Radiology 2 Flashcards
4 forms of fractures
strain
stress
pathological
incomplete
what do we do with new fractures?
orthopedic referral- we don’t adjust new fractures
what do you do with cervical spine fractures?
CT- defines fracture extent and comminution
MRI will assess neuro impact
potentially neurologically unstable fractures (collar, stabilize, 911)
jefferson burst fracture
axial compression compresses C1 between and occiput and C2
hangman’s fracture
hyperextension leading to fracture at pedicles or posterior
AKA type IV spondylo
Type II dens fracture
fracture through base of dens
type III dens fracture
fracture into body of C2
teardrop fracture
usually hyperextension (avulsion), could be hyperflexion (impaction)-Rust sign
unilateral facet dislocation
perched facet
one facet goes fully in front of the facet below; the other facet stays behind the facet below, but is elevated toward the top of the facet
compression fracture of cervical spine
usually wedge-shaped, but subtle in cervical spine
bilateral facet dislocation
aren’t ambulatory most of the time (so don’t pick it!)
what do you do with thoracic spine fracture
CT will define fracture extent and comminution; MRI will asses neuro impact
compression fracture of thoracic spine
usually wedge shaped with high impact trauma; often concave with osteoporosis
if height is reduced by >30%, may be comminuted with pedicle widening (do CT)
how do you know the thoracic spine fracture is old or new?
look for step defect and/or line of trabecular impaction/condensation
new is under 3 months of age
compare with prior films
MRI evaluates presence of marrow edema in new fracture
how do you evaluate lumbar spine fractures?
CT will define the fracture extent and comminution
MRI will assess neurological impact
compression fracture of lumbar spine
same discussion as with thoracic compression fractures
pars defect
most common at L5, but any level possible
stress fracture in teen years
type I AC tear
no radiographic evidence
type II AC tear
AC rupture + coracoclavicular= elevation of the distal clavicle within acomion
type III AC tear
AC rupture + coracoclavicular rupture= complete elevation of distal clavicle
humeral dislocation
> 90% anterior and inferior
complications of Bankart and Hill-Sach’s fracture
elbow injuries
may be difficult to see, so evaluate secondary indicators of fat pad elevation
torus/buckle fracture
buckling of periosteum, painful but uncomplicated
greenstick fracture
bend, but not full fracture
colles fracture and smith fracture
both distal radius fractures, different angulation
scaphoid fracture
usually at waist, risk of being occult, non-union, AVN (MRI finds them)
lunate dislocation
pie, widening (dissassociation) of scapholunate space
boxer fracture:
distal metacarpal head fracture with risk of healing with angulation
gamekeeper thumb
avulsion of ulnar collateral ligament at first proximal phalanx base
bennett fracture
fracture of first metacarpal base
ankle fractures
usually avulsions of the lateral malleolar tips
osteochondritis dessicans
focal AVN, most commonly at knee and talar dome; MRI finds it
SCFE
salter harris fracture, usually young, overweight males
crutch the patient, get them off weight-bearing, and refer to orthopedic urgently
salter harris fractures
mnemonic (SALTR or ME ME) type I: slipped (epiphysis off physis) type II: above (metaphysis and physis) type III: lower (epiphysis and physis) type IV: through (epiphysis, physis and metaphysis) type V: rammed (mashed the physis)
fracture management
refer to orthopedist/neurologist
CT to evaluate for comminution
MRI to evaluate marrow signal and neurological compromise
lab studies for pathology (CBC, DXA, MRI)
stabilize the region
is it old or new?
re-radiograph for long bone healing/callus
do NOT THRUST until it’s healed
avascular necrosis
AKA osteonecrosis childhood femoral head AVN (legg-calve-perthes) adult femoral head AVN (chandler's) lunate (keinbock's) scaphoid (preisser's) metatarsal head (freiberg's)
causes of AVN
most common (STARS) steroids, trauma, alcohol, radiation, sickle cell anemia, idiopathic, clotting, pregnancy, renal disease
AVN
marrow death, so MRI is best to evaluate and can find it within 24 hours of onset
management of AVN
take patient off weight bearing and refer to orthopedist urgently
myositis ossificans
heterotopic bone formation
biceps and quads
6 months to develop
