Rad Midterm Flashcards

avulsion fx
Terms Definitions
Lumbar
Spondylosis
Ankle fxs
FYI
Cervical vertebrae
bony landmarks
Thoracic vert
bony landmarks
Shiny corner sign
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Arthritis Mutilans/Opera Glass Appearance
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Synoviochondrometaplasia
aka's synovial chondromatosis, synovial osteochondromatosis, note: loose bodies aka joint mice
Whiplash syndrome
aka acceleration-deceleration, flexion-extension, hyperflexion-hyperextension, sprain-strain, myofascial injury, ST injury, neck sprains 20-60% of MVA, forced hyperextension-hyperflexion of C/S, C/S facet joint source of pain in as many as 85% of pts
DISH
aka Forestier's disease, thick, flowing hyperostosis (dripping candle was), cleft through the hyperostosis at the disc level, uninvolved deep fibers of ALL, lucency at level of IVD represents anterolateral fibrous discal extension, not to be confused w/ a fx, enthesopathy of upper 1/3 of SI joints (can be one or both or neither)
AS
erosions = "rosary bead erosions", reactive sclerosis
Anterior body squaring
AS and Paget's
Type VII
relatively common, epiphyseal alterations in the absence of involvement of the growth plate or metaphysis, ex: transchondral fx's (osteochondritis dissecans), fragment may be purely cartilaginous in nature or may consist of both cartilage and bone, complications: irregularity or the articular surface with secondary OA and intraarticular loose bodies
Extracapsular hip fx's
intertrochanteric, subtrochanteric, avulsion fx's of the greater or the lesser trochanter (an isolated fx of the lesser trochanter is usually a result form an underlying bone pathology), Intertrochanteric: usually comminuted, oblique fx line splits the trochanters, Subtrochanteric: 2 inches below the lesser trochanter, uncommon, pathologic fx's often occur here (paget's and mets), Mid-diaphyseal fx of the femur = uncommon, Avulsion of the greater trochanter: usually in elderly as a result of a fall, lesser trochanter avulsion fx's: in children or adolescent athletes, otherwise usually PATHOLOGIC
Enteropathic arthropathy
or gastrointestinal origin esp ulcerative collitis (10% of pts) and Crohn's disease (6-7% of pts), peripheral joint S&S: usually resolves with no sequelae, spinal involvement: changes identical to those seen with AS
Degenerative terms spine: Spondylosis
endplate osteophyes/spondylophytes, subchondral sclerosis
Osteophytes/Spondylophytes
spurs at anterolateral portion of vertebral bodies, initially traction spurs become larger, may eventually become claw osteophytes
Insufficiency fx's
Looser's zones (pseudofx's, umbau zonen, Milkman's syndrome, increment fx's), can be due to vascular pulsations, discrete regions of uncalcified osteoid, on convex side of long bones at 90 degrees to long axis of the bone, multiple, ass. w/ bone softening disorders (Paget's, ricket's, osteomalacia, FD, osteogenesis imperfecta)
Healing
thickness of growth plate increases, peaking at 10 days, fibrin fill in the cleavage line and cartilage cells continue to grow, dissolution and resorption of the fiber occurs in 3 weeks, and normal growth resumes, residual growth recovery lines or transphyseal linear striations may occur, 25-30% develop some degree of deformity, 10% develop significant deformity such as impaired growth, epiphyseal malposition and rotation, osteonecrosis
Seronegative arthropathies (No RF)
AS, Enteropathic arthropathy, Psoriatic arthritis, Reiter's syndrome
PA
interphalangeal jt of toe common site of involvment, pencil-in-cup deformity of the 3rd digit, DIP then PIP then MCP, progression of erosion - tapered bony end -
Intercalary bone
calcification of the anterior fibers of the annulus fibrosis, will eventually be part of an osteophyte
Early AS
widened joint, frayed jt margin, sclerosis on the iliac side of the SI joints, B/L and symmetric
Coccygeal fx
M/C transversely oriented, seldom seen on AP film, fx line is usually oblique, slight ant displacement may be seen, DDX: developmental variations
Greenstick fx
