Musculoskeletal Radiology

Front 1

Simple/closed fracture

Back 1

Fracture in which the skin surface is not penetrated.

Front 2

Compound/open fracture

Back 2

Fracture in which the skin surface is penetrated or broken and creates an open wound.

Front 3

Spiral/torsion fracture

Back 3

A fracture in which at least one part of the bone has been twisted.

Front 4

Oblique fracture

Back 4

A fracture in which the break has a curved or sloped pattern.

Front 5

Compression fracture

Back 5

A fracture in which the bone collapses on itself, seen in vertebral fractures.

Front 6

Avulsion fracture

Back 6

A fracture in which a fragment of bone is separated from the main bone mass.

Front 7

Transverse fracture

Back 7

A fracture at a right angle to the bone's axis.

Front 8

Greenstick fracture

Back 8

An incomplete fracture in which the bone is bent. This type occurs most often in children.

Front 9

Comminuted fracture

Back 9

A fracture in which the bone fragments are driven into each other.

Front 10

Linear/fissure fracture

Back 10

A fracture that is parallel to the bone's long axis.
Most common type of skull fracture and may not require any intervention.

Front 11

Displaced fracture

Back 11

A fracture in which there is a loss of alignment.
Defined by the abnormal position of the distal bone fracture in relation to the proximal bone.

Front 12

Angulation displacement

Back 12

Medial angulation - varus
Lateral angulation - valgus
Ventral, volar and/or dorsal should also be used.

Front 13

Rotation displacement

Back 13

Term usually used on long bones to describe internal or external rotation of the distal segment compared to the proximal.

Front 14

Overlapped displacement

Back 14

A fracture resulting in overlapping displacement of the two segments.

Front 15

Distracted fracture

Back 15

A fracture resulting in increased overall bone length, due to the distraction (widening) of the bone components.

Front 16

Depressed skull fracture

Back 16

Fractured pieces of bone pushed inward.

Front 17

Diastatic skull fracture

Back 17

Fracture in which the sutures are widened, usually occurs in children under 3 years old.

Front 18

Basilar skull fracture

Back 18

Fracture of the bone at the base of the skull.

Front 19

Battle's sign

Back 19

Panda bear or raccoon eyes appearance that often occurs with a basilar skull fracture.

Front 20

Multiple myeloma

Back 20

A plasma cell cancer that involves multiple organ systems. Bone pain is common due to destruction or osteolytic lesions.

Front 21

Orbital/blowout fracture

Back 21

Fracture of walls or floor of orbit, pushing contents into sinuses, trapping or damaging intraorbital.
Water's view (x-ray) or CT to diagnose.
Caused by blunt trauma (fist fight).

Front 22

What are the most common cervical spine fracture x-ray views?

Back 22

AP, lateral, odontoid

Front 23

What is required to obtain a good cervical spine x-ray?

Back 23

Adequate film
Alignment
Bony landmarks
Cartilaginous space
Disc space
Soft tissues

Front 24

What constitutes an adequate c-spine x-ray?

Back 24

All 7 cervical vertebrae must be visible, including C7 on a lateral view.
Must also have correct density and show soft tissue as well as bony structures.

Front 25

What are the lines of alignment on a lateral c-spine x-ray?

Back 25

Anterior vertebral line (r) -anterior vertebral bodies
Posterior vertebral line (br) -posterior vertebral bodies
Spinolaminar line (g) -posterior spinal canal
Posterior spinous line (bl) -tips of spinous processes
Misalignment indicates ligament injury or fracture; immobilize the patient.

Front 26

What are the lines of alignment on an AP c-spine x-ray?

Back 26

Should have a "bamboo appearance.
Height of vertebral bodies and joint spaces should be equal.
Spinous processes should be midline and aligned.
Misalignment indicates dislocation.

Front 27

C-spine bony landmarks

Back 27

Pedicles - L/R should superimpose on lateral
Facets - double cortical lines, distance should be equal at all levels
Lamina - posterior poorly seen on lateral
Spinous processes - increase in size
- Vertebral bodies should line up in arch
- Each body should be rectangular, equal in size
- Anterior height should equal posterior height

Front 28

What is the significance of cartilage on a c-spine x-ray?

Back 28

Predental space should not be greater than 3 mm in adults and 5 mm in children.

Causes of an increased space include fracture.
CT or MRI is recommended.

Front 29

What is the significance of disc space on a c-spine x-ray?

Back 29

Disk spaces should be:
- symmetric
- equal in height at anterior and posterior margins
- equal height at all levels
Degenerative disease in older patients may lead to spurring and loss of disc height.

Front 30

What constitutes an adequate odontoid view?

Back 30

Should be able to view the entire odontoid (dens) and lateral borders of C1-C2.

Should have uninterrupted cortical margins blending with body of C2 (bony margin).

Front 31

What should the proper odontoid alignment be?

Back 31

Occipital condyles should line up with the lateral masses and superior articular facet of C1.

Distance from dens to lateral masses of C1 should be equal bilaterally. If head is tilted, the vertebrae should be shifted out on the other side.

