Radiology III - MSK

Question 1

Describing a fracture

Answer 1

• Location? Bone, side, proximal/distal, medial/lateral
• How many parts? Simple or comminuted
• How far are they apart? Nondisplaced or displaced
• Is an angle formed by the parts? Angulation

Question 2

Describing a fracture - Special cases

Answer 2

• Joint involvement?
• Salter-Harris?
• Other pediatric subtypes: bowing/plastic, buckle/torus, greenstick
• Open/compound?

Question 3

Tibial plateau fracture

Answer 3

• Tibial plateaus: Weight-bearing surfaces of proximal tibial, 1 each medial & lateral
• Involves articular surface –> lipohemarthrosis
• Younger people often require higher force injury to produce fracture

Question 4

Bones of the wrist mnemonic

Answer 4

SLTP TTCH

Question 5

Scaphoid fx

Answer 5

• High risk of complication relative to other fractures

- “Anatomic snuffbox tenderness”

Question 6

Colles fx

Answer 6

• Distal radius fx, mildly impacted
• Extra-articular
• Dorsal angulation
• Very common, most often from FOOSH

Question 7

Bone infection algorithm

Answer 7

• Start off w/ plain films

- If X-rays negative –> obtain MRI, bone scan, or CT

Question 8

MRI contrast

Answer 8

• Contradicted in pts w/ renal failure (GFR < 30)

- NSF: Severe systemic illness, disabling & fatal

Question 9

Osteoarthritis (*Per Dr. Mullen know this!)

Answer 9

Degenerative change of joint

1. Joint space loss
2. Osteophyte formation
3. Subchondral sclerosis
4. Subchondral cyst formation

Question 10

Salter- Harris classification

Answer 10

• Pediatric fx that involves growth plate

Question 11

Extremity x-ray indications

Answer 11

• Pain
• Trauma
• Redness/swelling/infection or inflammation
• Foreign body
• Arthritis/degenerative change

Question 12

Advantages of extremity x-ray

Answer 12

• Quick & cheap

- Low radiation

Question 13

Disadvantages of extremity x-ray

Answer 13

• Soft tissues can be seen but generally poor
• Uses radiation
• Challenging in large, uncooperative, or pts w/ deformities
• Interpretation requires experience

Question 14

Elbow fx

Answer 14

• Intra-articular fracture –> lipohemarthrosis
• Pediatric pts tend to fracture the supracondylar humerus
• Adult pts tend to fracture the proximal radius (head, neck, or both)

Question 15

Smith fx

Answer 15

A “reverse Colles” w/ volar angulation

Question 16

Hip fx types

Answer 16

• Subcapital
• Transcervical
• Intertrochanteric
• Subtrochanteric
• Differences in px & fixation

Question 17

Cellucitis

Answer 17

Infection of the subcutaneous soft tissues = swelling & edema on x-rays

Question 18

Osteomyelitis

Answer 18

Infection of the bone = bone destruction

- “osteo” is often occult on x-rays