aka Hickory stick, incomplete fx, occurs primarily in infants and children under the age of 10 (greater amount of pliable woven bone), bone bends causing tension on convex side & produces a transverse fx & concave side remains intact, heals w/out complications in most instances
Whiplash CT
primary role in detection and assessment of Fx's, prevertebral lesions and hematomas, bone fragments and their relation to the cord, and disc herniations but to a lesser degree
Associated ST injuries
Vascular: intrapelvic hemorrhage due to laceration of large bld vessels, ecchymosis of the scrotum and (labia), inguinal area and buttocks, Bladder and urethral: usually result of pubic bone fx's w/ widening of the PS, 10-40% incidence, laceration or complete rupture of the urethra, bladder, ureters at the trigone, Bowel: laceration or obstruction at the rectum, Diaphragm: (M/C left since the liver protects the right) do a chest xray
Open Fx
Penetrates the skin, opening the underlying tissue to the external environment and significantly increasing the risk of a complicating infection, Old term to be avoided: Compound
Multiple fx
more than one complete, non-comminuted fx in the same bone
Intracapsular hip fx's
anything proximal to the intertrochanteric region (subcapital, midcervical, basocervical), M/C subcapital, midcervical and basocervical = uncommon, can be impacted or displaced, high incidence of non-union and AVN because of poor blood supply 9major blood supply = medial and lateral femoral circumflex arteries), 25% of intracapsular fx's will result in non-union, 8-30% will result in AVN depending on early detection (x-raay changes will appear 3-5 moos and as late as 2-3 yrs post-injury, ave 1 yr), Garden classifications: 4 stages, incidence of complications increases progressively w/ each stage, subcapital fx's are often overlooked due to minimal displacement, pathological fx's are common (usually basocervical)
Type I
6%, pure epiphyseal separation that may widen GP, difficult to assess, needs comparison x-ray, look for ST swelling, shearing/avulsive force, good prognosis, M/C under 5 yos, secondary to birth trauma, location: proximal humerus and femurm distal humerus, may complicate scurvy, rickets, osteomyelitis, hormone imbalance
Bamboo Spine/Poker Spine
ossification of the outer annulus fibers = marginal syndesmophytes
Vacuum Phenomenon
N2 gas, active degeneration, esp after extension
Degenerative terms spine: Interverteral osteochondrosis
disc narrowing, disc calcification, vacuum phenomenon of Knuttson/Phantom disc
RA in Hips
B/L protrusio acetabuli aka Otto's pelvis, uniform jt loss, erosions, no osteophytes
Proximal Femur fx
uncommon in young to middle-aged unless severe trauma, moderate to minimal trauma may induce fx in osteoporotic bone, bone softening dxs, malignancy, or radiation induced AVN may predispose hip to fx, 2:1 female:male ratio, 5:1 female:male w/ intracapsular fxs, ave age = 70 yos, 10% of white females and 5% of white males will sustain a fx of the prox hip by the age of 80 (@ 90 yos = 20% and 10% respectively), 20% of pts with prox femur fx will get a pulmonary embolism and die w/in 6 mos, x-ray: AP pelvis, AP hip spot, frog leg, specialized groin lateral, CT: useful for obscured fxs, intraarticular frgmts, MRI: for occult and stress fxs, Isotopic bone scan: occult stress fxs, but as many as 20% of acute fxs not detected 24 hrs post injury, 5-10% not visible 72 hors post injury
Rider's bone
Avulsion fx of ischial tuberosity by hamstring or apophysitis, acute or chronic, frequently bilateral, w/ healing unexplained overgrowth of avulsed apophysis ocurs often leaving a wide gap (possibly fro hyperemia of apophysis) avulsed apophysis can grow larger than ischium, complications: reduction of hip mobility, called rider's bone because is often seen w/ horseback riders from chronic repetitive stress, DDX when healed: Osteochondroma
Proximal tibiofibular joint dislocation
anterior, posterior or superior, anterolateral M/C, unusual injury, fall in sitting position w/ leg flexedd beneath body or twisting injury (parachutist)
Patellar dislocation