Tips of lateral mass of C1 should line up with the lateral margins of the superior articular facet of C2.

Front 32

What soft tissues can be seen on a c-spine x-ray?

Back 32

Nasopharyngeal space (C1) – 10 mm

Retropharyngeal space (C2-C4) – 6mm

Retrotracheal space (C5-C7) – 22 mm
--- 14 mm (children)

Front 33

Jefferson fracture

Back 33

A fracture of C1 (atlas) anterior and posterior.
Caused by axial compression with or without extension or force.

Posterior arch is more common and results from hyperextension, such as diving into a pool.

Front 34

Hangman's fracture

Back 34

A fracture of the C2 (axis) pars interarticularis as a result of hyperextension with or without axial loading, as in a motor vehicle accident (MVA).

Anterior movement (spondylolisthesis) of C2 results.

Front 35

Clavicle fracture

Back 35

Typically due to a fall on the arm or onto lateral shoulder.

Front 36

Acromioclavicular (AC) dislocation

Back 36

Typically due to direct downward blow to the tip of the shoulder (football, wrestling, hockey).

Front 37

Shoulder/humerus fracture

Back 37

Can occur at proximal end, midshaft or at distal epicondyle (medial/lateral).

Front 38

Shoulder dislocation

Back 38

Typically occurs anterior and inferior. Caused by external rotation abduction force on humerus, or posterior to posterior-lateral blow.

Front 39

Shoulder osteoarthritis

Back 39

Typically need three views - AP, axillary and lateral

Front 40

Radius fracture

Back 40

Typically due to fall with outstretched hand. Presents with pain and difficulty with supination/pronation.

Front 41

Colles' fracture

Back 41

Distal radius fracture with dorsal displacement of the hand/wrist caused by a fall on outstretched arm.

Front 42

Nursemaid's elbow

Back 42

Dislocation of the radial head.

Front 43

Ulnar fracture

Back 43

Mechanism is direct impact, as with a fall.

Front 44

Elbow dislocation

Back 44

Usually caused by fall on the outstretched arm, most commonly resulting in posterior displacement of the olecranon to the humerus. Arm is shortened and held flexed.

Front 45

Boxer's fracture

Back 45

Result of axial loading of the 4th and 5th metacarpal, as in hitting another person or hard object.

Front 46

Scaphoid fracture

Back 46

Can develop avascular necrosis if fracture occurs at the proximal pole.

Front 47

Pelvis fracture

Back 47

Result of direct trauma, can cause nerve blood vessel, bladder or bowel complications.

Front 48

Hip/femur fractures

Back 48

Most common in patients over 50 years of age.
Typically results from a fall.
Can involve femoral neck or trochanter.

Front 49

Femoral neck fracture

Back 49

The involved extremity is externally rotated and slightly shortened.

Front 50

Femur trochanteric fracture

Back 50

Intertrochanteric - involved extremity may be internally rotated and slightly shortened. More common at a later age than femoral neck fracture.

Greater trochanteric fracture

Front 51

Hip dislocations

Back 51

Posterior dislocation is more common.
Typically shortening, adduction and internal rotation of the extremity is seen.

Front 52

Slipped capital femoral epiphysis

Back 52

A disorder in adolescents in which a fracture of the growth plate results in separation of the ball of the hip joint from the femur.
- More common in males
- Causes painful limp and limited hip internal rotation and abduction
- Change in ROM is usually diagnostic

Front 53

Avascular necrosis of the hip

Back 53

Death of the bone tissue (necrosis) due to decreased or interrupted blood supply resulting in bone collapse and deterioration of the articular surface.

Front 54

What three views should be obtained when evaluating the knee?

Back 54

AP, lateral and sunrise/skyline view

Front 55

What diagnosis would you make based on this x-ray?

Back 55

Osteoarthritis in knee

Front 56

Chondromalacia patella

Back 56

Abnormal tracking of the patella leading to inflammation and degeneration of the patella.

Front 57

Tibia fractures

Back 57

Can occur on plateau, shaft or malleolus.

Front 58

Fibula fractures

Back 58

Can occur on head, shaft or malleolus.

Front 59

Ankle/foot malleolar fracture

Back 59

Bimalleolar - both medial and lateral involved

Trimalleolar - medial, lateral and distal tibia involved

Front 60

Calcaneal fracture

Back 60

Typically due to fall or jump from tall height.

Front 61

What are the most important determinants in the analysis of a potential bone tumor?

Back 61

- Morphology
--- well-defined or ill-defined osteolytic, sclerotic
- Age of patient - most important
- X-ray is most useful exam

Front 62

What morphology do most bone tumors have?

Back 62

Osteolytic

Front 63

What is the most reliable indicator in determining is lesions are benign or malignant?

Back 63

Zone of transition between the lesion and adjacent normal bone - well-defined or ill-defined.

