skel rad 3

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skel rad 3
2011-10-23 11:04:45
factures trauma xrays

boucher xrays chiro
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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
  67. SP fractures
    MC in lower cerv spine (clay shocelers fracture)

    maybe due to acute hyperfelxion trouma or from repeated pull fo te upper trapezius and rhomboid mm

    must see C7 on LCN

    * produces a double spinous sign of AP view

    fract frag will be displaced inf b/c pull of trapezius
  68. TP fractures
    • uncommon as an isolated injury
    • secondary to lat flexion injury or to direct blow
    • DDX from ununited secondary growht center at C7 or T1
  69. hyperextension sprain
    • part of continuum
    • disruption of ALL lig or ant disc
    • maybe assoc with transient subluxation or disloc
    • duckling of ligamentum flavum may produce a pinchers-like effect on the spinal cored
  70. hyperextenion teardrop fracture
    fracture of the ant body margin secondary ot a hyperext force

    georges post body lin eis intact and the fracture frag is displaced ant and inf
  71. how can you tell hyperext from hyperflex injury w/ vert body fracture?
    b/c HE- teardrop pieace is not compressed at all just broken off (stable)

    HF- ant body is smooshed ( unstable)
  72. hyperflexion sprain
    • part of conintuum
    • secere sprain will result in disruption of the post lig (supraspinatus and interspinous), joint caps and PLL
    • x-rays may show sig flexion at one level, angular kyphosis and widening of iterspinous dist
  73. bilat facet disloc
    • mechanism of injury is hyperfleion on neutral spine
    • facets at one leel ride up and over facets the the level below

    • facets may be completely ant to or just perched on top of inf facets (locked)
    • required immediate surgical referral for reloc and fusion
  74. unilat facet disloc
    • MOI hyperflex on a rotated spine
    • pat may present with toticollis
    • MC than bilat
    • vert body will rot a lot
    • decrease in laminar space
  75. radigraphic finigs of URFD **
    "bow-tie"dignof LCN of offset pillars

    flex and anterolisthesis at level of diloc

    abrupt chang ein size of lamina at level of disloc

    oblique and lat image on same view

    AP viw-abrupt deviation of SPs

    easier to do with infection/cold bc more swelling
  76. thoracic compression fracture
    • MC of all thoracic fractures
    • may be seen in osteroporotic pat secondary to trivial trouma or health pat w/ severe trauma

    MC seen in lower thoracic and upper lumnar
  77. xray signs of compression fract
    • ant vert body wedging
    • -loss of ant body height secondary to compressive forces b/c of flexion
    • -ant wedging seen witha cute and chronic fract
    • -must DDX from physiologic ant vert body wedging
  78. how do you tell acute vs chronic with thoracic compression fract?
    buckling- step sign- break in cortex with ant displacement of up endplace -ACUTE

    zone of condensation - white line paralleling the sup endplace - due to overlapping trabeculae- ACUTE

    paraspinal mass- alteration of paraspinal line due to hematoma- ACUTE
  79. vertebroplasty
    injection of bone cement into vert body for treatment of acute compression fracture

    for severe osteoporotic

    still have disc but decrease of shock absorbance
  80. kyphoplasty
    exansion of vert body with baloon to reduce kyphotic angulation

    followed by injection of bone cement
  81. rib fractures
    • can occur as acute or stress fracture
    • very difficult to see on xray
    • complicatiiiiions include hemothorax, atelectasis and pneumothorax
  82. sternal fractures
    can occur from direct blow or hyperfexion injury

    often seen with car accidents b/c steering wheel

    har to see on xray-CT is needed to asses sterno-clav relationship
  83. seatbelt fracture
    fulcum of flexion is ant abdominal wall

    fract is paralle right through the vert body horizontally

    some are assoc withinjuries to the abdomincal organs

    high incidence of assoc neuro injury

    very subtle and very seriosu

    AKA chance fracture
  84. vertical compression injuries
    produce burst fract

    MC T12-L2

    considered unstable injuries

    advance imaging is needed to assess the spinal canal
  85. limbus bones
    vert body edge separations

    produced by herniations of neucles pulposis b/w ring of apophysis and vert body

    post limbus bones may be assoc with low back and or leg pain
  86. schmorl's nodes
    herniation of nucleus pulposis into vet body

    due to: normal stresses on weakeed endplate, repeated stresses on normal endplate or single acute trauma
  87. giant ant schmorl's nodes
    large schmorl's node, probably produced by one traumatic episode

    vert body will be increased in int's anterior to post dimension, compared to adjacent vert
  88. post arch fracures (lumbar spine)
    • art pillar fractures
    • transverse process fract
    • SP fract
    • pars fract
  89. articular pillar fractures (lumbar)
    • MOI twisting
    • must DDX b/w oppenheimers ossicles - ununited secondary growth centers of inf AP - may produce focal pain
  90. TP fractures (lumbar)
    • may be due to direct blow or aculsive injury
    • MC L3
    • assoc w/ hematomar inabdominal mm and kidney or uteteral injuries - hows your urine? blood?

