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ORTHO > RADIOLOGY > Flashcards

RADIOLOGY Flashcards

1
Q

INDICATIONS FOR XRAYS IN ORTHO

A

⦁ hx of blunt trauma
⦁ deformity of bone or joint following injury
⦁ hx of pain, swelling, or loss of motion of a joint, have a sense of instability
⦁ infection
⦁ foreign body
⦁ night pain

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2
Q

MRI

A

MRI = provides good contrast between the different soft tissues of body; easy to evaluate fluid within muscle or tendon to tell if torn or not. especially useful in imaging brain, muscles, heart, and cancer

BRAIN, MUSCLES, HEART, CANCER

  • very rarely get MRI to evaluate bone; more for soft tissues (ligament, tendon, muscle injury)
  • most bones evaluated with xray or CT
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3
Q

indications for MRI

A

⦁ evaluate soft tissue injury as opposed to bony injury. Ex: ligament, tendon, muscle injury
⦁ better evaluate soft tissue mass
⦁ r/o fluid collection in the body
⦁ define abnormalities within bone seen on xray
⦁ r/o stress fracture or infection
⦁ evaluate spinal injury

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4
Q

MRI TO EVALUATE SOFT TISSUE INJURIES

A
  • Knee: ACL / MCL / PCL / LCL / meniscus, loose body
  • Shoulder: rotator cuff, biceps tendon, labrum
  • Elbow: UCL/RCL, extensor/flexor tendons for epicondylitis, biceps tendon rupture, loose body
  • Wrist: Extensor carpi ulnaris injury, TFCC tear
  • Ankle & Foot anterior tibial tendon injury, peroneal, tibial tendon, achilles tendon partial tear
  • Hip - Labral tear

Labral tear = one of the biggest reason to get MRI (inject contrast dye to evaluate labrum)

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5
Q

ASPIRATED FLUID FROM KNEE AND WHAT IT MEANS

A

⦁ bright red blood aspirated = ACL
⦁ dark red blood aspirated = venous blood = patellar dislocation
⦁ if blood / fat = tibial fracture

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6
Q

MRI FOR SOFT TISSUE MASSES

A

⦁ lipoma
⦁ hematoma
⦁ osteosarcoma
⦁ ganglion cyst

wouldn’t really get an MRI for ganglion cyst location on dorsal ganglion; but if ganglion cyst located elsewhere, may not be as sure…

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7
Q

MRI FOR FLUID COLLECTION IN BODY

A

⦁ Effusion of a joint - shoulder, hip
⦁ no need to MRI, olecrenon bursitis, patellar bursitis
⦁ infection of fluid collection within soft tissue compartments
⦁ baker’s cyst in the knee

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8
Q

MRI TO FURTHER EVALUATE BONE ABNORMALITIES FOUND ON XRAY

A 
⦁	Stress fracture: tibia, metatarsals, tibial plateau, femoral neck
⦁	lytic or blastic lesions seen on xray
⦁	bone contusion
⦁	r/o occult fracture, scaphoid fracture
⦁	AVN
⦁	osteomyelitis

Also used for spine pathology

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9
Q

seen better on MRI compared to xray

A

stress fractures (ex: tibia)
scaphoid fractures
AVN

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10
Q

risk factors for AVN

A

alcohol use

chronic steroid use

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11
Q

MRI FOR SPINAL PATHOLOGY

A 
⦁	Herniated disc
⦁	bulged disc
⦁	spinal stenosis
⦁	compression fracture (acute vs chronic)
⦁	neoplasm
⦁	pars defect
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12
Q

indications for CT

A

⦁ Cervical injury - can’t see on xray well due to overlapping shadows. can better rule out cervical fracture after trauma with CT
⦁ To better define comminuted fractures (acetabular fractures, calcaenous fractures, articular fractures)
⦁ evaluating joints for preop eval for surgery
⦁ CT Myelogram of spin = for ppl who can’t undergo MRI (pacemark/other metal objects). Myelogram = CT with dye injected into dura

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13
Q

Indications for CT Myelogram

A

patients who have had previous spinal surgery, or patients who don’t qualify for MRI (pacemaker/other metal objects) - -inject dye into dura

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14
Q

indications for CT over xray

A
  • cervical injury - ex: odontoid fracture
  • tibial plateau fracture
  • talus fracture
  • calcaneal fracture
  • bony bankart
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15
Q

