture 39

65
Q

Radiological findings osteosarcoma?

A
  • Variable: hazy osteolytic areas with unusually dense osteoblastic areas
  • poorly defined tumour margins
  • sunburst effect : cortex breached and tumour spread into adjacent tissues -streaks of new bone radiating out from cortex
  • Codman’s triangle: where tumour emerges from cortex, reactive new bone forms in angle between periosteum and cortex.
66
Q

Describe the Mercedes Benz sign

A
  • Sign on lateral view of shoulder indicating shoulder dislocation of disrupted
  • components = acromion(posterior), coracoid (anterior), blade of scapula (inferior), glenoid, (central), humeral head
  • if humeral head under coracoid and on ribs = ant dislocation
  • if under acromion = posterior
67
Q

! Xray signs of ant shoulder dislocation? (4)

A

AP
• humeral head inferomedial to glenoid
• disruption Maloney’s / gothic arch/shenton line of shoulder
• widened subacromial space >14 mm

Lateral
• head anteroinferior to coracoid process and glenoid fossa, disrupting Mercedes Benz sign

68
Q

! Name 5 signs lisfranc injury on xray

A

5 critical signs:
• discontinuity of line from medial base 2nd metatarsal to medial side of middle cuneiform on ap- diagnostic (and 1st mt with medial cuneiform)
• widening interval between 1st and 2nd ray on ap view. May see bony fragment (fleck sign)! in 1st metatarsal space representing avulsion of lisfranc ligament from base of 2nd metatarsal - diagnostic.
• dorsal displacement of proximal base of 1st or 2nd metatarsal on lateral view
• medial side of base of 4th metatarsal doesn’t line up with medial side cuboid on oblique view
• disruption of medial column line (line tangential to medial aspect of navicular and medial cuneiform) on oblique view

69
Q

Identify pathology picture 40

A

Multiple myeloma

• multiple “punched out” well demarcated lesions

70
Q

Identify pathology picture 41

A

Multiple myeloma
• multiple “punched out” well demarcated lesions
• no surrounding sclerosis
• marked bone expansion

71
Q

Identify pathology picture 42

A

Multiple myeloma
• multiple “punched out” well demarcated lesions
• no surrounding sclerosis

72
Q

! Name 5 radiological signs of osteoarthritis

A 
LOSS
• Loss of Joint space (narrowing)
• osteophytes
• subchondral sclerosis
• subchondral cysts
• eburnation of bone -ivory-like reaction occurring at site of cartilage erosion.
73
Q

Approach to foot xrays?

A

D ABCs

Details: name, date, time, view, area, side, skeletal maturity

Adequacy 3 views
• dorsal plantar view
• oblique view
Lateral

Alignment
• second metatarsal align with intermediate cuneiform on dp /ap view (disrupt = lisfranc )
• third metatarsal align with lat cuneiform on oblique view (disrupt = lisfranc )
• fourth metatarsal medial base align with medial side cuboid on oblique
• medial column line - tangential to medial navicular to medial cuneform

Bones
- bohler angle: angle between line from highest point of ant process of calcaneus to highest point of post facet, plus line tangential to sup edge of tuberosity. If angle <20 = calcaneal fracture.

Cartilage
• widening between first and second metatarsal = lisfranc

Soft tissue

74
Q

XR feature calcaneal #?

A

Lateral: loss Bohler angle. Line drawn from ant process calcaneus to peak of post articular surface, second line from peak post articular surface to peak post tuberosity. N= 25-40.

75
Q

Radiographic findings of Tb spine? (5)

A

Early infection: involvement of ant vertebral body with sparing of disc space

late: 
• disc space destruction
• lucency (black) and compression adjacent vertebral bodies
• severe kyphosis (gibbus)
• buckling collapse
76
Q

Label picture 43

A

See picture 44

77
Q

Label picture 45

A

See picture 46

78
Q

Label picture 47

A

See picture 48

79
Q

Label picture 49

A

See picture 50

80
Q

Identify pathology picture 119 trauma section

A

• Loss alignment lateral masses of C 1 C 2
. Widened space between peg and lateral masses c1
•thus subluxation

81
Q

Identify pathology picture 120 trauma section.

A
  • Loss alignment posterior vertebral and spinolaminar lines.
  • perched facets and dislocation injury of c5 c6
  • displaced body > 50% body width thus bifacital dislocation
  • widening pre-vertebral soft tissue line > 22 mm
82
Q

Identify pathology picture 121 trauma section.

A
  • Odontoid peg #
  • cortical ring c 2 incomplete
  • Break anterior line at C 1
83
Q

Radiographic findings of lunate dislocation? (6)

A

Pa
• Break in Gilula’s arc
• lunate and capitate overlap
• “piece of pie” sign due to triangular appearance of lunate from palmar rotation due to dorsal force of carpus

Lateral
• loss saucer cup and apple sign. Aka loss colinearity of radius, lunate, capitate.
• sl angle >70°
• spilled teacup sign

84
Q

Name 2 xr features of subcapital/ neck of femur #

A
  • Disruption Shenton’s line

* altered neck-shaft angle (normal 130 )

85
Q

Radiographic findings osteosarcoma? (4)

A
  • Characteristic blastic and destructive lesion:sunburst or hair on end pattern of matrix mineralisation (spicule formation, tumour extension into periosteum)
  • periostea reaction (Codman’s triangle)
  • large soft tissue shadow (mass)
  • destructive lesion in metaphysis may cross epiphyseal plate
86
Q

Treatment osteosarcoma?

