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DRG1004 > Week 2 - Wrist, Forearm, Elbow > Flashcards

Week 2 - Wrist, Forearm, Elbow Flashcards

1
Q

FOOSH

A

Fall On Out-Stretched Hand

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2
Q

TRO

A

To rule out

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3
Q

RTA

A

Road Traffic Accidents

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4
Q

what are distal radius fractures

A

Smith #
Colles #
Barton #
Reverse Barton #
Lunate die-punch #
Chauffeur #

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5
Q

what # is associated with palmar displacement of distal radius

A

smith #

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6
Q

what is # is associated with dorsal displacement of distal radius

A

colles #

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7
Q

what fractures involve dislocation of volar rim of radius

A

barton & reverse barton fracture

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8
Q

what involves volar rim dislocation of dorsal aspect of radius

A

barton / dorsal barton #

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9
Q

what involves volar rim dislocation of palmar aspect of radius

A

reverse barton / volar barton #

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10
Q

what is die-punch #

A

depression # of lunate fossa of distal radius; result of transverse load through lunate

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11
Q

what is chauffeur’s #

A

isolated # of radial styloid process

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12
Q

where is the tension forces sustained for chauffeur’s #

A

ulnar deviation & supinated wrist

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13
Q

what does chauffeur’s # result in

A

scapholunate instability

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14
Q

what is the fracture that involves radial styloid process

A

Chauffeur’s #

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15
Q

what does scaphoid # result in

A

perilunate instability

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16
Q

what causes scaphoid #

A

FOOSH

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17
Q

what is scaphoid # most common in

A

young adults

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18
Q

what are the diff dislocations caused by scaphoid #

A

lunate & perilunate dislocation

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19
Q

what is TFCC

A

triangular fibrocartilage complex

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20
Q

what modality is better for TFCC tear

A

MRI

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21
Q

what is positive ulnar variance

A

distal articular surface of ulna is more distal than articular surface of radius

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22
Q

what is the importance of positive ulnar variance

A

impt for ulnar impaction syndromes & TFCC thinning

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23
Q

what is ulnar styloid # associated w/

A

radial #; rarely isolated

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24
Q

how should wrist be positioned for PA projection

A
  • shoulder, elbow, wrist joints at same level
  • elbow flexed at 90 degrees, pronated forearm
  • fingers slightly flexed
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25
Q

where should u aim vertical central ray for wrist PA projection

A

center at mid-carpal joint; between radial & ulnar styloid process

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26
Q

what is the collimation of wrist PA projection

A

upper = proximal 2/3 of metacarpals
side = soft tissue margins of radius & ulna
lower = distal 1/3 of radius & ulna

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27
Q

what is the adjustment for wrist lateral projection

A

55kVp, 2.0 mAs

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28
Q

how should wrist be positioned for lateral projection

A
  • forearm rotated externally till ulnar aspect is perpendicular to IR
  • elbow should be 90 degrees
  • palmar surface perpendicular to IR
  • no gap between body & arm; close to patient’s body
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29
Q

where should u aim vertical central ray for wrist PA projection

A

center at mid-carpal joint

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30
Q

what is the collimation of wrist PA projection

A

upper = proximal 2/3 of metacarpals
side = soft tissue margins of radius & ulna
lower = distal 1/3 of radius & ulna

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31
Q

what is the ideal position for PA wrist

A
  • radial & ulnar styloids are at extreme lateral & medial edges
  • radioulnar articulation is open
  • minimal superimposition of metacarpal bases
  • scaphoid slightly foreshortened, lunate appears trapezoidal
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32
Q

what is the ideal area of PA wrist

A
  • carpal bones, 1/3 of distal radius & ulna, half of proximal metacarpals included
  • soft tissues surrounding wrist included
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33
Q

what is the ideal position for lateral wrist

A
  • palmar cortex of pisiform bone overlays central third of interval between palmar cortices of distal scaphoid pole & capitate head
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34
Q

