Ortho Med Unit I

Front 1

what is usually the first diagnostic imaging performed?

Back 1

X Ray

Front 2

for long bones, how many standard radiographic views do you need?

Back 2

2

Front 3

for joints, how many standard radiographic views do you need?

Back 3

3

Front 4

how are the Xrays named?

Back 4

by the beam entry and exit (anterior-posterior: beam entered anteriorly and exited posteriorly)

Front 5

what is the most radiodense substance on an Xray?

Back 5

heavy metals

Front 6

what is the least radiodense substance on an Xray?

Back 6

air

Front 7

if radiation penetrates an object, the developed film appears what color?

Back 7

black

Front 8

if radiation is blocked, the developed film appears what color?

Back 8

white

Front 9

this abbreviation is used when the patient is recumbent on the Xray-body is positioned horizontally and the horizontal beam is used

Back 9

DECUB

Front 10

what are the ABCS of reading radiographs?

Back 10

A-alignment
B-bone density
C-cartilage space
S-soft tissues

Front 11

what are three important things to consider about alignment on an Xray?

Back 11

(1) general skeletal architecture-# and size of bones
(2) general contour of bone-smooth and continuous cortical lines
(3) alignment of adjacent bones/joint articulations

Front 12

what structures are helpful in the bone for diagnosing texture abnormalities?

Back 12

trabeculae

Front 13

this is decreased opacity of bone on an Xray

Back 13

lucency

Front 14

this is increased opacity of bone on an Xray

Back 14

sclerosis

Front 15

most Xray views of the spine are taken with the patient in what position?

Back 15

recumbent

Front 16

to do an AP view of the hip on Xray, what position does the patient/their hip need to be in?

Back 16

supine, 15-20 of IR

Front 17

to do a lateral "frog leg" view of a patient's hip on Xray, what position doe sthe patient/their hip need to be in?

Back 17

supine, hip flexed, abducted, and ER

Front 18

to do an AP view of the knee on an Xray, what position does the patient/their knee need to be in?

Back 18

supine, knee extended

Front 19

to do a lateral view of the knee on an Xray, what position does the patient/their knee need to be in?

Back 19

sidelying, involved knee on bottom

Front 20

to do a PA axial tunnel view of a patient's knee on Xray, what position does the patienttheir knee need to be in?

Back 20

prone or standing, knee flexed 40 degrees

Front 21

to do a tangential PF view of the knee on Xray, what position does the patient/their knee need to be in?

Back 21

supine, knee flexed 45

Front 22

to do an AP external rotation view of the shoulder on Xray, what position does the patient/their shoulder need to be in?

Back 22

supine, ER

Front 23

to do an AP internal rotation view of the shoulder on Xray, what position does the patient/their shoulder need to be in?

Back 23

supiner, IR, elbow flexed

Front 24

to do an AP view of the AC joint, what position does the patient need to be in?

Back 24

standing, bilateral, with or without weights

Front 25

what two Xray views are included in a trauma series of the shoulder?

Back 25

(1) axillary view of GHJ
(2) scapular Y view

Front 26

this imaging is when a computer combines multiple xray views to produce cross sectional images

Back 26

computer tomography (CT)

Front 27

these are 3-d reconstructions of structures based on CT scans

Back 27

reformations

Front 28

what are the two advantages of CT scan?

Back 28

(1) Ct has ability to produce fine detail (less than a millimeter)
(2) used to evaluate bone margins (good bone detail, cortical vs trabecular detail, used for tumors/fractures/osteophytes)

Front 29

what are four disadvantages of CT scans?

Back 29

(1) metal implants produce artifact
(2) high radiation doses
(3) expensive (relatively less than MRI)
(4) limited soft tissue detail (poor differentiation between ligament and tendon)

Front 30

this is a computer based use of radiofrequency and magnetic fields to generate axial, sagittal and cross-sectional images

Back 30

MRI (magnetic resonance MRI)

Front 31

this type of MRI is best for anatomical detail, can distinguish architecture of structures, and fat appears bright (increased bone marrow signal in fractures or osteomyelitis)

Back 31

T1 weighted image

Front 32

this type of MRI is more sensitive to water or fluid, less soft tissue detail; good for inflamed tendons, bursae, tumors, or abscesses

Back 32

T2 weighted image

Front 33

what type of MRIs combine T1 and T2 image properties?

Back 33

proton wighted images

Front 34

what are the two advantages to MRI imaging?

Back 34

(1) no radiation exposure
(2) excels in imaging soft tissue such as joint structures, ligaments, capsule, synovium

Front 35

what are the five disadvantages to MRI imaging?

Back 35

(1) patient must be absolutely still
(2) expensive
(3) relatively slow, long imaging time
(4) small space (claustrophobia)
(5) unstable implants/metal prohibit MRI

Front 36

MRI with contrast has increased sensitivity for what three conditions?

