upper limbs Flashcards
3 rules when assessing radiographs
always evaluate both views
adopt a systemic checking process for each projection
compare with previous radiographs
description of fractures
identify fractured bone
state
- site
- closed or open
- fragments
- direction of fracture
- articular surface involvement
- position of the two major fragments
- angulation
- rotational deformity
Salter-Harris fractures in paeds
Type 1 - ‘S’eparation: restricted to the growth plate
Type 2 - ‘A’bove
Type 3 - ‘L’ower
Type 4 - ‘T’hrough
Type 5 - ‘Er’asure / Impacted
Type 2-4 involves the growth plate and the adjacent metaphysis and/or epiphysis
Fractures in paeds
- torus/buckle: a bulge in the cortex
- bowing: associated bend in the bone shaft
- greenstick: bending of the shaft with a fracture on the convex surface
- salter-harris: involving the growth plate
type of fractures in general patients
transverse
linear
oblique nondisplaced
oblique displaced
spiral
greenstick
comminuted
type of bone and joint injuries
osteochondral fractures
- fracture of part of a joint surface
avulsion fractures
- small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone
stress fracture
- occur when repeated forces on the bones are abnormally high
pathological fractures
- usually caused by a focal lesion
x-ray appearances of fractures
- radiolucent line
- alignment: undisplaced or displaced
- bony margins: step or discontinuity of cortical margins
- impacted: band of increased bone density
- swelling of soft tissue
skier’s thumb
- usually accompanied with torn medial collateral ligament
- at times, may accompany an avulsion of base of proximal phalanx
Bennett’s fracture
involves base of 1st metacarpal
rolando’s fracture
comminuted intra-articular fracture of the base of the 1st metacarpal
boxer’s fracture
fracture of the neck of the 5th metacarpal
measurements to assess distal radius
- radial inclination = 23deg
- radial height = 12mm
- ulnar variance = 0.9mm
- tilt volar = 11-12deg
common causes of positive ulnar variance
- scapholunate instability
- ulnar impaction syndrome
- triangular fibrocartilage tears
cause of negative ulnar variance
kienbock’s disease (osteonecrosis of lunate bone)
findings suggestive of distal radius fracture
- radial inclination change > 5deg
- radial shortening > 5mm
- ulnar variance (-4.2mm to +2.3mm)
- volar tilt with dorsal angulation of > 5deg
terry-thomas sign
increased distance between the scaphoid and the lunate (scapholunate space) on PA wrist associated with scapholunate dissociation
colles fracture
- dinner fork deformity
- extra-articular
- dorsal displacement of distal fragment
smith fracture
- extra-articular
- ventral displacement of distal fragment
barton’s fracture
- involved the dorsal cortex of distal radius and articular surface
- intra-articular
reverse barton’s fracture
- involves the anterior cortex of distal radius and articular surface
- intra-articular
galeazzi fracture
- commonly result from FOOSH with extended wrist and hyperpronated forearm
- radial shaft fracture
- separation of distal radio-ulna joint
Monteggia type fractures
- displaced fracture of the ulna with shortening
- loss of alignment of the radiocapitellar line due to dislocation of the radial head
order of elbow ossification centre development
Capitulum
Radial head
Internal epicondyle (medial)
Trochlea
Olecranon
Lateral epicondyle (External)
6 months to 12 years
elbow fat pad indication
- displaced anterior fat pad = highly likely a fracture
- displaced posterior fat pad = suspected fracture
- fat pads not displaced = occasionally a fracture
normal elbow alignment
radio-capitellar line – both AP and lateral views
- line drawn along the mid radius should pass through the capitellum
anterior humeral line – lateral view
- line drawn along the anterior humeral margin should cut through 1/3 of the capitellum
normal shoulder growth in children
head - 1 year
greater tubercle - 3 years
lesser tubercle - 5 years
most common type of shoulder dislocation
anterior dislocation
- represent 95-98% of all glenohumeral dislocation
posterior dislocation of shoulder joint
- 2-5%
subluxations and dislocations of acromio-clavicular joints
anterior dislocations of shoulders mechanism of injury
caused by FOOSH or fall onto shoulder in abduction, external rotation and extension
humeral head comes to lie anterior, medial and somewhat inferior to its normal location and glenoid fossa
associated with
- bankart lesion
- hill-sacs lesion
xray view of anterior dislocated shoulder
- humeral head and glenoid surfaces not aligned
- humeral head lies below the coracoid
- humeral head is displaced medially
xray view of posteriorly dislocated shoulder
humeral head is forced posteriorly in internal rotation while the arm is abducted
can be cause by muscle contraction from electric shock/ seizure or axial load while arm is internally rotated, adducted, flexed
“lightbulb sign” on AP view as humerus is internally rotated
systematic approach in MSK
Alignment - check for change in position which may suggest fracture or dislocation
Bone cortices (any breach) and texture (change in density or trabecular pattern)
Cartilage - check for joint space, formation of osteophytes
Soft tissues - swelling