what is Monteggia #

A
  • # of proximal third of ulna
  • dislocation of proximal radial head & proximal radio-ulnar joint (PRUJ)
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35
Q

what is Galaezzi #-dislocations

A
  • # of distal part of radius
  • dislocation of distal radioulnar joint (DRUJ) & ulna
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36
Q

what are the routine radiographic views of forearm

A

AP
lateral

37
Q

how does one position patient for forearm lateral projection

A
  • shoulder, elbow, wrist joints at same level
  • elbow flexed at 90 degrees
  • abduct until forearm is in contact w/ IR (karate chop)
38
Q

where should u aim vertical central ray for forearm lateral projection

A

centered to mid forearm

39
Q

what is the collimation of forearm lateral projection

A

upper = wrist joint
side = soft tissue margins of radius & ulna
lower = elbow joint

40
Q

how does one position patient for forearm AP projection

A
  • fully extend forearm until posterior aspect is in contact w/ IR
  • adjust till radial & ulnar styloid processes and medial & lateral epicondyles are equidistant from IR
41
Q

where should u aim vertical central ray for forearm AP projection

A

centered to mid-forearm area

42
Q

what is the collimation of forearm AP projection

A

upper = wrist joint
side = soft tissue margins of radius & ulna
lower = elbow joint

43
Q

what is the ideal position of AP forearm

A
  • radial styloid process seen laterally
  • radial tuberosity seen medially
  • ulnar styloid process projected distally to midline of ulnar head
  • olecranon process situated within olecranon fossa
44
Q

what is not seen when radial & ulnar styloid processes and medial & lateral epicondyles are not equidistant to IR for AP forearm

A
  • radial styloid process seen laterally
  • radial tuberosity seen medially
  • ulnar styloid process projected distally to midline of ulnar head
45
Q

what is not seen when elbow is not fully extended for AP forearm

A
  • olecranon process situated within olecranon fossa
46
Q

what is the ideal area of AP forearm

A

wrist joint, elbow joint & soft tissue margins included

47
Q

what is the ideal exposure for AP forearm

A
  • sufficient contrast & density seen in bony trabeculae details & soft tissue margins
  • adequate penetration seen by olecranon over olecranon fossa
48
Q

what is the ideal position for lateral forearm

A
  • ulnar styloid process seen posteriorly
  • 1/3 of radial head superimposed with coronoid process
  • distal radius & ulna superimposed
  • elbow joint space appears open
49
Q

what is not seen when palm is not perpendicular to IR for lateral forearm

A
  • ulnar styloid process seen posteriorly
  • 1/3 of radial head superimposed with coronoid process
  • distal radius & ulna superimposed
50
Q

what is not seen when distal humerus & forearm are not on the same plane

A

elbow joint space appears open

51
Q

what is the ideal area for lateral forearm

A

wrist joint, elbow joint, surrounding soft tissue margins included

52
Q

what is the ideal exposure for lateral forearm

A
  • sufficient contrast & density seen in bony trabeculae details & soft tissue margins
  • adequate penetration seen by olecranon over olecranon fossa
53
Q

ORIF

A

open reduction internal fixation

54
Q

how should one position patient for lateral elbow

A
  • shoulder, elbow, wrist joints at same level
  • flex affected elbow at 90 degrees w/ medial aspect of elbow in contact w/ IR
  • used 15 degrees positioning pad to support wrist
55
Q

where should u aim vertical central ray for elbow lateral projection

A

centered at lateral epicondyle

56
Q

what is the collimation of elbow lateral projection

A

upper = distal third of humerus
side = surrounding soft tissue margins
lower = proximal third of radius & ulna

57
Q

how should one position patient for AP elbow

A
  • radial & ulnar styloid processes and medial & lateral epicondyles are equidistant from IR
  • externally rotate & supinate arm till posterior aspect in contact w/ IR
58
Q

where should u aim vertical central ray for elbow AP projection

A

2.5 cm distally from midpoint of imaginary line between medial & lateral epicondyles of humerus