Back 36

(1) labral tears
(2) rotator cuff tears
(3) meniscal injuries

Front 37

this is an imaging technique that uses sound waves to get different signal intensities from different structures

Back 37

ultrasound

Front 38

this refers to the ablity of tissue to reflect ultrasound waves back toward the transducer and produce an echo

Back 38

ethogenicity

Front 39

the higher the ethogenicity of tissues, the (brighter/duller) they appear

Back 39

brighter

Front 40

these images on ultrasound appear brighter than surrounding tissues, i.e. tendons

Back 40

hyperechoic

Front 41

these images on ultrasound appear darker than surrounding tissues, i.e. bursae or cysts

Back 41

hypoechoic

Front 42

what imaging technique excels in soft tissue diagnostics-can do stress testing of involved structure, real time imaging on tendon gliding, muscle contraction

Back 42

ultrasound

Front 43

what are the four advantages of ultrasound?

Back 43

(1) fast
(2) inexpensive
(3) no health risks
(4) dynamic evaluation of structure (real-time)

Front 44

what are the two disadvantages of ultrasound?

Back 44

(1) experience and skill of operator is a limiting factor
(2) quality of image may be decreased by obesity

Front 45

this type of imaging is used to measure bone metabolic activity

Back 45

scintigraphy/bone scan

Front 46

what is injected prior to a bone scan, allowing the most metabolically active areas of bone to show increased uptake (appear as hot spots)

Back 46

radio-labeled phosphate

Front 47

is the bone scan sensitive, specific, or both?

Back 47

only sensitive

Front 48

what condition is the bone scan both sensitive and specific for?

Back 48

multiple myeloma

Front 49

what are two advantages of using bone scans?

Back 49

(1) reveal stress fractures before radiograph
(2) determination of distribution of lesions (in cancer staging)

Front 50

what are two disadvantages of using bone scans?

Back 50

(1) not sensitive to cause of increased uptake
(2) areas of common increased uptake: old fractures, open epiphyseal plates, SIJ, DJD

Front 51

for osteoporosis, what imaging technique is the gold standard for diagnosis?

Back 51

DEXA scan (bone densitometry)

Front 52

what are three things that are shown on DEXA scan that can help diagnose someone with osteoporosis?

Back 52

(1) decreased bone mass
(2) resorption exceeds deposition
(3) unable to detect on plain x-ray until 30% bone loss

Front 53

this is known as "adult Rickets"; the patient has soft bones and is unable to form mature bone, resulting in bowing of long bones (cannot be distinguished from osteoporosis on x-ray)

Back 53

osteomalacia

Front 54

this condition is when the deposition of new bone exceeds resorption, increased bone density, and loss of normal bone contour

Back 54

osteopetrosis

Front 55

this disease is the altered regulation of bone deposition and resorption; it progresses longitudinally through involved bone (cortical thickening, bone enlargement, prone to fracture)

Back 55

Paget's disease

Front 56

this bone problem is associated with steroids, chronic alcohol use, and sickle cell anemia; increased bone density beneath joint surface; bone resorption during revascularization

Back 56

avascular necrosis

Front 57

what places in the body are commonly seen to have avascular necrosis?

Back 57

(1) femoral head
(2) humeral head
(3) scaphoid

Front 58

the hallmark of this disease is the non-uniform narrowing of joint space, asymmetric cartilage loss, subchondral sclerosis and cysts, and bony spur formations

Back 58

degenerative arthritis/osteoarthritis

Front 59

this disease is when there is a calcification within the substance of a muscle that follows direct/indirect trauma with a hematoma

Back 59

myositis ossificans/heterotopic ossification

Front 60

what medication may be used as a prophylactic in someone with a myositis ossificans?

Back 60

indocin

Front 61

what are six things that a physical therapist should do when assessing a radiograph?

Back 61

(1) assess bony alignment
(2) assess possible bony restriction to movement
(3) visualize the exact location of fracture (know where to stabilize during motion)
(4) appreciate the position of fixation
(5) assess bone healing
(6) more comprehensive evaluation (adds visual dimension)

Front 62

what are five decision making factors to consider when deciding whether to give a patient an imaging test or not?

Back 62

(1) cost of imaging modality
(2) availability
(3) radiation exposure
(4) possible contraindications to some modalities
(5) what information can be obtained from test

Front 63

end of the bone

Back 63

epiphysis

Front 64

growth plate of the bone

Back 64

physis

Front 65

flare of bone

Back 65

metaphysis

Front 66

shaft of bone (long bone)

Back 66

diaphysis

Front 67

what part of bone is less vascular and has slower healing times?

