Skeletal Trauma Flashcards by Butch Josef Abuel

In cervical spine radiograph, line 1 pertains to the prevertebral soft tissue, it should be several mm from the first 3 or 4 vertebral bodies and then moves farther away at what level

level of laryngeal cartilage

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from C3 or C4 to C7, prevertebral soft tissue line should be

less than one VB width from the anterior vertebral bodies and it should be smooth in contour

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Line 2 in cervical spine radiograph wherein anterior osteophytes can enroach on this line, interruption of this line is a sign of serious injury

anterior vertebral bodies

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Line 3 in cervical spine radiograph is

similar to anterior vertebral body line except that it connects the posterior vertebral bodies

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Line 4 in cervical spine radiograph

connects the posterior junction of the lamina with the spinous processes and is called the spinolaminar line

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spinal cord lies between what imaginary lines in cervical radiograph

lines 3 and 4

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line in cervical radiograph that is not really a line so much as a collection of points– points being the posterior tips of the spinous processes

line 5

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largest spinous process in cervical spine

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anterior arch of C1 should not be greater than __mm from the dens

2.5 mm

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in children, anterior arch of C1 distance from the dens can be up to

5 mm

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widened anterior arch of C1 from the dens means

disruption of transverse ligament between C1 and C2

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3 component of degenerative disease

osteophytosis,
sclerosis,
narrowing of disc space

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a blow to the top of the head such when an object falls directly on the apex of the skull, can cause the lateral masses of C1 to slide apart (beyond that margins of C2 body), splitting the bony ring of C1. this is called

Jefferson fracture

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fracture of C6 or C7 spinous process wherein the supraspinous ligaments attached to the spinous process undergo a tremendous force pulling on the spinous process and avulsing it

Clay-Shoveler’s fracture

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unstable, serious fracture of the upper cervical spine that is caused by hyperextension and distraction. fracture of the posterior elements of C2 and usually, displacement of the C2 body anterior to C3

Hangman’s fracture

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True or false: patients with hangman’s fracture often escape neurologic impairment because of the fractured posterior elements of C2 that, in effect, causes a decompression and takes pressure off the injured area

true

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severe flexion of the cervical spine can cause a disruption of the posterior ligaments with anterior compression of a vertebral body, this is called

flexion “teardrop” fracture

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flexion “teardrop” fx is commonly associated with ____, often from the posterior portion of the VB being displaced into the central canal

spinal cord injury

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severe flexion associated with some rotation can result in rupture of the apophyseal joint ligaments and facet joint dislocation. this can result in locking of facets in an overriding position that, in effect, causes some stabilization to protect against further injury. this is called

unilateral locked facets

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secondary to hyperflexion at the waist. this causes distraction of the posterior elements and ligaments and anterior compression fo VB. this is secondary to a VA, while restrained by a lap belt

seatbelt injury

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seatbelt injury involves what levels

T12, L1 or L2 level

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fracture of the posterior body is called ____, related to seatbelt fracture

Smith fracture

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fracture through the spinous process is called ______, related to seatbelt fracture

Chance fracture

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break or defect in the pars interarticularis portion of the lamina

spondylolysis

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nose of Scottie dog

transverse process

eye of Scottie dog

pedicle

front leg of Scottie dog

inferior articular facet

ears of scottie dog

superior articular facet

neck of scottie dog

pars interarticularis

portion of the lamina that lies between the facets

pars interarticularis

if the Scottie dog has a collar around the neck, what is its implication

break in the pars interarticularis, denoting spondylolysis

if spondylolysis is bilateral and the VB in the more cephalad position slips forward on the more caudal body, this is said to be present

spondylolisthesis

wedge compression fracture that typically occurs 1 to 2 weeks after the initial trauma

Kummell disease

fracture at the base of the thumb into the carpometacarpal joint

Bennett fracture

tx of Bennett fracture

internal fixation

comminuted fracture of the base of the thumb that extends into the joint

Rolando fracture

fracture of the base of thumb that does not involve the joint has been called a

pseudo-Bennett fracture

avulsion injury at the base of the distal phalanx, where the extensor digitorum tendon inserts

Mallet finger of baseball finger

dense fibrocartilaginous band that covers the joint on the volar aspect and can get interposed in the joint once it is torn, often requiring surgical removal

volar plate

innocent-appearing fracture that often requires internal fixation; an avulsion on ulnar aspect of the first metacarpophalangeal joint, where the ulnar collateral ligament of thumb inserts

Gamekeeper's thumb

fall from an outstrestched arm that causes disruption of ligaments between capitate and lunate, allowing capitate to dislocate from the cup-shaped articulation of the lunate

Lunate/perilunate dislocation

this dislocation if not treated promptly, can result in permanent medial nerve impairment, as it can get impinged by the volarly displaced lunate

Lunate/perilunate dislocation

on AP view, lunate is triangular or pie-shaped

Lunate/perilunate dislocation

normal shape of lunate on AP

rhomboid shape

fracture that is most commonly associated with perilunate dislocation

transscaphoid fx

other wrist bones that are also known to fracture frequently when a perilunate dislocation occurs (3)

capitate, radial styloid and triquetrum

special view to check for hook of hamate fracture

carpal tunnel view

seen as a bony protuberance off the hamate on the ulnar aspect of carpal tunnel

hook of hamate

commonly occurs from fall on the outstretched hand and in professional baseball, tennis and golf players

hook of hamate fracture

occurs after a fall onto the outstretched hand, results into rupture of scapholunate ligament, which allows the scaphoid to rotate volarly and the lunate to tilt dorsally

rotary subluxation of the scaphoid

on AP wrist radiograph, a space is seen between the scaphoid and the lunate, where ordinarily they are closely opposed. this is called