BONE SCAN

A
  • can be full body or localized to a body part
  • will show bone turn over and osteoblastic acttivity, but will NOT show osteoclastic activity
  • bone scans = best used for mets disease - such as prostate cancer
  • not good for lytic lesions (clastic activity) - such as Multiply Myeloma
  • other reasons for scans = stress fracture (MRI), infection (MRI), or occult (hidden) fractures
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16
Q

bone scans = not good for

A

multiply myeloma
lytic lesions
- clastic activity

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17
Q

tibial stress fracture

A

bone scan or MRI

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18
Q

one place bone scans are definitely used for =

A

tibial stress fracture

and mets

19
Q

PLAIN XRAYS IN ORTHO - KNOW HOW TO DESCRIBE FRACTURE

A 
⦁	Displacement
⦁	angulation
⦁	impaction
⦁	intra-articular
⦁	comminuted
⦁	spiral
⦁	greenstick
⦁	buckle
⦁	transverse vs oblique
  • be wary of intra-articular fractures
  • get AT LEAST 2 xray views 90 degrees to each other
  • re-xray in about 1 week
20
Q

view of xray good for evaluating glenohumeral joint

A

axillary view

also true AP

shoulder Y view = good for dislocations / fractures

21
Q

xray of hand

A

get AP, oblique, and lateral

22
Q

most commonly fractured bone in children & adolescents

A

CLAVICLE

M > F

80% are in the middle 1/3 of clavicle (mid shaft)
15% are distal 1/3
5% are proximal 1/3 (uncommon) - more worrisome

23
Q

Y view is an xray view of the

A

shoulder

24
Q

mortis is an xray view of the

A

ankle

25
Q

zanca view

A

30-45 degree cephalic tilt

for clavicle fracture, along with AP view

helps evaluate displacement and comminution

26
Q

humerus fracture = worry about radial nerve, which would cause

A

radial palsy

27
Q

humerus fractures

A

2nd most common upper extremity fracture, after radius
usually occurs in adults > 65

  • in adults > 65 = 3rd most common fracture, after radius and hip

women > men

28
Q

what views for humeral head fracture

A

AP
lateral
Y view

29
Q

TREATMENT OF HUMERAL HEAD FRACTURES =

A

Treat comorbidities that may increase the risk of non-union: Osteoporosis, alcoholism, tobacco use, mental illness, steroid use, rheum dz

30
Q

what views for humeral shaft fracture

A

AP & LATERAL
get shoulder & elbow in views

  • humeral shaft fractures = worried about radial nerve (most common) - could also damage median or ulnar nerve –> results in radial palsy.
31
Q

distal radius fracture = worried about which nerve

A

median

32
Q

scaphoid fracture = worry about

A

AVN - radial artery

MRI for scaphoid fracture

33
Q

scapholunate dissociation

A

gap between scaphoid and lunate bones = indicative of scaphoid lunate dissociation - tear

damage to scapholunate interosseous ligament

34
Q

SCAPHOID FRACTURES

A

scaphoid fracture = worry about necrosis (avn - due to radial artery compression)

⦁ get PA, lateral, and scaphoid view (AP with 30 degrees supination & ulnar deviation)

⦁ look for widening of scapholunate distance

⦁ high risk of nonunion

⦁ xray may be normal initially; check for snuffbox tenderness

⦁ repeat xray in 10-14 days

⦁ bone scan = more cost effective than MRI; can show uptake in 72 hours

⦁ MRI = same sensitivity as bone scan, but better specificity. expensive

⦁ CT - helps to see fracture line & displacement….

35
Q

snuffbox tenderness

A

scaphoid fracture (navicular)

36
Q

terry Thomas sign

A

scapholunate dissociation

37
Q

colles fracture vs smith fracture

A

both are distal radius fracture

colles = hand = dorsal / posterior angulation (opposite direction of where the fracture is bending)

smith = hand = ventral / anterior angulation

38
Q

Bennet’s Fracture vs Rolando fracture

A

intraarticular fracture through base of the 1st MCP

Rolando’s fracture = comminuted bennet’s fracture - T or Y shaped

39
Q

Boxer’s fracture

A

fracture at neck of 5th metacarpal
(maybe 4th too)

(from punching with a clenched fist)
- always check for bite wounds

40
Q

TUFT FRACTURE

A

fracture of the cancellous bone at the distal tip of the finger

41
Q

pistol grip deformity

A

obese kid

42
Q

Maisonneuve fracture

A

ankle injury results in concomitant fibular fracture

⦁ see widening of the ankle mortise = strongly suggests a tear of the distal tibiofibular syndesmosis

43
Q

fibular fracture = need to look at

A

ankle! - mortise view

44
Q
  • proximal shaft of 5th metatarsal (similar to boxer’s fracture of the hand)
A

jones fracture

ORTHO (15 decks)

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