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220 Cards in this Set
- Front
- Back
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Fracture of medial malleolus. Mechanism of injury?
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eversion injury.
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Mechanism of Maisonneuve fracture?
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external rotation
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Weber A mechanism
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inversion, usually results in sprain
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Weber B mechanism
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eversion injury
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Weber C mechanism
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eversion + external rotation
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What ligament ruptured in anterior process of calcaneous injury?
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Bifurcate ligament
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Tibial plateau fractures more common medially or laterally?
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Laterally
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What is the purpose of MRI with osteochondritis dessicans
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Staging
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What is the common location of OCD?
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Lateral aspect of medial femoral condyle
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Extension teardrop fracture. Stable or unstable?
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Stable
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Flexion teardrop fracture, stable or unstable?
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Unstable
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Ratio of patellar/tendon in patella alta
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0.8
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Deepened lateral femoral notch sign
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ACL tear
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Which condyle is larger?
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Medial
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What is O'Donohue's unhappy triad?
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ACL, MCL, medial meniscus
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Cyclops lesion
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Progressive loss of extension after ACL reconstruction
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PCL tear, must check for what
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Arteriovascular injury
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What bony structure is avulsed in PCL tear
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Posterior tibial plateau
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What is pseudohypoparathyroidism?
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Body lacks response to PTH (type II diabetes of hypoPTH)
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What is the differential of bilateral acetabular protrusio?
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POOR - Paget's, osteomalacia, osteoarhtritis, rheumatoid, ankylosking spondylitis
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What is the checklist for describing lytic lesions?
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Margins
Mineralization Soft tissue mass Cortical breakthrough Expansile |
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Mnemonic for generalized osteosclerosis?
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MARBLES - Mastocytosis, Anemia, Renal osteodystrophy, Blastic, Lymphoma, Enigmas (Metal), Sickle cell
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What are the types of periosteal reaction?
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Thick
Hair on end Triangular appearance (Codman) |
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Codman triangle, periosteal reaction
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Osteosarcoma, Ewing, lymphoma
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Lytic lesion > 50
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Mets, myeloma, lymphoma, MFH
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Lytic osteosarcoma type
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Fibroblastic osteosarcoma
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Permeative and lytic
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Ewings
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Types of lytic appearance
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1A - Sclerotic border - NOF
1B - Well defined, not scerlotic - GCT 1C - wide zone of transition- Ewings |
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Lytic lesion in child
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Ewings, osteomyelitis, osteosarc
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Lytic and expansilve
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ABC, GCT (20-40), lytic osteosarcoma
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Thick periosteal reaction
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Stress frature, osteoid osteoma, chronic infection
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Malignant transformation of Paget's percentage
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1%
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Sarcomas
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Osteosarcoma, MFH, Chrondrosarc
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Bizarre tibia
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Adamantimoma
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ST mass and permative leaion
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Blue cell primary lymphoma
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Phleboliths in hand
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Malfucci syndrome
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Enchondromas at growth plates
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Ollier's
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Ollier's symptoms
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1. Worse to have
2. GBM 3. Pancreatic CA 4. Angiosarcoma 5. Chondrosarcoma from enchondromas |
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Arcs and whorls
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Enchondroma
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Endosteal scalloping, cortical breakthrough, soft tissue mass
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Enchondroma
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Malignant transformation with Malfucci?
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High
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Where does giant cell tumor start?
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Metaphysis
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Comrpession fracture in young child
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EG, osteomyelitis, mets (MEO)
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Expansile lytic in old
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Mets, plasmacytoma/myeloma, GCT
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Expansile lytic in child
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ABC, GCT, chondroblastoma, lytic osteosarc (COAG)
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Sheperd's crook
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fibrous dysplasia of hip
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Polyostotic tumors
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polyostotic fibrous dysplasia, Brown tumors, EG, leukemia, infection (PLEIB)
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Vertebra plana
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EG, Langerhans
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Beveled edges in skull
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EG
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Hole in hole appearance, diaphyseal
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EG or fibrous dysplasia
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Cortically based lytic lesion
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NOF
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Metaphyseal based lytic lesion
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Chondroblastoma, GCT
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Permeative lesion, young pt, nonaggressive periosteal reaction
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EG, subacute osteo
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Lytic lesion with thick perosteal reaction, young pt
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Osteo, EG (hadr to differentiate EG from osteo)
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What causes H-shaped vertebral bodies
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Small vessel occlusion
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Ivory vertebral body, diffuse sclerosis
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Sickel cell, renal osteodystrophy
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Sepiginous on MR
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Infarcts in sickle cell
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Focal sclerotic lesions, hair on end aggressive
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Blastic mets - prostate, breast, lung, GI, carcinoid, embryonal cell CA
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Central location
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UBC
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Common location of UBC
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Prox humerous, prox femur, distal tibia
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Distal acrolysis
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Scleroderma
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What are the 3 patterns of psoriatic arthropathy?