Terry Thomas sign

scaphoid fx is a potentially serious injury because of high rate of

avascular necrosis

what fx would you suspect if with a history of wrist trauma there is pain over the snuffbox of the wrist

scaphoid fx

tx of avascular necrosis

surgical metallic screw fixation and bone grafting

Terry thomas sign is seen in

rotatory subluxation of the scaphoid, which means the scapholunate ligament is ruptured

what part of scaphoid fx usually undergoes necrosis and why

proximal fragment because the blood supply to the scaphoid begins distally and runs proximally

increased density of the proximal pole of scaphoid compared with the remainder of carpal bones

avascular necrosis

avascular necrosis is common in what other carpal bones aside from scaphoid

lunate

avascular necrosis of lunate is called

Kienbock malacia

if ulna is shorter than radius, it is termed

negative ulnar variance

ulnar variance that has has an increased incidence of Kienbock malacia

negative ulnar variance

if ulna is longer that the radius, it is termed

positive ulnar variance

ulnar variance with increased incidence of triangular fibrocartilage tears

positive ulnar variance

common avulsion fx in the wrist that is seen in lateral radiograph as small chip of bone off the dorsum of wrist

triquetral fracture

dorsal angulation of distal forearm and wrist

Colles fracture

volar angulation of distal forearm and wrist

Smith fracture

sometimes, radius and ulna suffer a traumatic insult, and the force on the bones causes bending instead of a frank fracture, this is termed

plastic bowing deformity

fracture of ulna with a dislocation of proximal radius

Monteggia fx

fx of the radius with dislocation of the distal ulna

Galeazzi fx

helpful indicator of a fracture about the elbow is

displaced posterior fat pad

ordinarily, the posterior fat pad is not visible on a lateral view of the elbow because

it is tucked away in the olecranon fossa of the distal humerus

in an adult with visible posterior fat pad with history of trauma, the fracture site is almost always in the

radial head

in a child with visible posterior fat pad, what fracture is usually present

supracondylar fracture

most common shoulder dislocation

what type of shoulder dislocation is present if the humeral head is seen to lie inferiorly and medial to the glenoid

anterior dislocation

in shoulder dislocation, humeral head often impacts on the inferior lip of the glenoid causing an indentation on the posterosuperior portion of the humeral head; this is called

Hill-Sachs deformity

bony irregularity or fragment off the inferior glenoid, which occurs from the same mechanism as Hill-Sachs deformity is called

Bankart deformity

impaction fracture on the anterior portion of the humeral head

reverse Hill-Sachs lesion or trough sign

most common cause of posterior shoulder dislocation is

seizure

true or false: posterior shoulder dislocation often happens bilaterally

true

best way to unequivocally diagnose a dislocated shoulder radiographically is to obtain a

transscapular view (scapular Y-view)

an entity that can be mistaken for a dislocated shoulder is _____, which displaces the humeral head inferolaterally, but on transscapular view, the humeral head is in its proper place

traumatic hemarthrosis

seen in patients who are osteoporotic or who have undergone radiation therapy can present as patchy or linear sclerosis on the sacral ala that may or may not show cortical disruption on plain radiographs

sacral stress fracture

these fractures have a characteristic appearance on radionuclide bone scans, termed the Honda sign

bilateral sacral stress fracture

4 common sites for pelvic avulsion

ischium, superior and inferior anterior iliac spine and iliac crest

true or false: pelvic avulsion fractures sometimes mimic or looks like a malignant lesion that may lead to radical treatment

true

these pelvic fx typically occur as the result of an athletic injury and are benign. in adults however, isolated avulsion fx in this area usually only occur in the setting of an underlying bone lesion, such as metastasis, and should prompt inspection for an underlying lesion and further investigation for a site of primary malignancy

avulsion fx in the lesser trochanter of proximal femur

lesser trochanter fractures are much more commonly seen in the setting of this fracture and in that setting are not necessarily associated with underlying malignancyt

comminuted intertrochanteric hip fractures

in these joints, DJD can present as erosions (4)

TASS - TMJ, - acromioclavicular joint, - symphysis pubis and - sacroiliac joint

stress fx, DJD or osteoarthritis in symphysis pubis are common in

ultramarathoners, cross-country skiers, soccer players and other athletes

when the SI joints are involved with DJD, this can closely resemble a

human leukocyte antigen B27 (HLA-B27) spondyloarthropathy

femoral insufficiency fractures commonly develops in

compressive or medial side of the femur

often clinically misdiagnosed as a "heel spur" or plantar fasciitis and can be somewhat subtle radiographic finding

calcaneal stress fx

this radiograph should be obtained in cases of knee trauma to look for a fat-fluid level

cross-table lateral

fracture-dislocation of tarsometatarsals

Lisfranc fracture

a key to normal alignment metatarsals is

medial border of second metatarsal should always line up with the medial border of the second (middle) cuneiform

this fracture is seen most commonly in patients who cathc the forefoot in something such as a hole in the fround or a horseback rider falling and hanging by the forefoot in the stirrups. it is also commonly seen in neurotrophic or Charcot joint in diabetics

Lisfranc fracture

normal Bohler angle

20 to 40 degrees