Test #1 Flashcards
Areas of normal uptake in bone scintigraphy?
Long bone metaphyses, thyroid, kidneys, sternum, spine, S.I., bladder
Type of forces that produce fxs?
Torsion, compression, shearing, rotation, angulation(bending)
Types of incomplete fxs?
Green stick, torus, bowing, stress
What to look for to detect a fx?
Abnormal line of lucency, offset of the cortex, increased bone density, soft tissue swelling, obliteration or displacement of myofascial planes, periosteal & endosteal responses, joint effusion, intracapsular fat (FBI sign), double cortical line, irregular metaphyseal corners, zone of impaction
Factors which influence fx healing?
Pt’s age, site & type of fx, position of the fragments, status of blood supply, quality of immobilization or fixation, complications
What are the phases of the circulatory/inflammatory phase?
Cellular phase, vascular phase, primary callus phase
Steps during cellular phase
Hematoma, Inflammatory response, granulation tissue replaces the hematoma
Steps during the vascular phase
Ingrowth of new blood vessels leading to hyperemia, increased osteoclastic activity, hair growth, tan skin
Circulatory phase occurs when?
First 5-30 days
What happens during the Reparative/metabolic phase?
Callus formation becomes more orderly & woven bone is replaced by more mature bone
How long does the Reparative/Metabolic phase last?
4-6 weeks in the young & 6-15 weeks in adults
What happens during the remodeling/mechanical phase?
Bone is deposited & removed according to Wolff’s law, restoration of the medullary cavity & bone marrow
How long does the Remodeling/Mechanical phase last?
May take months or years to complete
What happens in first 5-10 days following a fx?
Resorption of the fx line occurs creating an increase in width of the actual fx line
What happens 10-30 days following a fx?
“Veil” of new bone formation adjacent to fx site (callus)
Immediate complications of delayed union/nonunion?
Articular injury, compartment syndrome, fat emboli
Intermediate complications of delayed union/nonunion?
Osteomyelitis, hardware failure, RSDJ, myositis, delayed union
Delayed complications of delayed union/nonunion?
Osteonecrosis, DJD, osteoporosis, nonunion, malunion
Contributing factors to nonunion?
- Distraction
- Inadequate immobilization (99% of problems)
- Infection
- Impaired circulation (avascular necrosis)
- Soft tissue b/w fragments
M/C site for non-union?
Mid-clavicle, ulna, tibia
5 P’s assoc. w/ Volkmanns Ischemic Contracture?
- Pulselessness
- Pain
- Pallor
- Paresthesia
- Paralysis
Premature DJD is M/C where?
Weight bearing joints (hip, knee, ankle)
What views are in a head series?
AP Caldwell, AP Towns, L & R Lateral, Base view, Waters view (shows sinuses)
Most spinal trauma is secondary to?
MVAs & falls
Most common sites for spinal fxs?
C1-C2 - cord injury less common b/c canal is large
C5-C7 - canal is smaller so cord injuries more common
T12-L1
What type of forces disrupt ligaments?
Rotational & shearing forces
What is located in the anterior column of the spine?
ALL, ant. annulus fibrosis, anterior body
What is located in the middle column of the spine?
PLL, pos. annulus fibrosis, pos. body
What is located in the pos. column of the spine?
Neural arch & intervening soft tissues
For an injury to be considered stable what column has to be intact?
Middle column
If an injury disrupts 2 of 3 columns is it considered stable or unstable?
Unstable
What is the M/C mechanism of spinal injury?
Flexion
Types of hyperflexion injuries
Bilateral facet dislocation, Clay-Shovelers, Hyperflexion sprain/strain, Odontoid process fx, Simple wedge fx, Flexion teardrop fx
What is the most unstable fx in the C-spine compatible w/ life?
Flexion teardrop fx
Types of hyperextension injuries
Extension teardrop fx, fx of pos. arch of C1, Hangman’s fx, Articular pillar/facet fx, spinous process fx, Hyperextension sprain/strain
Types of rotation injuries
Laminar/facet fx (extension), Transverse process fx (C-7), Unilateral facet dislocation (flexion), Rotary atlantoaxial fixation
Types of lateral flexion injuries
Uncinate process fx, Transverse process fx (M/C)
Lateral flexion injuries are usually located where?
Junction of TVP & pedicle
Types of shearing injuries
Fx/dislocation in thoracic & lumbar spine, Atlanto-occipital dislocation
Types of dislocation injuries
Chance fx (seat belt fx), Atlanto-occipital dislocation
List findings that suggest instability
Increased angulation b/w vert. bodies that is at least 11degs greater than adjacent segments, ant. or pos. translation greater than 3.5mm, segmental spinous process widening, facet joint widening, lateral tilting of vertebral bodies
A majority of signs of cervical trauma can be visualized on what view?
Neutral lateral view
What segments need to be shown on a neutral lat. view of the C-spine?
C7 & T1
The retropharyngeal space should be no more than?
7mm
The retrotracheal space should be no more than?
21mm
Minimum views of a 3-view cervical series?
APOM, APLC, neutral lateral
Most common fx of C1?
Pos. arch fx of atlas
M/C location of extension teardrop fx is C-spine?
C2/C3
Important clue indicating an articular pillar/facet fx?
Acute cervical radiculopathy
M/C location for articular/pillar fx of C-spine?
C4-C6 (C6)
This fx usually has a “horizontal facet sign”?
Articular pillar/facet fx
2 types of fxs that result from compression injuries?
Jefferson’s fx & burst fx
This fx will show bilateral offset or spreading of the lat. masses known as the “Overlap sign”?
Jefferson’s fx
Posteriorly displaced fragments may produce spinal cord injury in this type of fx?
Burst fx
This fx is assoc. w/ MVAs, wrestling, diving; caused by abrupt flexion, direct blow extension?
Clay-Shoveler’s fx
This fx is assoc. w/ the “double spinous process” sign?
Clay-Shovelers
3 types of fusion
Synostosis (congenital), Ankylosis (pathological), Arthrodesis (surgical)
This is seen in Down’s syndrome, inflammatory arthritides, & Jefferson’s fx?
Transverse ligament disruption
3 things that suggest injuries?
Soft tissue changes, zone of impaction, step defect
Types of stable Fxs
Pos. arch fx of atlas, extension teardrop fx, Jefferson’s fx, Simple wedge fx, Clay-Shovelers fx, Type I odontoid process fx, Type III odontoid process fx, Unilateral facet dislocation
Types of unstable fxs
Hangman’s fx, Articular pillar/facet fx, Burst fx, Flexion teardrop fx, Hyperflexion strain/sprain, Bilateral facet dislocation, Transverse ligament disruption, Type II odontoid process fx