    must DDX from lumbar type ribs @ L1
  91. SP fract (lumbar spine)
    • may be produced by flex, et or direct trauma
    • MC in lower cerv and upper thoracic spine
  92. pars fracture
    • most are stress related injuries
    • acute pars fractres are usually due to jumping injuries

    SPECT scan needed ( injects pat w/ dye then bascially a CT)

    acute fract may heal with bracing
  93. cause of type 3 spondylolisthesis
  94. fractures of pelvis ring
    single break or double break
  95. single break of pelvis
    aculsion fract

    fract of iliac ceast (duverney fract), sacrum, coccyx, and ischial rami

    STABLE with few complications
  96. avulsion fract of pelvis
    ischium, AIIS, ASIS, iliac crest, pubic symphysis, lesser trochanter

    • AKA rider's bone= ishical avulsion
    • from overpull of hamstring or adductor magnus mm
    • seen w/ running, jumping, ft ball
    • may be assoc w/ injury of sciatic nerve
  97. AIIS AND ASIS aculsion fractures
    ant inf iliac spine- overpull of rectus femoris muscle (sunning, socer and hockey)

    ASIS- overpull sartorius muscle or hyperextension of trunk (runners and football)
  98. iliac crest avulsion
    normal ossification occurs lat to medial

    gluteus minimus, oblique abdominus, TFL, lat dorsi and glut max attach

    avulasions are seen w/ runner and football
  99. pubic smphysis avulsion fract
    abrupt contraction of adductor longus
  100. lesser trochanter aculsion
    produced by overpull of iliopsoas muscle

    clinicall, pat in unabl to flex hip or climb stairs

    commonly seen in runners, footballa nd basketball
  101. duverney facture
    • single break of iliac crest
    • stable injuries
  102. sacral fractures
    difficult to detext on x-ray due to superimposed soft tiss and gass,

    look for alteration of arcuate lines on the sacrum

    can be vertical or horizontal
  103. double break fractures
    • incudeins the following: **
    • 0 malgaigne, bucket handle, sprung pelvis, diastasis pubis

  104. malgaigne fracture
    • fract through two sites in the obturator ring and homolat SI jt
    • MC pelvis ring fractre
    • diastasis (widening of SI joint) and fracture on SAME
  105. bucket handle fracture
    • fracture through two sites in theobturator ring and the onctrlat SI joint
    • DIASTASIS AND FRACTURE ON opposite sides
  106. sprung pelvis
    • dislocation of both SI jts and pubic synphysis
    • mechanism of injury is violent trauma
  107. straddle fracture
    • bilateral double vertical fracture through four sites of obturator rins
    • assoc with injuries to the baldded lower urethra
  108. hip fractures
    • intracapsular fracture have a greater incidence of post-traumatic complications
    • MC omplication is avascular necrosis-resultiing from injury to femoral cirumflex aa

    the mroe vertical the fracture line in femoral neck fract the great the likelihood of non-undior
  109. stress fractures
    most occur in femoral neck and pubic rami

    femal long dist runners are most prone to this injury

    patients complain of groin or hip pain aggravated by walking
  110. post hip dislocations
    much mc than ant hip dislocations

    MOI is compressive force applid to flexed knee

    femoral head diplaces sup and lat

    advanced imaging shoud be considered to eval assoc injuries
  111. ant hip disloc
    • MOI is forced abd and ext rot
    • femoral head diplaces inf and medial
    • advanced imaging should be considered to eval for associated injuries
  112. femoral fracture
    acute fracture of the proximal femur are rare in ahlete sand usually follow significant trauma

    femoral shaft fracture occur MC in the middle third and displacement is common

    major complication of femur fractures is fat embolism
  113. skipped femoral capital epiphysis
    SFCE-MC seen in males 10-15yo

    MC in blacks

    occur bilat 1/4 of time

    1/2 have histo of trauma

    classic presentation is obese male with hip, groin or knee px and a limp

    xray findings: alterend klein's line , widened physis on slipped side, decreased height of epiphysis on slipped side
  114. DDX of painful limp on kid
    slipped femoral capital epiphysis, legg-cave-perthes disease, developmental dyplasia of the ip, tumore, infection, juvenile chronic artheritis
  115. avulsion fract of the patella
    • secondary to froceful hyperext or hyperflex
    • usually assoc w/ injury to the quads or patellar tendons
  116. acute fract of patella
    • body frat are not commone
    • occur socondary to forceful hyperext or hyper fles
    • fract frag separate due to muscle pull
  117. sliding larson johansson disease
    • stress related to the patella occuring in adolescents
    • frag of lower pole of the patella
    • resembles avulsion or tendon rupture
  118. osgood-schlatter's disease
    • painfull fragmentaion of the tibial tubercles apophysis
    • tibial tuercle apaophysis norlaly fuses by 13 yo
    • comparison xray of opposite knee is necessary
    • pain, redness, and swelling over the tibial tuberosity
  119. osteochondritis dissecans
    common condition seen in adoescenets and young adults