Front 64

Criteria to diagnose Aneurysmal Bone Cyst (ABC)

Back 64

- Well-defined osteolytic
- 10-20 years old

Front 65

Criteria to diagnose Chondromyxoid Fibroma (CMF)

Back 65

- Well-defined osteolytic
- 10-20 years old

Front 66

Criteria to diagnose Eosinophilic Granuloma (EG)

Back 66

- Well-defined or ill-defined osteolytic or sclerotic
- 0-20 years old

Front 67

Criteria to diagnose Giant Cell Tumor (GCT)

Back 67

- Well-defined or ill-defined osteolytic
- 20-40 years old

Front 68

Criteria to diagnose Fibrous Dysplasia (FD)

Back 68

- Well-defined osteolytic or sclerotic
- 10-20 years old

Front 69

Criteria to diagnose Hyperparathyroidism with Brown Tumor (HPT)

Back 69

- Well-defined osteolytic
- 20-40 years old

Front 70

Criteria to diagnose Non-Ossifying Fibroma (NOF)

Back 70

- Well-defined osteolytic
- 10-20 years old

Front 71

Criteria to diagnose Simple Bone Cyst (SBC)

Back 71

- Well-defined osteolytic
- 0-20 years old

Front 72

Criteria to diagnose multiple myeloma

Back 72

- Well-defined or ill-defined osteolytic
- Over 40 years old

Front 73

Small zone of transition

Back 73

Results in a sharp, well-defined border and is a sign of slow growth. A sclerotic border especially indicates poor biological activity.

Front 74

Wide zone of transition

Back 74

An ill-defined border with a broad zone of transition is a sign of aggressive growth and is a feature of malignant tumors.
Infections and eosinophilic granuloma may mimic a malignancy.

Front 75

What is a periosteal reaction?

Back 75

Non-specific reaction occurs when periosteum is irritated, resulting in benign or aggressive type.
Benign is seen with benign tumors or trauma.
Aggressive is seen with malignancy, infections or eosinophilic granuloma.

Front 76

How do you detect a benign periosteal reaction?

Back 76

Results in a thick, wave and uniform callus formation resulting from chronic irritation.
If slow-growing, the periosteum has time to lay down thick new bone and remodel it into a more normal-appearing cortex.

Front 77

How do you detect an aggressive periosteal reaction?

Back 77

Multilayered, lamellated or demonstrates bone formation perpendicular to the cortical bone, may be spiculated and interrupted.
Codman's triangle may be present, referring to an elevation of periosteum away from the cortex and forming an angle where elevated periosteum and bone come together.

Front 78

Osteoid osteoma

Back 78

Tumor of unknown etiology that is composed of osteoid and woven bone, usually smaller than 1.5 cm diameter. Can occur in any bone, but in 2/3 of patients, the appendicular skeleton is involved.

Classic presentation
- Focal bone pain at site of tumor
- Pain worsens at night, increases with activity
- Pain dramatically relieved with aspirin
- X-ray shows round lucency, with dense sclerotic central nidus

Front 79

Osteochondroma

Back 79

Abnormal growth that forms on the surface of a bone near the growth plate that develops during childhood or adolescence.
It is an outgrowth of the growth plate and consists of both bone and cartilage.

Front 80

Enchondroma

Back 80

Intramedullary cartilaginous cysts commonly found in the small bones of the hands and feet. Grow in childhood and remain present in adulthood, often found in patients 10-20 years old.
On x-ray, appears as small (less than 5 cm) lobe-shaped or oval with well-defined margins. Larger lesions have lucent defect with endosteal scalloping (erosin) and cortex is expanded and thinned. Calcifications can range from punctuate to rings.

Front 81

Aneurysmal Bone Cyst (ABC)

Back 81

Lesions are located on the surface of bone, metaphysis and epiphysis and usually occurs in 20-30s. X-rays show striking expansile lesion with internal septae or longitudinal striations. If highly expansile and at end of bone, it may be referred as a "finger in a balloon."

Front 82

Osteosarcoma

Back 82

Peak age is 18-20 and males more commonly affected.
Most common presentation is pain and a mass, occurring near a joint.
Located in metaphysis of long bones, appears as a mixed sclerotic and lytic lesion, that may permeate bone and nearby cortex, causing a soft tissue mass and periosteal reaction.
Half of lesions are near knee joint.
Has a "sunburst pattern" appearance.

Front 83

Chondrosarcoma

Back 83

Slower growing than osteosarcomas and tumor produces cartilaginous matrix.
Metaphysis is most common location in long bones.
More common in people over 60.
Presents with pain and swelling in a bone.
Fusiform, lucent defect with scalloping of the inner cortex and periosteal reaction.
Extension into the soft tissue may be present.

Front 84

Ewing's sarcoma

Back 84

Most common in pelvis, femur, tibia, and humerus, typically metaphysis.
More common in males and presents in childhood.
Usually lytic and central, endosteal scalloping is often present.
Lamellated or "onion skin" periosteal reaction, caused by and splitting and thickening of the cortex by tumor cells, followed with a "moth-eaten" or mottled appearance and extension into soft tissue.

Front 85

Benign bone tumors

Back 85

Osteoid osteoma
Osteochondroma
Enchondroma
Aneurysmal bone cyst

Front 86

Malignant bone tumors

Back 86

Osteosarcoma
Chondrosarcoma
Ewing’s Sarcoma