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1. Ray like/single digit
2. Multiple/distal 3. Rheumatoid like |
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Pencil in cup deformities
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Psoriatic arthritis
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Hook-like osteophytes at MCP with subchondral scerlosis and no erosis
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Chondrocalcinosis
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PVNS - uniarticular or polyarticular
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always uniarticular
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Wide SI joints
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Primary hypoparathyroidism
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Klippel Feil
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only upper levels
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Where does subscap m attach?
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Lesser tuberosity
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Idiopathic soft tumor calcification, what population?
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Female, black, young
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Erosions in a young patient
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Hemophilia, Septic joint, Juvenile arthritis
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Flowing myofascial Ca in sheetlike configuration
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Connective tissue disorder, dermatomyositis, polymyositis
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5 D's of neuropathic joint
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Destruction, disorganization, debris, increaed density, dislocation
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When see destruction, look for...
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aggressive periosteal reaction
Septic arthritis vs. osteomyelitis |
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Types of Lisfranc joint injury
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Traumatic - dorsiflex injury, base of 1st with mdial cuneiform
Neuropathic Divergent-Split metatarsals Homolateral-all going same way |
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Mixed sclerotic and lucent lesions in kid
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Chronic osteo
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Bony ankylosis
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Juvenile chronic arthritis
Klippel Fiel absetn clavicles -> cleidocranial dys |
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Lunate + triquetral fusion
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Postinfectious osteomyelitis with fusion
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Expansile lesion prox fibula, no fluid
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GCT
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Hypolastic coccyx/sacrum
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Caudal regression syndrome
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What is abnormal kyphosis > 40 degrees?
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Scheurmann's kyphosis
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Which levels are affected by Clay Shoveler's fracture?
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C6-C7
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Which femur fractures are extraarticular?
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Intertrochanteric
Subtrochanteric |
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What are the subtypes of a femoral neck fracture?
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Transcervical
Basicervical |
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Which femur fractures are intraarticular?
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Capital
Subcapital Transcervical Basicervical |
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What are the subtypes of a capital fracture?
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Suprafoveal
Infrafoveal |
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Of the acetabular column and acetabular wall, which is lateral and which is medial?
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Column = medial
Wall = lateral |
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Where does the popliteus tendon insert?
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Popliteral hiatus
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What type of screw has distal threads?
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Cancellous screws
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What type of screw has threads throughout?
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Cortical screws
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Unilateral SI joint erosion
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Reiter's
Psoriasis |
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Bilateral SI joint erosions
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Reiter's
Psoriasis Ankylosing Spondylitis IBD |
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Lateral mass scrfews versus transpedicular screws - inwards or outwards?
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Transpedicular screws = inwards
Lateral mass screws = outwards |
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How long does it take to fix an ankle fracture?
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2 months
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What is it called when the anterosuperior labrum is missing and the MGH ligament is thickened?
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Buford complex
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What to suspect when the infraspinatus is small and there is fat infiltration?
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Subscapular nerve entrapment
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What to suspect when there is teres minor and/or deltoid fat infiltration?
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Quadrilateral space syndrome
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What nerve goes through the quadrangular space?
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Axillary nerve
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What artery goes through the quadrangular space?
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posterior humeral circumflex artery (PHCA)
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Muscle edema on MRI without trauma is suspicious for?
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Parsonage-Turner syndrome - idiopathic brachial neuritis
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What levels does Sheurman's disease involve?
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T7-T10
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Which is higher, the anatomic neck or the surgical neck?
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anatomic neck - higher
surgical neck - lower |
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Positive ulnar variance predisposes to what syndrome?
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Ulnar impaction syndrome
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Negative ulnar variance predisposes to what?
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AVN of the lunate
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What is a round lucency in the anterosuperior aspect of the neck of femur?
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Pitt's pit
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Where does Harry insert?
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Base of 1st metatarsal
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What is associated with a central anterior VB projection?
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Morquito
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What is associated with an inferior anterior VB projection?
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Hunter
Hurler |
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What T1/T2 signals are seen with Modic type 2 changes? What do they represent?
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T1+,T2+
Fatty infiltration Infection |
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If the disc is bright with Modic type 2 changes, then what does that represent?
