Radiology Review Flashcards
What are the 4 joints of the shoulder girdle?
Acromioclavicular joint
Glenohumeral joint (shoulder joint)
Sternoclavicular joint
Scapulothoracic joint
What are the 2 necks of the humerus?
Anatomical neck
Surgical neck
Where is the surgical neck of the humerus?
The neck of the humerus just below the head of the humerus
Where is the anatomical neck neck of the humerus?
Opposite the greater tuberosity as a diagonal line
Its a groove separating the head of the humerus from the rest
What forms the intertubercular groove/sulcus on the humerus?
Greater tuberosity and lesser tuberosity
What supports the Glenohumeral joint?
Glenohumeral ligaments
They form the joint capsule
What needs to be checked in a humerus fracture?
The neurovascular status
How to remember which side Ulnar is in the upper limb?
Ulnar = close to U
What is the most common type of shoulder dislocation?
Anterior dislocation
What sign signifies a posterior shoulder dislocation?
Light bulb sign
How do you refer to the direction of a dislocation?
Always describe the position of the distal part to the proximal part
What is a Hill-sachs deformity/lesion?
Dent/fracture in the posterolateral humeral head due to anterior dislocations
Infraspinatus and teres minor jams the humeral head against the glenoid fossa
What is a Bankart lesion?
When the force of the humeral head in the dislocation tears off part of the glenoid labrum
How does a hill-sachs lesion appear on an x-ray?
Dent in humeral head (posterolateral)
What are the ligaments that support the acromioclavicular joint?
Coracoclavicular ligament
Coracoacromial ligament
Acromioclavicular ligament
What are the 2 types of fracture that can occur at the elbow?
Supracondylar fracture
Intra articular fracture
What is a supracondylar fracture at the elbow?
Fracture that occurs above the condyles of the humerus
What is a fracture at the elbow above the condyles of the humerus called?
Supracondylar fracture
What is the dark areas surrounding joints?
Fat pads
If no fracture line is clearly visible, what may indicate that a fracture is present?
Why?
Increased size of the fat pads (Larger dark area)
Due to fluid like blood and/or fat in the joint from the broken bone
What type of dislocation is most common with the elbow?
Posterior dislocation
What is the method of injury which causes a Colles fracture/Dinner fork fracture?
FOOSH
How does a Colles fracture present?
Dinner fork deformity
Dorsal angulation
Why do scaphoid fractures often result in Avascular necrosis?
Retrograde blood supply
So if a fracture occurs damaging the blood supply, the proximal part has no blood supply
What artery supplies blood to the scaphoid?
Radial artery
Why can buckle fractures occur in children?
There bones are soft so Can be squashed since the bones start as a cartilaginous matrix
What is a Greenstick fracture?
What age group does this happen in?
Where theres a fracture on one side of the cortex with the other side being fine
Kids
What are the 3 bones that make up the pelvis?
Ilium (part of ilium you can palpate at top)
Ischium (bit you sit on)
Pubis
What bone does the femur articulate with at the knee joint?
Femur with Tibia
What bone articulates at the distal articulation of the Talus?
Talus and navicular
What does the navicular articulate with distally?
Navicular with 3 cuneiforms
Which bones do the cuneiforms articulate with?
Medial cuneiform = 1st metatarsal
Middle cuneiform = 2nd
Lateral cuneiform = 3rd metatarsal
What does the Cuboid bone articulate with at the distal end?
4th and 5th metatarsal
When assessing the Hip what is the first line of investigation?
What are the potential second line investigations?
Radiographs (X-ray)
Ultrasound/CT/MRI
Why are radiographs a good first line imaging technique?
Cheap
Quick
Low radiation dose
On examination, how does a patients lower limb with a Neck of Femur Fracture present?
Leg shortened
ABducted
Externally rotated
What classifies as a Neck of Femur (NOF) fracture?
Any fracture of the proximal femur up to 5cm below the lesser trochanter
What are the 2 types of Neck of Femur Fractures?
Intracapsular
Extracapsular
What is an Intracapsular Neck of Femur Fracture?
Fracture of the proximal femur above the intertrochanteric line
Why is an intracapsular Neck of Femur fracture worrying?
Neck of Femur at risk of Avascular necrosis due to medial femoral circumflex artery being damaged (ligamentum Teres artery not sufficient to supply head in adulthood)
What is the intertrochanteric line?
Line between the greater trochanter and the lesser trochanter of the femur
Who are more likely to get intracapsular neck of femur fractures?