59
Q

what is the collimation of elbow AP projection

A

upper = distal third of humerus
side = surrounding soft tissue margins
lower = proximal third of radius & ulna

60
Q

what is the ideal position for AP elbow

A
  • medial & lateral epicondyles seen
  • radial tuberosity superimposed on ulna & seen medially
  • 1/8 of radial head superimposes ulna
  • olecranon process situated within olecranon fossa
61
Q

which projection involves 1/8 of radial head superimposing on ulna

A

AP elbow

62
Q

what is not seen if radial & ulnar styloid process and medial & lateral epicondyles are not equidistant from IR of AP elbow

A
  • medial & lateral epicondyles seen
  • radial tuberosity superimposed on ulna & seen medially
  • 1/8 of radial head superimposes ulna
63
Q

what is the ideal area of AP elbow

A
  • distal third of humerus included
  • surrounding soft tissue included
  • proximal third of radius/ulna included
64
Q

what is the ideal exposure of AP elbow

A
  • sufficient contrast & density as seen by bony trabecular details & soft tissue margins
  • adequate penetration as seen by olecranon over olecranon fossa
65
Q

what is the ideal position of lateral elbow

A
  • 3 concentric arcs seen
  • radial tuberosity not seen
  • 1/3 of radial head superimposes ulna
66
Q

what is not seen for lateral elbow if palm is not perpendicular to IR

A

1/3 of radial head superimposes ulna

67
Q

what is not seen if affected shoulder, elbow & wrist are not on same plane for lateral elbow

A

3 concentric arcs

68
Q

what forms the 3 concentric arcs

A

trochlear sulcus, capitulum, medial trochlea

69
Q

what is the ideal area of lateral elbow

A
  • distal third of humerus
  • surrounding soft tissues
  • proximal third of radius/ulna
70
Q

what is the ideal exposure of lateral elbow

A
  • sufficient contrast & density seen in bony trabeculae details & soft tissue margins
  • adequate penetration seen by well defined concentric arcs & anterior fat pads
71
Q

how to differentiate between smith & colles #

A

smith = palmar / anterior displacement
colles = dorsal / posterior displacement

72
Q

what is the dinner fork deformity

A

colles #

73
Q

what does a typical colles # extends into

A

distal radio-ulnar joint

74
Q

what is the garden spade deformity

A

smith’s #

75
Q

what % of all hand fractures involves scaphoid #

A

10%

76
Q

what % of all carpal fractures involves scaphoid #

A

55%

77
Q

what is the 2nd most common carpal #

A

Triquetrum # (21%)

78
Q

what does a scaphoid waist # cause

A

avascular necrosis of proximal scaphoid poles

79
Q

what is a perilunate dislocation

A

disruption of normal r/s between lunate & capitate

80
Q

what is a lunate dislocation

A

separation of lunate from both capitate & radius

81
Q

what causes lunate & perilunate dislocation

A

great force applied onto hyperextended wrist

82
Q

what modality can be used to determine avascular necrosis

A

radio-nuclide imaging

83
Q

what does raised anterior fat pad indicate

A

joint effusion & & not seen on radiographs

84
Q

what other additional radiographic projections are used to show radial head

A

lateral elbow
- with hand in lateral position
- with pronated hand
- with palm facing away frombody

85
Q

what should one do if the patient is unable to extend his elbow

A
  • modify AP projection
  • ascertain injury site
86
Q

what is monteggia #

A

Proximal radioulnar joint (PRUJ) with ulna #

87
Q

what is the angulation to show scaphoid via PA w/ ulnar deviation

A

15 to 20 degrees

88
Q

what neurovascular could occur from elbow injuries

A

radial nerve
median nerve
brachial artery

89
Q

what is supracondylar #

A
  • common # among children
  • unnecessary movement leads to fragments damaging nerve & artery

DRG1004 (12 decks)

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