lateral, horizontal or vertical, M/C = lateral (from trauma or torsional stress w/ fast change in direction), relocation is simple and can be done by the patient, but recurrent dislocations are then common, patella stabilization braces increases stability in up to 73% of the cases, flake fx = osteochondral fx associated w/ patellar dislocations as medial facet impacts the lateral femoral condyle. CT or sunrise view
Bimalleolar fx
usually transverse on one side because of tensile forces and oblique or spiral on the opposite side, diffuse ST swelling may be present, UNSTABLE
Hip dislocations
usually result of severe trauma such as MVA, 5% of all dislocations, can be anterior (15%) or posterior (85%)
Type III
8%, fx through physis and epiphysis, M/C 10-15 yos, M/C medial/lateral distal tibia, proximal tibia, distal femur, minimal displacement, arrest deformity rare, but is intraarticular and may require open reduction
C/S compression fxs: Teardrop
triangular-shaped bone separated from the ant inf corner of a vert body, may occur from hyperextension injury or hyperflexion injury (unstable injury because of injury to the IVD, ALL and post ligamentous structures, which may cause uni or bilateral facet dislocation), injuries from hyperflexion can also cause slippage of the segment, ass w/ acute ant cervical cord syndrome = complete motor paralysis and loss of the ant column sensation of pain and temp, maintenance of post column sensations of positions, vibration, and motion, upper extremity involvement > lower extremity
Chance/Lapbelt Fx
Horizontal splitting of sp and neural arch, ends in upward curve usually reaching the upper surface of the body just in front of the neural foramen, AKA fulcrum fx because of hyperflexion over the ant abdomen (compression and distraction forces), upper L/S, use of lapbelt in 1950's and 60's, high incidence of internal visceral damage (50% handbook of fxs), neuro deficits (15%), involvement of posterior and middle columns, transverse fx thru post elements with or without angulation of the sup portion, empty vertebrae sign
Type IV
10%, fx contains both metaphyseal and epiphyseal fragments, M/C lateral condyle of the humerus <10 yos and tibia >10 yos, vertically oriented splitting force, requires immediate open reduction and alignment to prevent growth arrest, joint deformity guarded prognosis, M/C/C of premature partial closure of the physis
C/S compression fxs: Burst
vertical compression to head propelling nucleus pukposus thru endplate into body = fx of the vertebra vertically = comminution with fragments migrating centrifugally, post displaced fragment of bone may creat extrinsic pressure on the ventral surface of the cord = neuro deficit or paralysis, CT = best imaging modality, lateral plain film reveals comminuted vertebral body flattened centrally, frontal film: vertical line
AIIS avulsion
by rectus femoris, active flexion is limited, long erm disability uncommon, common in rugby, soccer, football, DDX when healed - osteochondroma
Patellar Tooth Sign
enthesopathy at site of attachment of the quads tendon
OPLL without DISH
when not DISH almost exclusively in Japansese dissent
Infraction
a form of impaction with only a minor break in the cortex, used to describe minor localized break in the cortex, leaving minimal bone deformity, especially the vertebral endplates (osteoporosis)
C1 fxs: Lateral masses
uncommon, CT examination, avulsion fx of the transverse ligament at the ledial aspect of the lateral masses may be occasionally observed, isolated fx of the TP can occur
Oblique fx
typically occurs at the shaft of the long tubular bone, its course is approx 45 degrees to the long axis of the bone
Type II
75%, fx through physis and portion of metaphysis = Thurston-Holland sign = Corner sign, shearing/avulsive forces, periosteum remains intact on the side of the metaphyseal fx, helps with reduction, good prognosis, M/C 10-16 yos, locations: distal radius (50%), tibia, fibula, femur, ulna
Segond's fx
