spine

Question 1

which muscle attaches to the ASIS

Answer 1

sartorius muscle

Question 2

which muscle attaches to AIIS

Answer 2

rectus femoris

Question 3

what is shenton’s line

Answer 3

runs anatomically along the medial edge of the femoral neck and the inferior edge of the superior pubic ramus

interruption of shenton’s line may suggest a NOF fracture in adults or DDH in children

Question 4

type of stable fractures

Answer 4

iliac wing fracture
sacrum fracture
superior and inferior pubic ramus fractures

Question 5

type of unstable fracture

Answer 5

lateral compression fracture with the pelvis pushed inward

anterior-posterior compression fracture

vertical shear fracture with one half of the pelvis shifted upward

Question 6

normal SI joint anatomy

Answer 6

width approx equal

inferior margin of iliac bone lines up with the inferior aspect of sacral part of the joint on both sides

Question 7

normal SP anatomy

Answer 7

no widening (<5mm)
superior margins at about the same level

Question 8

types of intra-capsular fractures

Answer 8

located at the NOF
- subcapital
- transcervical
- basicervical

Question 9

type of extra capsular fractures

Answer 9

located below the intertrochanteric line
- intertrochanteric
- subtrochanteric

Question 10

cervical spine AP peg view checklist

Answer 10

• alignment of the lateral margins of C1 with the adjacent lateral margins of C2
• equal spaces on each side of the peg
• any fracture line across base of the peg

Question 11

common conditions and injuries of the lumbar spine

Answer 11

spondylolisthesis
spondylosis
spondylolysis
ankylosing spondylitis
wedge fracture
burst fracture
chance fracture
spinal metastases

Question 12

what does the anterior column of spine consist of

Answer 12

• anterior longitudinal ligament
• anterior annulus fibrosis
• anterior 2/3 vertebral body

Question 13

what does the middle column of spine consist of

Answer 13

• posterior longitudinal ligament
• posterior annulus fibrosus
• posterior 1/3 vertebral body

Question 14

what does the posterior column of spine consist of

Answer 14

posterior elements
- pedicles, facets
- lamina
- spinous process

posterior ligaments

Question 15

what is considered stable spinal fracture

Answer 15

affects one column only

Question 16

what is considered unstable fracture

Answer 16

affect 2 or more columns

Question 17

what is spondylolisthesis

Answer 17

displacement of vertebra over another
caused by trauma, natural degenerative changes (spondylosis))
grading
- grade I: displacement up to 25%
- grade II: 25-50%
- grade III: 50-75%
- grade IV: 75-100%

Question 18

what is spondylolysis

Answer 18

• fracture of the pars interarticularis
• most common in lower lumbar vertebrae
• may develop spondylolisthesis

Question 19

what is spondylosis

Answer 19

osteoarthritis of spine
narrowing of the intervertebral disc space
osteophytes
intervertebral foramina stenosis

Question 20

what is ankylosing spondylitis

Answer 20

form of arthritis which causes inflammation of the spine
calcification of anterior and posterior longitudinal ligaments and intervertebral discs
fusion of spine

Question 21

what is spine metastases

Answer 21

spread of malignant cancer cells to the spine
lytic or sclerotic lesion
“winking owl sign”
- destruction of the pedicles

Question 22

at what age do ASIS apophysis appear and fuse to skeleton

Answer 22

appear: 13-15
fuse: 21-25

Question 23

at what age do AIIS apophysis appear and fuse to skeleton

Answer 23

appear: 13-15
fuse: 16-18

Question 24

at what age do iliac crest apophysis appear and fuse to skeleton

Answer 24

appear: 13-15
fuse: 21-25

Question 25

at what age do ischial tuberosity apophysis appear and fuse to skeleton

Answer 25

appear: 13-15 fuse: 20-25

Question 26

at what age do greater trochanter apophysis appear and fuse to skeleton

Answer 26

appear: 2-3 fuse: 16-17

Question 27

at what age do lesser trochanter apophysis appear and fuse to skeleton

Answer 27

appear: 11-12 fuse: 16-17

Question 28

difference between male and female pelvis

Answer 28

male: narrower and less flared oval or heart shaped angle of pubis arch is <90deg female: broader has round pelvic inlet angle of pubic arch is >90deg

