Radiology Flashcards
Acromion Fracture
This radiograph shows a fracture of the base of the acromion, arrows on magnified image, with no other fracture or dislocation evident.
Although generally treated non-operatively, when there is significant displacement an acromion fracture can cause impingement of the adjacent rotator cuff and may require internal fixation.
Pneumothorax
Anterior knee dislocation
most common mechanism is hyperextension of the knee
cruciate ligaments usually ruptured + medial and lateral collaterals freq torn
Mx: reduction of dislocation + reconstruction of any ruptured ligaments
Despite optimal surgical care, many of these patients will end up with a reduced range of movement and early onset of osteoarthritis.
Rigler’s sign in small bowel obstruction
note how only the inner (luminal) side of the bowel wall is visible as there is gas in the lumen to outline it. On the right-hand image, taken from the supine PFA of an elderly patient with perforation due to small bowel obstruction, there is gas in the lumen and in the peritoneal cavity so we can see both sides of the wall clearly (arrows). In both cases, the valvulae conniventes are visible extending across the full width of the dilated bowel lumen, confirming that this represents small bowel rather than colon.
Cauda Equina Compression – MRI
(a) shows that the disk extrusion has completely displaced the CSF from the spinal canal at this level – the contour of the disk is outlined by the dashed line on the same image in (b). (d) is normal
Tension pneumothorax due to rib fracture
CXR shows a large left pneumothorax (pleural line indicated by white arrows) with shift of the trachea and mediastinum to the right. There is a subtle fracture of one of the lower left ribs (yellow arrow). Note also the extensive surgical emphysema extending into the neck (orange arrows).
Lipohaemarthrosis of the knee
due to underlying fracture
Pharyngeal Pouch: Zenker’s Diverticulum
area of weakness = Killian’s dehiscence
Sliding Hiatus Hernia
Medical mx of small bowel obstruction?
Gastrografin enema (therapeutic for adhesional obstruction)
‘Medical’ mx of large bowel obstruction?
Gastrograffin enema: mechanical obstruction
Sigmoid Volvulus
detort w flatus tube
Caecal volvulus
~ 10% can be detorsed by colonoscopy
often needs surgery
Gastric Volvulus
Film: Gastric dilatation, Double bubble on erect films
Presentation: Vomiting, Pain, Failed attempts to pass NGT
Risk Factors:
Rolling hiatus hernia
Gastric / oesophageal surgery
Mx:
Endoscopic manipulation
Emergency laparotomy
Diverticulosis
What is Hinchey Grading used for?
Diverticulitis
Hinchey Grading
1: small confined pericolic abscess (<5% mortality)
2: large abscesses extending into pelvis (<5%)
3: purulent peritonitis (~15%)
4: faecal peritonitis (~45%)
Crohns
deep, linear ulcers (arrows) that have filled with barium in this stenosed terminal ileum are known as ‘rose-thorn ulcers’
also assoc w
- String sign of Kantor: narrow terminal ileum
- Cobble-stoning: ulceration of mural oedema
- Skip lesions
Supracondylar Humeral #
Classification
Extension: distal fragment displaces posteriorly
Flexion: distal fragment displaces anteriorly
Complications
NV: brachial artery and median nerve mainly
Compartment syndrome
Malunion: gunstock deformity (cubitus varus)
Surgical neck humeral fracture
-> axillary n damage, posterior circumflex artery
Mx: collar and cuff or ORIF
Pelvic fracture
Complex pelvic fracture involving the pubic symphysis (diastasis) and acetabulum
Young and Burgess Classification
- Lateral compression: ipsilateral pubic rami #s
- AP compression: open book #
- Vertical shear: inherently unstable
Complications: Haemorrhage, Urethral injury, Bladder injury
Causes of problems w union after fracture?
Infection
Ischaemia
Interfragmentary movement
Interposition of soft tissue
Intercurrent illness
Weber classification?
fibular fractures
Relation of # to joint line
A: below joint line
B: at joint line
C: above joint line
B and C represent possible injury to the syndesmotic ligs between tib and fib → instability