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Infection
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If the disc is dark with Modic type 2 changes, what does that represent?
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Fatty infiltration
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What T1/T2 changes are seen with Modic type 1 changes, and what does that represent?
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T1-/T2+
Edema Inflammation |
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What T1/T2 changes are seen with Modic type 3 changes, and what does that represent?
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T1-/T2-
Sclerosis |
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Which side are tibial plateau fractures more common?
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laterally
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What is the classificaiton system of tibial plateau fractures?
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Schatzker
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What is the most common type of Schatzker tibial plateau fracture?
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Type II - split and depression of the lateral tibial plateau
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Which Weber fracture is most unstable?
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C
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What is the chance that the ACL is torn in a Segond fracture?
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95%
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What is the 2nd most common carpal fracture?
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triquetral fracture
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Which is more common, perilunate or lunate?
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perilunate
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What always points anterior?
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coracoid
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Does craniosynostosis after the first year cause dolicocephaly?
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no
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What is seen on MRI with impingment syndrome?
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clinical diagnosis
can see coracoacromial arch narrowing |
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What is the mechanism of injury for O'Donoghue's unhappy triad?
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Lateral force on the knee
(Valgus stress) |
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What causes a cyclops lesion?
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Fibrous ball in the intercondylar notch
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What is the sign seen in talocalcaneal coalition?
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lateral C sign
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What ist he sign seen in calcaneonavicular coalition?
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anteater nose
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Rugger jersy like spine
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osteopetrosis
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What is the mechanism of posterolateral corner injury?
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Hyperextension with varus stress
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What other injury is posterolateral corner injury associated with?
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Knee dislocation
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Which side is the patellar retinaculum on?
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Medial side
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In which lesion do you use lidocaine to separate joint pain from bone pain?
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Enchondroma
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How long does periostitis last?
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7-14 days
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When does hard callous start to form?
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2 months
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Young child with compression fracture?
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EG, infection/osteo, mets
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What are the types of ABC?
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Primary and secondary
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Which age patients get ABCs?
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young pts
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What must ABC be differentiated from?
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osteosarcoma
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What is the treatment for ABC?
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Tissue diagnosis, curretage, and pack
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Do most chondrosarcs have matrix?
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yes
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How aggressive are ABC's? Do they metastasize?
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locally aggressive as sarcoma, but do not metastasize
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Polyostotic tumors
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polyostotic fibrous dyspasia
Brown tumors EG leukemia infection |
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Muscle inserting into ASIS?
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Sartorius
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Muscle inserting into AIIS?
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Rectus femoris
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Inserting into ischial tuberosity?
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Hamstring
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Which pelvic avusion fracture may need surgery?
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ischeal tuberosity
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Which orientation is a fracture in the 5th metatarsal?
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transverse
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Multiple bone islands
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Osteopoikilosis
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Lytic lesion with thick sclerotic rim in the proximal femur?
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Fibrous dysplasia
Liposclerosing myxofibrous tumor |
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Where are most liposclerosing myxofibrous tumors found?
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80% in proximal femur
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What is the early sign of ankylosing spondylitis in the spine?
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Shiny corner sign (Romanus lesion) seen in the anterior superior lumbar vetebra.
Increased T1 signal |
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What are the stages of Paget's disease?
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lytic
mixed sclerotic |
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What is seen in the head during the lytic phase of Paget's?
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osteoporosis circumscripta - large areas of radiolucency
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What age group and gender gets synovial chondromatosis more?
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Adult men
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What are the two types of synovial chondromatosis?
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primary - idiopathic
secondary - from degenerative disease |
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What is the disease when 2nd and 3rd phalanges have subperiosteal resporbtion?
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Brown tumor
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How often can the correct diagnosis of a soft tissue tumor be made on MR?
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1/3 of the time
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When is gad used in MR soft tissues?
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postop only
not used routinely |
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What is the management of myxoid liposarcoma?
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biopsy
don't think cyst unless can prove its a cyst |
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What is the most frequent soft tissue neoplasm in kids?
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intravascular venous malformation (i.e. hemangioma)
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What two soft tissue tumors image the same?
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MFH and fibrosarcoma
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What are two types of fibromatosis?
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superficial and deep
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Does fibromatosis metastasize?
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locally agressive but does not metastasize
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What are common locations for liposarcoma?
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Retroperitoneal and extremities
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What is the localized form of PVNS?
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Giant cell tumor of tendon sheath
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What joint pathology are low on T2?
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PVNS/GCTTS
amyloid fibromatosis hemophilia/chronic hemorrhage |
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What are the three muscular spaces?