Back 67

diaphysis

Front 68

what mineral contributes to the hardness and rigidity of bone?

Back 68

hydroxyapatite (calcium + phosphate)

Front 69

what percentage of the bone is made up of the mineral hydroxyapatite?

Back 69

70%

Front 70

what percentage of the bone is made up of organic materials?

Back 70

30%

Front 71

what organic materials make up the bone and provide flexibility and resilience to the bone?

Back 71

collagen type I, matrix, cells

Front 72

what percentage of the bone is cellular?

Back 72

2%

Front 73

these bone cells lay down organic matrix (collagen)

Back 73

osteoblasts

Front 74

these bone cells are mature osteoblasts in organized bone

Back 74

osteocytes

Front 75

these bone cells resorb bone in Howships lucanae and secrete acid phosphatase

Back 75

osteoclasts

Front 76

this is the primary bone that is arranged randomly, has a low mineral content, is immature, and remodels to lamellar bone

Back 76

woven bone

Front 77

what type of bone does woven bone mature into?

Back 77

lamellar bone

Front 78

this is mature bone that is orderly, regular orientaton of collagen fibers

Back 78

lamellar bone

Front 79

this type of bone is 5-30% porous, is stiffer than cancellous bone (more dense)

Back 79

cortical

Front 80

this type of bone is 30-90% porous and is less dense

Back 80

cancellous

Front 81

what are the three phases of secondary bone healing?

Back 81

(1) inflammatory phase
(2) reparative phase
(3) remodeling phase

Front 82

what are three events that occur during the inflammatory phase of secondary bone healing?

Back 82

(1) fracture creates bleeding and hematome
(2) bone necrosis at fragment end, inflammatory infiltrate
(3) granulation tissue replaces hematome, fibroblasts produce collagen

Front 83

what is the time frame of the inflammatory phase of secondary bone healing?

Back 83

1-5 days after injury

Front 84

what are the three things that occur during the reparative/callous phase of secondary bone healing?

Back 84

(1) subsidence of pain and swelling marks beginning
(2) soft callus forms, making fracture sticky providing some resistance to bending
(3) hard callous forms, converting to woven bone

Front 85

what is the time frame for the soft callous phase of the reparative phase of secondary bone healing?

Back 85

1-6 weeks after injury

Front 86

what is the time frame for the hard callous phase of the reparative phase of secondary bone healing?

Back 86

4-8 weeks after injury

Front 87

what is the time frame of the remodeling phase of secondary bone healing?

Back 87

6 weeks to months

Front 88

what phase in the secondary healing process of bone converts woven bone to lamellar bone?

Back 88

remodeling phase

Front 89

this law states that bone orients along lines of stress (bone resorption occurs with decreased stress, bone hypertrophy occurs with increased stress)

Back 89

Wolff's law

Front 90

this effect in the remodeling phase of bone is when pressures are converted to electric charge and are carried by osteocytes

Back 90

piezoelectric effect

Front 91

this type of bone healing occurs in surgically compressed or fixated fractures, and there is no visible callus formation; haversian remodeling occurs

Back 91

primary bone healing

Front 92

bone is the storage site for what two minerals, and in what form?

Back 92

calcium and phosphate in the form of hydroxyapatite

Front 93

bone is controlled by what two substances?

Back 93

parathyroid hormone and vitamin D

Front 94

what are the three target organs for parathyroid hormone and vitamin D?

Back 94

(1) intestine
(2) kidney
(3) bone

Front 95

what are three ways to restore calcium levels in the body?

Back 95

(1) increase intestinal absorption
(2) decrease urinary excretion
(3) increase release of calcium from the bone

Front 96

this is a break in the continuity of the bone

Back 96

fracture

Front 97

this occurs when the bone's capacity to absorb energy is exceeded

Back 97

fracture

Front 98

what are the three phases of the stress/strain curve pertaining to fracture?

Back 98

(1) elastic phase
(2) plastic deformation
(3) failure (actual fracture)

Front 99

what type of loading produces a transverse fracture?

Back 99

bending

Front 100

what type of loading produces a spiral fracture?

Back 100

torsional

Front 101

what type of loading produces a compression or impacted fracture?

Back 101

axial

Front 102

what type of loading produces an avulsion fracture?

Back 102

tensile

Front 103

what type of loading produces an oblique fracture?

Back 103

combined loading (such as axial and bending)

Front 104

what are four ways that fractures are described?

Back 104

(1) location (bone involved, proximal, mid shaft or distal)
(2) open vs. closed
(3) simple vs. comminuted
(4) complete or incomplete

Front 105

this type of fracture has multiple pieces

Back 105

comminuted

Front 106

what are three ways that a fracture deformity is described?

