Trauma - masterclass Flashcards
Appearance of different x-ray densities on CXR?
Black = air
Grey = fat
Grey/white = muscle/soft tissue
White = bone
Bright white = metal
Basic CXR techniques?
Standard “PA” view - x-ray passes from posterior to anterior.
“AP” view
Lateral view
The heart lies anteriorly in the thorax, so PA view minimises magnification of cardiac shadow. true/false?
True
Why are PA CXR views preferred over AP?
The heart shadow is magnified so heart size cannot be assessed accurately
The scapulae overlie and partly obscure the lungs
It can be difficult for the patient to take an adequate inspiration
Useful mnemonic for assessing image quality?
“RIPE”
Rotation
Inspiration
Projection - note if AP or PA. Assume PA if not labelled
Exposure
Appearance of pleural effusion on CXR and CT?
Fluid density at the dependent part of the hemithorax. i.e. at the bases in erect CXR; posteriorly in supine CT.
Causes collapse of adjacent lung which appears denser (white).
Appearance of bronchiectasis on CT and CXR?
There is dilatation of bronchi, with or without thickening of bronchial walls and mucus plugging. ‘Tram-track sign’ can be seen on CT and CXR. The ‘Tree-in-bud sign’ and the ‘Signet ring sign’ can be seen on CT.
“Tram track” sign = dilated airway with thickened walls, similar to tram-track.
“Signet ring sign” = dilated bronchus and accompanying pulmonary artery branch are seen in cross-section.
What is a flail chest?
A traumatic condition of the thorax. It may occur when 3 or more ribs are broken in at least 2 places.
Occurs when a portion of the chest wall is destabilised, usually from severe blunt force trauma.
Everybody with 3 or more ribs broken in multiple places will develop a flail chest. true/false?
false
A flail chest is considered a clinical diagnosis as everybody with this fracture pattern does not develop a flail chest.
Pneumothorax presentation on CXR?
Reduction in lung markings in the apices.
Can also notice faint outline of the collapsed lung where the wall of the lung has detached from the internal body wall due to pressure changes.
What is lung consolidation?
when the air in the small airways of the lungs is replaced with a fluid, solid, or other material such as pus, blood, water, stomach contents, or cells.
Lung consolidation appearance on CXR?
The consolidated parts of your lung look white, or opaque, on a chest X-ray.
What is a pleural effusion and a haemothorax?
Pleural effusion is the accumulation of fluid in between the parietal and visceral pleura, called the pleural cavity.
Haemothorax is a pleural effusion due to accumulation of blood.
Appearance of pleural effusion on CXR?
Fluid will surround the lung base forming a ‘meniscus’ – a concave line obscuring the costophrenic angle and part or all of the hemidiaphragm.
Overall there would be white clouding in the base of the lungs.
What are abdominal x-rays commonly used for?
Obstruction/ileus
Pneumoperitoneum
Appearance of obstruction/ileus on abdominal x-ray?
Small bowel obstruction include dilation of the small bowel (>3cm diameter) and much more prominent valvulae conniventes creating a ‘coiled-spring appearance’.
What is pneumoperitoneum?
the presence of air or gas in the abdominal (peritoneal) cavity
What is the most commonly injured solid organ?
Spleen
What is 2nd most commonly injured solid organ?
Liver
Types of bone fractures?
Transverse
Oblique
Spiral
Comminuted
Avulsion
Impacted
Greenstick
What fracture type can a surgical neck of humerus fracture be?
Can be angulated impacted (when ends of bones are driven into each other).
Unimpacted
Comminuted
What is an x-ray of the fat pad of the elbow useful for?
Assessing for the presence of an intra-articular fracture of the elbow.
An anterior fat pad is often normal. However a posterior fat pad seen on a lateral x-ray of the elbow is always abnormal. true/false?
true
What is a positive anterior sail sign?
Also known as the anterior fat pad sign, describes the elevation of the anterior fat pad to create a silhouette similar to a billowing spinnaker sail from a boat.
It indicates the presence of an elbow joint effusion.
What is a greenstick fracture?
A type of broken bone. A bone cracks on one side only, not all the way through the bone. It is called a “greenstick” fracture because it can look like a branch that has broken and splintered on one side.
Greenstick fractures usually occur in children younger than 10 years old. true/false?
True
Children’s bones are softer and more flexible.
In teens and adults, the injury may break the bone all the way through. But in children, the bone breaks on one side only.
Most common cause for a scaphoid fracture?
FOOSH (falling on outstretched hand)
Colle’s fracture cause?
Falling on outstretched hand
Presents with a dinner fork deformity.
Smith’s fracture cause?
Falling on hand whilst wrist is flexed.
If untreated what complication could occur with scaphoid fracture?
AVN (avascular necrosis).
What arteries supply blood to the femoral head?
medial femoral circumflex artery, lateral femoral circumflex artery and obturator artery
What is an intracapsular fracture of femur?
Fracture of internal capsule of femoral head.
Can be rated using Garden Classification
Garden classification system (non-displaced fractures)?
I
Incomplete
II
Complete fracture but nondisplaced
Garden classification system (displaced fractures)?
III
Complete fracture, partial displacement
IV
Complete fracture fully displaced
What is an extracapsular fracture of femur?
Outside the capsule, subdivided into:
Inter-trochanteric, which are between the greater trochanter and the lesser trochanter.
Sub-tronchanteric, which are from the lesser trochanter to 5cm distal to this point.
Blood supply to femoral head is anterograde. true/false?
False
The blood supply to the neck of the femur is retrograde, passing from distal to proximal along the femoral neck to the femoral head.
This is predominantly through the medial circumflex femoral artery, which lies directly on the intra-capsular femoral neck.