avulsion fx of bony insertion of the TFL (iliotibial band) a the margin of the lateral tibial condyle, a small bony is seen adjacent to the lateral tibia, MRI: high signal intensity at the site of the lateral tibial insertion, 75-100 % associated with ACL tear, 70% associated with meniscal tears, most disrupt the lateral capsule
Proximal fibula fx's
rare and usually found associated with ligament injury of knee or fx's of the lateral tibial plateau, or fx of the ankle, can present as impacted, comminuted fx fo the head of the fibula, or as avulsion of proximal pole (biceps femoris or LCL), can be associated w/ damage to the common peroneal nerve, lateral compartment syndrome & ligamentous peroneal nerve syndrome = association of rupture of the lateral capsular and ligamentous structures and peroneal nerve injury
Vertical sacral fx
result of indirect trauma to the pelvis, > than 50% suffer pelvic organ damage, no evidence on lateral view, sacral base tilt or CT may be needed, fx line usually runs nearly entire length of sacrum, examine neural foramina, mid-sagitally oriented fxs have low incidence of neuro compromise
C/S compression fxs: Wedge
result of mechanical compression of the involved vertebra btwn the 2 adjacent ones from hyperflexion, stable: IVD, ALL and other post ligamentous structures are intact, 2/3rds at C5-C7, lateral views shows sharp, triangular, ant wedging of the sup endplate, if ant body measures >/= 3mm less than post = wedge fx, retropharyngeal space may be increased, prevertebral fat strip displacement, a fragment of bone may occur near the ant surface of the vert endplate, lack of vertical line on AP views rules out burst fx
Burst fxs L/S
a specific form of compression fx where a posterosuperior fragment is displaced into the spinal canal, considerable force of axial compression and flexion, neuro injury in up to 50% (spinal cord, conus medullaris, cauda equina, best demonstrated on MRI or CT), if canal stenosis is present causes surgical treatment implicated, vertical fx line on AP radiograph often seen, widening of the interpediculate distance causing fx within the neural arch, a coronally
Specialized groin lateral
aka cross table lateral, film rests against hip on injured side w/ uninjured leg raised out of the field of view, the horizontal beam is directed perpendicular to the femoral neck, complications: uninjured leg may superimpose area of interest even if raised as high as the pt can tolerate, can NOT be obtained with B/L hip injuries
Ulnar Styloid erosion: 3 common sites
prestyloid recess, extensor carpi ulnaris, radioulnar joint
Sagittal section of discovertebral jt
ALL, PLL, Cartilage plate, Epiphyseal ring, Nucleus
Rotator cuff tear with retraction
superior displacment of the humeral head, subchondral sclerosis, osteophytes with acromion
Chronic Juvenile Arthritis
before the age of 16, M/C females, hypoplastic bodies (C2-4) w/ fused apophyseal joints
OA in C/S: Facet arthrosis
osteophytes, sclerosis, loss of joint space
RA in SI
rare site of involvement, mild loss of jt space, iliac erosions, sclerosis (minimal or mild)
Trolley track & Dagger sign
calcification of inter and supra spinous ligaments, calcification of the apophyseal joints and ligamentum flavum
Odontoid fx's
40-50% of C2 fx's, 30% have ass fx's of other segments, developmental lateral tilts of the dens are rarely more than 3 degrees, co anything above should be considered to be a fx, difficult to recognize: odontoid displacement (= disruption of anterior cortex, usually >3mm), angulation of the dens >3 degrees to the left or right, odontoid tilt, fx line, disrupted Harris ring, enlarged C2 body, retropharyngeal swelling, signs of non-union = smooth sclerotic margins, widening of the fx line, progressive osteolysis of the dens, a "vacuum" phenomenon within the fx
Odontoid fxs: Type I
Avulsion from apical or alar ligament stress (speculation), uncommon, rarely complicated by non-unionm immobilization bracing
Iliac wing fx
AKA Duverney's fx, direct force from a lateral direction causing splitting of wing, best seen on oblique view, stable fx because surrounding large muscle attachments prevent separation of the fracture fragments, can be comminuted, more common in osteoporosis
Distal femur fx's: Femoral condyle