Question 29

what landmarks can be seen in a judet's view

Answer 29

ilioischial line (posterior column) anterior acetabular wall roof of acetabulum iliac crest

Question 30

what landmarks can be seen in an obturator oblique view

Answer 30

iliopectinal line posterior acetabuluar wall roof of acetabulum obturator foramen

Question 31

what are the blood supplies to the capsule of femur

Answer 31

deep femoral artery --> medial and lateral circumflex femoral artery

Question 32

risk factors of pelvic injuries

Answer 32

osteoporosis ageing excessive alcohol consumption physical inactivity visual impairment female

Question 33

causes of fractures of pelvis

Answer 33

high energy trauma bone insufficiency avulsion fracture

Question 34

how should the assessment of AP pelvis be

Answer 34

1. scrutinise both the inner and outer contours of the main pelvic ring 2. two small rings forming the obturator foramina 3. widths of SI joints should be equal 4. superior surfaces of the body of each pubic bone should align; width should not exceed 5mm 5. sacral foramina and arcuate lines should have smooth surface 6. region of acetabulum 7. check apophyses in adolescents and young adults

Question 35

pitfall of acetabulum

Answer 35

Os acetabuli - small bone ossicle at the superior margin of the acetabular rim is a common finding - represents either unfused ossification centre or an impingement effect from a longstanding injury

Question 36

how to assess a lateral cervical spine

Answer 36

1. technical quality - include C1-7 - C1 to C2 articulation - superior surface of T1 2. identify the anterior arch of C1 3. position of anterior cortex of odontoid and the coffee bean 4. alignment of - anterior cortex of peg with anterior cortex of C2 - posterior cortex of peg with posterior cortex of C2 5. normal - Harris' ring - posterior arches of C1 and C2 - C3 to C7 - 3 main contour lines - pre-vertebral soft tissues

Question 37

how to assess AP thoracic and lumbar spines

Answer 37

1. alignment of vertebral bodies and spinous process 2. check for loss of vertebral height 3. check the vertebral disc spaces 4. check the vertebral end plates 5. trace the posterior elements - pedicles - laminae - spinous processes 6. ensure the vertebral and spinous processes are intact 7. no visible paraspinal line 8. check for fracture of transverse process

Question 38

what is the width of pre-vertebral soft tissue in the cervical

Answer 38

C1-4 = 7mm C5-7 = 22mm any bulge or local increase in width suggest of haemorrhage

Question 39

what is the normal measurement of the alantodental interval

Answer 39

<3mm un adults <5mm in children

Question 40

how does normal C3 to C7 look like

Answer 40

- fairly uniform in square or rectangle shape - anterior and posterior vertebral body should be about the same height

Question 41

how does a normal harris ring look like

Answer 41

appears slightly incomplete at its inferior and superior aspects disruption in anterior or posterior ring is suggestive of either fracture of the base of peg or C2 body fracture

Question 42

how to assess AP cervical spine

Answer 42

alignment of lateral margins of C1 with adjacent lateral margins of C2 equal spaces on each side of the peg check for any fracture line across the base of peg alignment of spinous process should lie mid-line and have equal amount of space between the lateral masses of the vertebra should be aligned smoothly

Question 43

how to assess lateral lumbar and thoracic spine

Answer 43

- height of vertebral body - check 3 columns - fragment of bone detached from the anterior aspect of a vertebral body - check for more abnormalities

Question 44

3 main contour lines to assess lateral cervical xray

Answer 44

anterior vertebral line posterior vertebral line spinolaminar line (extra: posterior spinous line)