skel rad 3

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  1. complete fracture
    a fractuure which both cortices of bone have been disrupted.
  2. incomplete fracture
    • a fracture that involves only one cortex of bone
    • commone in kids
  3. greenstick fracture
    • incomplete fracture of the long bones of extremities
    • seen only in kids
    • bone bows out so you know theres a fracture but you can't see it
  4. torus fracture
    • incomplete fracture of the long bones of extremitiesseen only in kids
    • bulge (looks like a roman pillar) it's typticaly only in one spot
    • because of that you have to look at all views
    • primary location is distal radius
  5. closed fracture
    • "simple"
    • factures is covered by intact skin
  6. emulsion fracture
    muscle rips off the bone
  7. open fracture
    • "compound"
    • is not covered by intact skin
    • there is communication between the fracture and the outside enviornment
    • it is suscepticble to infection (toes and fingers)
  8. comminute fracture
    fracture that has more than 2 fracture fragments
  9. transvers fracture
    • in long bones
    • suggestive of pathology
  10. oblique fractre
    common in long bones
  11. vertical fracture
    more common in small bones
  12. spiral
    • suggests a rotatiional mechanism of injury
    • if see clean fratures in multiple views
  13. displacement of fracutre fragments
    avulsed, impacted and distracted
  14. aculsed fracture
    • a ligamentous of tendinous insertion site
    • the frament is pulled away fromt he parent bone
  15. impacted
    • forces produce a compression of bone
    • impaction of trabeculae on each other
    • look for a white zone of condensation
  16. distracted
    fracture framents areheld apart by interposed soft tissues or muscle pull
  17. apposition
    how are the 2 fracture ends doing? do the need to be pinned or are they alligned?

    typically let kids be even if bad apposition bc the bones will still grow back together
  18. stress fracture
    • fatigue fracture
    • insufficiency fracture

    they creep up on you ie. from running
  19. fatigue fracture
    • a fracture produced by abnormal stress of NORMAL bone
    • athletes
  20. insufficiency fracture
    a fracture produced by normal stress on ABNORMAL bone ie. osteoporosis
  21. burst fracture
    comminuted fracure of a vertebral body produced by an axial load on a neutral spine

    fracture fragments displace anteriorly and posteriorly


    associated with injury to the spinal cord
  22. T1 vs T2 mri
    • T1- fat bright
    • T2 - H2O bright

    for fractures get a ster image b/c fracture will light up
  23. stability vs instability
    • assessed with spinal injuries
    • potential for injury to the spinal cord
    • many different differing opinions
    • if unstable you'll probably need to refer out
  24. three columns of the spine
    • anterior: ALL and ant 2/3 of vert body and disc
    • middle: PLL and post 1/3 body and disc
    • posterior: post arch and ligaments (pedicle, TPs, laminae, articular facets, SPs)
  25. rule with 3 columns and stability
    injuries involving one column are likely to be stable

    injuries involving 2 or 3 are likely to be unstable and will likely result in neurologic injury
  26. flexed neck with flexion injury causes
    • dens
    • SP
    • bilat facet dislocation
  27. flexed neck with compression injury causes
    wedge teardrop
  28. neutral neck with compression injury causes
    • jefferson's
    • burst
  29. extended neck with compression injury causes
    • SP
    • hyperextention fracture/dislocation
  30. extended neck with extension injury causes
  31. extended neck with distraction injury causes
  32. rotacted neck with flexion injury causes
    unilat facet dislocation
  33. roated neck with commpression injury causes
  34. rotated neck with extension injury causes
    • facet
    • lamina
  35. laterally flexed neck with comprassion injury causes
    • lat wedge body fracture
    • facet
  36. lat flexed neck with lat flexion injury causes
    • lat wedge body fracture
    • facet
  37. checklist for spinal instability
    • ant elements destroyed - 2 pts
    • post elements destroyed - 2 pts
    • a/p translation > 3.5 mm- 2 pts
    • flex/ext >11 degreees between levels - 2 pts
    • cord damage - 2 pts
    • root damage - 1 pt
    • abnormal disc narrowing - 1 pt
    • dangerous loading anticipated - 1 pt
  38. rules with checklist for stability
    5+ pts = unstable

    flex and ext views are used for a lot of them

    designed by white

    the big ones are the A/P translation and flex/ext >11 degrees
  39. a/p translation > 3.5 mm
    • use georges line
    • if > 3.5 dr. major considers in unstable no matter what
    • adding up flex and ext views need to be <3.5
  40. retropharyngeal soft tissure
    6@2 - check at c2 shouldnt exceed 6mm
  41. retrotraheal interspace
    • 22@6
    • at C6 shouldn't exceed 22 in adult
    • and 14 in kids
  42. precervical fat stripe
    • parallels the ant longitudinal lig to C6
    • can be displaced by edema and hemorrhage
  43. loss of lordosis in cervical spine
    • secondary to muscle spasm
    • hard b/c don't know what pat looked like before
  44. acute kyphotic angulation
    indicates ligametous disruption (nucal and interspinal lig)