intra-articular, confined to one or both condyles, T or Y shaped, if separation occurs the jt can become deformed, intra-articular loose body may displace from condylar articular surface
Malgaine's fx
M/C fx of pelvis, 1/3 of all pelvic fxs, Ipsilateral double vertical fx of sup pubic ramus and ischiopubic ramus with fx or dislocation of the SI jt, sup and post displacement of hemipelvis with fx of L5 TP may be present, vertical shearing forces to pelvis, unstable, high morbidity and mortality rate, complications - rupture of diaphragm and bowel
Chip fx
aka Corner, a form of avulsion fx that is usually limited to the separation of a small chip of bone from the corner of a phalanx or other short or long tubular bone
Radiographic signs for compression fx's: Step defect
buckling of the anterior cortex (greatest stress), usually near sup vertebral endplate, vertebral endplate actually slides forward, may be the only sign if the compression fx is subtle
Lateral Malleolus fx
most distal portion of fibula is the lateral malleolus, M/C fx there is an oblique or spiral fx extending from the inferior and anterior margin upward and backward to the posterior margin of the shaft of the distal fibula, result of outward or external rotation of the foot, medial oblique projection shows radiolucent oblique line w/ adjacent ST swelling (McKenzie's sign), small avulsion fx's may also be present, talar dome osteochondral defects may exist
Post Apophyseal Ring Fxs
Separation of the post vertebral body ring apophysis (post limbus bone), relatively uncommon, M/C in adolescence and young adults but can be encountered into 4th decade owing to apophyseal fusion, stiffness spasm numbness weakness neurogenic claudication and occasionally cauda equina, may be asymptomatic, M/C L4-L5 and L5-S1 but all L/S levels can be affected and even T12, surgical removal may be necessary, coexisting disc herniation common, 15-20% visible on plain film x-ray, CT is definitive
Lumbar facet arthrosis with degen spondy
note the facet hypertrophy and sclerosis as well as the slight anterolisthesis, axial CT scan shows evidence of lateral recess stenosis
OA Hand
M/C location for OA in the hand = DIP followed by the PIP articulations
Dislocation of the C/S: Atlanto-Occipital
rare, usually fatal injury (usually a pedestrian), hyperextension and distraction (usually ant), prevalent in pediatric pts (survive 3x's> than adults)
Circulatory or inflammatory phase of fx repair
10 days, cellular phase: hematoma function in ST surrounding fxed bone, 1st 5 days, vascular phase: network of dilated tributaries forming around periphery of injured area and cause active then passive hyperemia promoting active secretion of osteoid, elevation of periosteum and granulation tissue formation giving rise to mature callus, primary callus formation: muscle, CT and bone marrow form blastema accounting for 70% of osteoir in a femoral shaft fx (14 days after a fx)
Complications from hip dislocations
nerve injury in 10% of adults and 5% of children, sciatic nerve paralysis (usually peroneal branch) from posterior, myositis ossificans and AVN of femoral head in up to 10%, post-traumatic degenerative arthritis
Avulsion fx of the tibial tuberosity
usually occurs in association with a comminuted or subcondylar fx of the proximal end of the tibia, M/C in adolescents boys, may be predisposed by the presence of osgood-schlatter, an associated disruption of the patellar tendon may occur, usually takes plave during athletic activties with knee flexed and the quads tendon contracted and firmly resisting further flexion
OA in C/S: Uncinate and Facet arthrosis
hourglass shape of the IVF, nerve entrapment?
Horizontal (transverse) sacral fx
M/C, S3 and S4 near lower end of SI jt, difficult to ID, AP view, lateral view & sacral base tilt (35 degrees), look at foraminal lines on AP, disruption of ant cortex and anterior angulation of distal fragment on lateral, complications: sacral roots and plexus compromise, suicidal jumper's fx = affects S1 and S2 segments (nned high velocity)
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