Skeletal Trauma Flashcards
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
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
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
Line 3 in cervical spine radiograph is
similar to anterior vertebral body line except that it connects the posterior vertebral bodies
Line 4 in cervical spine radiograph
connects the posterior junction of the lamina with the spinous processes and is called the spinolaminar line
spinal cord lies between what imaginary lines in cervical radiograph
lines 3 and 4
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
largest spinous process in cervical spine
C7
anterior arch of C1 should not be greater than __mm from the dens
2.5 mm
in children, anterior arch of C1 distance from the dens can be up to
5 mm
widened anterior arch of C1 from the dens means
disruption of transverse ligament between C1 and C2
3 component of degenerative disease
- osteophytosis,
- sclerosis,
- narrowing of disc space
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
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
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
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
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
flexion “teardrop” fx is commonly associated with ____, often from the posterior portion of the VB being displaced into the central canal
spinal cord injury
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
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
seatbelt injury involves what levels
T12, L1 or L2 level
fracture of the posterior body is called ____, related to seatbelt fracture
Smith fracture
fracture through the spinous process is called ______, related to seatbelt fracture
Chance fracture
break or defect in the pars interarticularis portion of the lamina
spondylolysis
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
anterior
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