    will be seen with facet subluxations and disloc
  45. torticollis
    • muscle spasm
    • antlant-axial rotary fixations
    • nilateral facet dislocation
  46. widened interspinous space
    at each level the interspinous distance should not exceed 1.5 times the levels aboce and below

    measure from base of the SP not tip
  47. rotation of vert bodies
    will see double contour of the post vert bodies
  48. increased atlanto-dental interspace
    • upper limits of normal
    • 3mm for adults
    • 5mm for kids

    if increased= may gape with flex/ext injuries
  49. anterior atlanto-axial subluxations
    less common than dens fractures due to strength of transverse lig

    produced by head injury

    differentially diagnose from v-shaped ADI wich is noral variant

    evaluate spinolaminar junction line ( lower limit of normal for central canal at C1 is 16)
  50. central canal diameter
    Targs = 80% of vert body diameter

    • A-P dameter
    • C-16
    • C2-14
    • C3-13
    • C4-12
  51. atlanto-axial roatary fixatoin
    unknown etiolgoy- may be due to laxity of capsular structures, alar and transverse lig

    may occur following upper respiratory tract infection or trauma

    patient presents with torticollis (unlike normal tort the mm spasm is onthe long SCM side)

    rot views with opten mouth and CT scans

    treatemtn: traction or maybe surgery

    R lat mass larger means L rot
  52. Post arch fracture of C1
    • MC fracture of C1 but still not common
    • MOI is axial compression and hyperextenssion
    • Fracture occus through sulsuc for vertebral artery
    • opten associated with SP fracture in the lower cervical spine
  53. jefferson fracture
    • burst fracture of C1
    • MOI is axial compression
    • Best visualized on the APOM view-appears as offset of the lateral masses of C1-C2
    • over 8 mm of offset indicated tearing of the transverse lig
    • *if C1 lat mass more lat then C2
    • don't confuse with "pseudo-jefferson's fract" in kids
    • arounf 4 yrs old atlas grows faster than axis -prod offset of lat masses on the APOM view
    • axis catches up around 10
  54. Lat mass fracture
    • rare
    • MOI lat compression
  55. odontoid fracture
    • MOI: ant frct/disloc = hyperflex
    • post fract/disloc = hyperext
    • lat displacement = lat flex\

    • S&S may be mild
    • oblique views may help
    • diff diag: physiologic post tilt of dens, mach bands, ossiculum terminaale (type 1), os odontoideum (type 2), normal synchondrosis in kids
  56. classification for dens fractures
    • Type 1= fract of the apex of dens, rare, stable, oblique
    • Type 2= fract throughthebase of dens, MC, unstable
    • Type 3= fract extends into body (cancellous bone) of C2, unstable

    get MRI w/ all of them
  57. os odontoideum
    • considered by many to represent an old, ununited frature of the odontoid process
    • must be assessed for stability
    • if see not from an acute fracture
    • could be congenital?
  58. hangman's frature
    • bilat fract through lat pars interarticularis
    • *traumatic spondyolisthesis of C1 & C2
    • MOI is hyperextension
    • often seen as a result of car accident when head hits windshield
    • can be through pedicles as well
    • can even go through body of C1 and C2
  59. SP fracture
    • Rare at C2
    • ununited SP apphysis may mimic a fracture
    • if secondary growth ceneter it would be inline with main pies of bone
    • if old fracture- displaced from line of main piece of bone
  60. vertebral body fracture
    • MOI = hyper flexion
    • appear as fracture of ant vert body margin
    • often confused with normal cariants or DDD
    • post cert body height has t be pretty unchacned for compression fracture
    • if it is decreased means burst fracture
  61. fracture fake outs
    • intercalary bone
    • developmental platyspondylyl
    • normal cert body apophysis
  62. burst
    • comminuted fracture of the vert body
    • MOI axial compression on neutral spine
    • risk of neuro deficit from post projected framents
    • post and and aspect body involved
    • unstable b'/c damage to 2 columns
  63. what color is bone on a CT
  64. compression fracture
    only ant vert body affected and smooshed
  65. post arch fractures
    • MC loc for fractures in cervical spine
    • account for 50%of cerv spine fract
  66. art pillar fractures
    • most at C5-C6
    • hyperextension
    • focal pain over an art pillar

    CT would allow for definitive and get CT if pat arent responding to conservative care or who show neuro deficit
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skel rad 3
boucher xrays chiro
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