Older osteoporotic patients following low energy falls
What is an extracapsular Neck Of Femur Fracture?
Fracture of proximal femur below the intertrochanteric line
Who more commonly gets extracapsular fractures of the neck of femur?
Younger/middle aged patients with high energy injuries like RTCs
What is a dislocation of the hip?
Complete dissociation of femoral head from acetabulum
What is subluxation?
A partial dislocation where there is abnormal articulation between parts that shouldn’t be articulating
In a Neck of Femur Fracture why is the lower leg shortened, abducted and externally rotated?
Shortened = thigh muscles pull distal fragment up
Abducted = gluteus medius and minimus abduct the distal fragment
Externally rotated = gluteus medius + minimus and the Short lateral rotators:
-piriformis
-superior Gemellus
-Obturator internus
-inferior Gemellus
-Quadratus femoris
What are the 2 causes of dislocation of the hip?
Traumatic dislocation (high energy… RTC)
Congential = developmental dysplasia of hip
What is the most commonly seen type of traumatic hip dislocation?
Posterior dislocation
On examination, how does the lower limb present with a posterior hip dislocation?
Shortened
Adducted (Opposite to NOF fracture)
Medially rotated (Opposite to NOF fracture)
Flexed
What nerve is at risk of damage as a result of a posterior hip dislocation?
What condition can be caused?
Why can this happen?
Sciatic nerve
Sciatic nerve palsy
Sciatic nerve sits posterior to the femur
On examination, how does an anterior hip dislocation present?
Lower limb is:
-externally rotated
-abducted
-slightly flexed
Similar to the Neck Of femur fracture (just not shortened)
What nerve is at risk of damage as a result of a anterior hip dislocation?
What condition can be caused?
Why can this happen?
Femoral nerve
Femoral nerve palsy
Femoral nerve runs anterior to femur
What is a central hip dislocation?
When he femoral head is driven through the acetabulum causing a fracture
Why is a central hip dislocation so dangerous?
Risk of intrapelvic haemorrhage from pelvic venous plexuses
What happens in Osteoarthritis of the hip?
What are the common presentations of osteoarthritis on an x-ray?
Breakdown of hyaline cartilage in a synovial joint leading to rubbing and injury to bone
LOSS
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
What are the 2 types of osteoarthritis?
Primary (idiopathic)
Secondary (precipitating cause:
-trauma
-infection
-obesity
-endocrine abnormalities)
What are some primary risk factors of osteoarthritis?
-age
-female
-non Caucasian
-genetics
-nutrition
How is osteoarthritis of the hip treated?
Weight reduction
Activity mod
Analgesia + NSAIDs
Steroid of Hylaruronic acidic injections
Total hip replacement
What does a straight line that is not a fracture line indicate on an x-ray?
(See page 28 of radiology review lecture if confused)
Fluid build up
Suggests a potential fracture
LIPOHAEMARTHROSIS (blood + fat in fracture)
What usually causes femoral shaft fractures?
High velocity trauma
RTCs
Fall from height
How does a femoral shaft fracture present?
Proximal fragment = abducted due to glut medius and minimus, flexed because of iliopsoas
Distal fragment = Adducted due to adductors
What may be potentially compromised as a result of a distal femoral shaft fracture?
Popliteal artery
What type of knee injury usually occurs as a result of a high energy injury with axial loading of the knee?
Tibial plateau fracture
What is affected in a tibial plateau fracture?
Why condyle is most commonly affected?
The articulating surface of the tibia within the knee joint
Either uni-condylar or bi-condylar
Lateral tibial condyle most commonly affected
What are some complications of Tibial Plateau fractures?
Articular cartilage damaged
Post traumatic osteoarthritis
Meniscal tears or ACL injury
What can cause a patellar fracture?
Direct impact
Eccentric contraction of quadriceps
What can be mistaken for a fracture patellar?
What causes this?
Which area of the patella does this happen at?
Bi-partite patella (not pathological)
Failure of union of a secondary ossification centre
Superolateral portion of patella
What is the Unhappy triad?
Large fore to the lateral aspect of knee joint causing injury to:
-Medial collateral ligament (MCL)
-Medial meniscus
-Anterior Cruciate Ligament (ACL)
What are the ligaments which at least 3 of the 4 need to be ruptured for the knee to dislocate?
ACL (Anterior Cruciate Ligament)
PCL (Posterior Cruciate Ligament)
MCL (Medial Collateral Ligament)
LCL (Lateral Collateral Ligament)
What vessel is at risk in a knee dislocation?
Popliteal artery