    MC in males

    throught to be due chronic injury

    fragment is avascular

    MC loc is lat aspect of themedia femoral condyle
  120. osteochondral fracture
    foten used interchangeable with the dissicans

    MOI is sheearing, rotatory force

    hiroty of specific injury, pain, tenderness and effusion
  121. segond fracture
    aculsion fractur eof lat aspect of prox tibia at the TFL / casular insertion site

    MOI is internal rot with varus stree

    commonly assoc with meniscal and ant cruciate lig tears
  122. anterior curciate ligament tear
    • ACL
    • MOI is sudden pivoting motion
    • pat may hear a "pop" or feel their knee five out
    • immediate sumptoms include swelling and px when walking
  123. lat femoral notch
    correlation b/w a deep lat femoral notch and tears of the ACL

    depth greater than 1.5 mm is rliable indirect xray sign of torn ACL
  124. ACL reconstruction
    • patellar tendon- (+)=bone to bone healing
    • (-) patellar tendon and patell are compromised, ant knee pain

    • hamstring tendone: (+) less pain, smaller incision
    • (-) takes longer for graft to become rigid
  125. PCL tear
    broader and stronger than ACl

    injuries often go unrecognzed

    • MOI force on ant tibia when knee is flexed or hyperext and rot
    • injuries occur with forced HE with foot in forsiflexion
  126. syptoms of chronic PCL
    • px with ascending or descending strirs
    • px on starting a run
    • px with lifting
    • px when walkign longer dist
    • sensation of instability on uneven ground
    • medial jt line px
  127. pelligirini-stieda
    post-traumatic ossification of the medial collat lig
  128. tibial plateau fract
    • AKA bumper fract
    • MC occurs at thelat plateau secondary to valgus injuries
    • assoc w/ injuries to ACL and MCL and lat meniscus
    • also assoc w/ peroneal nerve palsy
    • soft tiss injuries are seen w/ MRI
  129. fbi sign
    • fat/blood interface
    • sows as a straight line on the corss table lat view of theknee
    • fat in the jt is pathognomonic for an intra-art fract (marrow fat leaks into the jt)

    blodd sinks to bottom, fat floats on top
  130. ankle sprain
    • many grading sys to describe MOI and severtiy
    • stress x-rays are most helpful to eval the degree of injury
    • comparison stress views ofo opposite angle are necessare to rule out noral lig laxity
  131. ankle disloc
    • mc ankle disloc is tibiotalar
    • subtalar disloc are not as common and indicate disruption of talonavicular and talocalcaneal lig
    • sutalar disloc are most oten medial diloc
    • sustentaculum tale acts as a lever
  132. osteonecrosis
    • MC at 2nd metatrarsal head (freibergs disease)
    • occurs MC w/ women

    xrays show flattening of irreg of metatrarsal head
  133. fibular fract
    • MOI - direct trauma, internal rot, exter rot
    • frat that are at the jt line tent to be UNSTABLE
    • maissoneuve fracture-prox fibular fract secondary to an eversion sprain of the ankle
  134. boot top fracture
    • aka skiers fract
    • fracture of tibial and ficular diaphyses
  135. maissoneuve fract
    • fract of the prox fibula secondary to ankle sprain or fract
    • easily missed if the entire fib is not palpated following an ankel sprain
  136. osteochndral fract of the talar dome
    • occurs from shearing, rotary or impaction forces
    • mary involve cart only or cart and underyling bone
  137. calcaneal fract
    • MOI is acute compressive trauma
    • will produce an alteration in BOEHLER's angle on a lat ankle film ( should be >28 degrees)
    • often assoc w/ compression fract int he thoracolumbar jxn
  138. chopart's fract/distloc
    • fract/ disloc through the talonavicular and calcaneocuboid art
    • uncommon injury
  139. lisfran fract/disloc
    • frat/diloc through the tarsometatarsal jt
    • MOI forced plantarflex
    • rupture of oblique lig running from 1st cuneiform to base of 2nd metatarsal
    • may injure dorasolis pedis artery
  140. jones fract
    • aka dancer's fract
    • fract tthroughteh prox diaphysis or metaphsis of 5th metatarsal
    • these are prone to non-union due to mm pull
    • they often require internal fixation
  141. avulsion of 5thmetatarsal base
    • MOI is brupt pull of peronues brevis muscle
    • these fract run perpendicularrr to metatarsal shaft
    • the normal apophysis at the bas of the fifth metatarrsal runs parallel to the shaft
  142. sesamoiditis
    • assoc with running and bicycling
    • injuries include inflammation, fracture and osteonecrosis

    treatment:: range from rest and longitunidal arch suppport to sesamoidectomy