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intermuscular
intramuscular subcutaneous |
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What disease has the split fat sign?
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schwannoma/neurofibroma
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What disease has the target sign?
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peripehral nerve sheath tumor
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What disease is associated with malignant peripheral nerve sheath tumors?
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NF1 - 25 - 70%
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What is the age range of synovial cell sarcoma?
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young adults and teenagers 15-40
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What is the T1 signal for synovial cell sarcoma?
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isointense to muscle
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How often is synovial cell sarcoma actually intraarticular?
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< 10%
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Where does synovial cell sarcoma get its name?
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Looks like synovium
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What can myxoid liposarcoma look like?
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myxoid MFH
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What are the most common soft tissue sarcomas?
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MFH/fibrosarcoma
pleomorphic sarcoma leiomyosarcoma |
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Is spontaneous hemorrhage into muscle common?
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No
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How to prove if a lesion is solid or cystic?
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ultrasound
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What is the enhancement of a fibromatosis?
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Enhances intensely
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What is the treatment for PVNS?
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debulk but always grows back
synovectomy and put in beta emitter |
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Does PVNS calcify?
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No
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Extraarticular differential for PVNS?
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giant cell tumor of tendon sheath
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Focal intraarticular differential for PVNS?
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Nodular synovitis
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What is the age group for synovial chondromatosis?
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young patient
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What does a split fat sign tell you?
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Between muscle, must be nerve
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What is the outside and what is on the inside of a target sign?
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myxoid outside
fibrous inside |
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What is the malignant transformation of NF1?
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MFPST
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What soft tissue mass has a serpentine appearance?
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Plexiform neurofibroma
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What is the most common to invade bone, most common to calcify, go to lymph nodes and lung?
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Synovial cell sarcoma
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When do you see transietn osteoporosis of the hip?
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Third trimester
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Nonaggressive periosteal reaction in diaphysis with cortical thickening
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chronic osteo
stress fracture osteoid osteoma |
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smooth periosteal reaction, nonagressive
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stress fx
osteomyelitis osteoid osteoma |
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agressive periosteal reaction, young
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osteomyeltiis
Ewings osteosarc, less likely lymphoma |
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large soft tissue mass
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Ewings
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circumferential soft tissue around permeative lesion classically is...
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classic lymphoma
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pheochromocytoma can be a ___ mets
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lytic
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central lytic lesion, with mixed sclerotic, bizarre
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adamantimoma
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anterior tibia cortex, young children
|
osseous fibrous dysplasia
looks like adamantimoma, cortical chondrome? |
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cortically based lytic lesion in prox femur, cookie cutter met
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bronchogenic carcionoma
|
|
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resportion of radial aspects, cortical tunnelling
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hyperparathyroidism and Brown tumors
|
|
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number 1 cause of secondary hyperPTH?
|
chronic renal failure
|
|
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how to differentiate enchondroma from chondrosarcoma?
|
MRI to look for source of pain
inject lidocaine to see if pain goes away |
|
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mineralized matrix with endosteal scalloping
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osteosarc and osteo
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what is the workup of chondrosarcoma?
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biopsy
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what other condition could be causing pain between enchondroma and chondrosarc?
|
bursitis is causing friction
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Where is chondroblastoma centered?
|
epiphyses
|
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Where is giant cell tumor centered?
|
metaphyses
|
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A matrix excludes what tumor?
|
GCT
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|
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What if you see lytic lesion in vertebral body in kid? Differential?
|
Follow it
EG lyphoma cervical chordoma vs. rhabdo vertebral body Ewings |
|
|
Everytime you say ABC you must also say
|
lytic osteosarcoma
|
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Chondroarcoma does not occur in kids. What what instead?
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chondroblastoma
Ewings/OM/lytic osteosarc |
|
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Ulnar translocation without erosion
|
lupus
|
|
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Fluffy peristitis, distal arthropathy
|
psoriasis, Reiters
|
|
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3 types of psoriasis
|
distal
diffuse ray-like |
|
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What is a Looser's zone?
|
pseudofracure
|
|
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Where is giant cell tumor in spine?
|
vertebral body, central location
|
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Where is ABC in spine?
|
posterior elements
|
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lytic lesion, sacrum
|
mets, chordoma, giant cell tumor, plasmacytoma
|
|
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vasc ca, scl phalanges
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HPTH
|
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Pivot shift contusion pattern
|
get coronal to examine ACL
|
|
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Insufficiency fractures of acetabular head tend to be ___
|
horizontal
|