A
  • complete resection - limb salvage, rarely amputation
  • neo-adjuvant chemo
  • bone scan and CT chest to rule out metastasis
87
Q

Which joints require 3 views? (4)

A
  • Ankle (ap, lat, mortise)
  • neck (AP, lat, odontoid)
  • Wrist. (ap, lat, oblique)
  • foot (ap, lat, oblique)
88
Q

How is mortise view of the ankle taken?

A

Modified ap view with ankle in 10-20° internal rotation so that medial and lateral malleoli are in same horizontal plane

89
Q

Identify pathology picture 134 in trauma section

A

Vertebral body fracture of C7

• anterior vertebral line disruption

90
Q

Identify pathology picture 135 in trauma section

A
  • C2 body #
  • misalignment lateral borders c1 and c2.
  • difference in space between odontoid process and lateral masses c2
91
Q

Identify pathology picture 131 in trauma section

A

Right superior Pubic ramus #

• disruption illopectineal line

92
Q

Identify pathology picture 133 in trauma section

A

Pubic rami and ischium #
• disruption obturator foramen
• disruption Shenton’s line
• disruption ilioischial line

93
Q

Identify pathology picture 136 in trauma section

A

Open book #
• pubic symphysis and sacroiliac joint separation
• left sided pelvic bone rotation causing disruption of all major lines

94
Q

Identify pathology picture 128 in trauma section

A

Acetabular # dislocation of roof

• iliopectineal line disruption

95
Q

Is picture 138 in trauma section an adequate xray?

A

No.
• can’t see C7 (must see until t1)
• neck too extended, hiding c1.

96
Q

Identify pathology and classify picture 141 in trauma section

A

Right femoral neck #
• disruption Shenton’s line
• garden type 4: complete displacement, complete fractures, varus alignment,

97
Q

Identify pathology picture 142 trauma section

A

Anteroinferior hip dislocation (rare)
• disruption Shenton’s line
• loss congruent femoral head with acetabulum
• femoral head appears larger than contralateral head thus anterior
• femoral head inferomedial to acetabulum thus anterior

98
Q

Identify pathology picture 143 trauma section

A

Posterior hip dislocation (most common)
• Loss congruence femoral head with acetabulum
• Shenton’s line disruption
• femoral head appear smaller than contralateral femoral head thus post
• femoral head superimposes roof acetabulum thus post
• decreased visualisation lesser trochanter due to internal rotation of femur

99
Q

Identify pathology picture 52

A 
Osteoarthritis of the hip joint
• loss joint space
• osteophytes around femoral head
• subchondral sclerosis
• subchondral cysts (appear dark)
100
Q

Identify pathology picture 53

A

Occult supracondylar fracture: Gartland type 1

• posterior fat pad or sail sign.

101
Q

Label picture 54

A

See picture 55

102
Q

Label picture 56

A 
Left = normal
Middle = femoral anteversion
Right = femoral retroversion
103
Q

Identify pathology picture 57

A

Anterior shoulder dislocation (most common)
• humeral head lie medial and inferior to glenoid fossa on ap (left)
• humeral head anterior and inferior to glenoid fossa, over ribs on lat view (right)
• humeral head inferior to coracoid process
• disruption of Mercedes Benz sign on lat view

104
Q

Identify pathology picture 58

A

Posterior shoulder dislocation
• light bulb sign
• glenohumeral joint widened

105
Q

Identify pathology picture 65

A

Supracondylar # Gartland type 3 with shortening, no apposition, anterior angulation
Post fat pad sign

106
Q

Label picture 67

A

See picture 68

107
Q

Classify and label picture 69

A

Ao classification
A: compression injuries (shortening)
B: distraction injuries (lengthening)
C: torsional injuries (rotation)

108
Q

Identify pathology picture 70

A

Salter Harris type 3 #of radius: epiphysis extending into physis intra-articular
Ulnar styloid avulsion #
Distal radio-ulnar joint dislocation

109
Q

Identify pathology picture 71

A

Bottom right = radial head dislocation

Disruption of radiocapitellar line ( through middle radius, should bisect capitellum in lat and AP)

110
Q

Identify line in picture 72

A

Anterior humeral line - should go through middle 1/3 capitellum
Displacement =#

111
Q

Identify pathology picture 73

A

Supracondylar # Gartland 1 minimally displaced
• disruption ant humeral line (doesn’t pass through middle 1/3 capitellum)
• post fat pad sign
• condyles displaced dorsally

Orthopaedics (20 decks)

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