Back 106

(1) displaced/nondisplaced
(2) angular deformity described in terms of distal segment alignment
(3) rotational

Front 107

this is a fracture that occurs in an abnormal or diseased bone, even though stress may be normal (i.e. fracture through cancer)

Back 107

pathological

Front 108

this type of fracture occurs due to repetitive loading

Back 108

stress fracture

Front 109

these types of fractures usually only occur in the pediatric population

Back 109

incomplete (Greenstick)

Front 110

this type of incomplete fracture occurs on the tensile side of the bone (opposite side of stress)

Back 110

Greenstick

Front 111

this type of incomplete fracture is a buckle fracture and occurs on the compression side of the bone

Back 111

torus

Front 112

this type of fracture occurs at a weak link in the pediatric joint, and is often injured before the ligament

Back 112

physeal

Front 113

what is the classification system for physeal fractures in the pediatric population?

Back 113

Salter Harris Classification

Front 114

this classification for an open fracture is an open fracture where the wound is less than 1 cm long; it is usually moderately clean, a spike of bone has pierced the skin; little soft tissue damage and is usually simple, transverse or short oblique

Back 114

Type 1

Front 115

this type of open fracture has a laceration greater than 1 cm long, and there is no extensive soft tissue damage, flap, or avulsion; slight or moderate crushing injury, moderate comminution, and moderate contamination

Back 115

type II

Front 116

this type of open fracture is characterized by extensive damage to soft tissue, including muscles, skin, and neurovascular structures; and a high degree of contamination. Fracture often caused by high velocity trauma, resulting in great deal of comminution/instability

Back 116

type III

Front 117

what are the three surgical emergencies that are associated with fractures?

Back 117

(1) open fractures (risk of infection)
(2) vascular injury associated with fracture
(3) acute compartment syndrome

Front 118

what are seven modes that can be used to treat fractures (both surgically and non-surgically)?

Back 118

(1) closed reduction (casting)
(2) percutaneous pinning
(3) ORIF (open reduction internal fixation)
(4) intermedullary fixation
(5) external fixation
(6) hemi-arthroplasty
(7) tension bands

Front 119

this is a manual manipulation of the extremity to align the fracture fragments; uses a three point fixation with plaster

Back 119

closed reduction (casting)

Front 120

this is the preferred treatment of certain fractures that are not amenable to non operature stabilization; dissection down to bone to reduce fracture fragments, use orthopedic hardware. Primary bone healing and shorter immobilization period

Back 120

ORIF (open reduction internal fixation)

Front 121

this mode of treating fractures is often used in smaller joints and still requires immobilization

Back 121

percutaneous pinning (K wires)

Front 122

this type of fracture treatment is a load sharing device that is good for long bones (tibia, femur, humerus); patients can usually weight bear immediately and heals with callous formation

Back 122

intermedullary fixation

Front 123

this treatment of a fracture uses pins or wires placed percutaneously through the bone; attached to an external frame that stabilizes the extremity, and can be temporary or final

Back 123

external fixation

Front 124

this fracture procedure is used in hip or shoulder fractures that are not candidates for plate fixation; usually intra-articular

Back 124

hemi-arthroplasty

Front 125

this fracture procedure is often used in patellar fractures to transfer distraction force of quads into a compressive force

Back 125

tension bands

Front 126

what are six factors that influence fracture healing?

Back 126

(1) vscularity of the bone and surrounding soft tissue
(2) efficacy of treatment received
(3) underlying health of patient
(4) severity of fracture and soft tissue injuries
(5) degree of energy involved in injury
(6) smoking dramatically decreases healing

Front 127

union of a fracture usually occurs within what time frame?

Back 127

6-8 weeks

Front 128

if this portion of the bone is stripped off, a major vascular supply is lost

Back 128

periosteum

Front 129

what are five things that affect the outcomes of fracture treatment?

Back 129

(1) accuracy of reduction
(2) efficiency of immobilization
(3) blood supply available to bone fragments
(4) polytrauma (avoiding prolonged bedrest)
(5) severity of soft tissue injury

Front 130

what are four fracture site complications that can occur?

Back 130

(1) delayed union
(2) non-union
(3) malunion
(4) osteoyelitis

Front 131

a non-union fracture usually occurs in fractures greater than what time frame?

Back 131

6 months

Front 132

this type of non-union fracture usually results from inadequate reduction

Back 132

atrophic

Front 133

this type of nonunion fracture results from inadequate immobilization

Back 133

hypertrophic

Front 134

what are five complications that can occur due to a fracture?

Back 134

(1) pulmonary emboli (related to long term immobilization)
(2) fat emboli from marrow (fat gets into blood and travels to heart and lungs in long bone fractures)
(3) neurovascular compromise
(4) infections/compartment syndromes
(5) avascular necrosis (AVN)-poor blood supply