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129 Cards in this Set
- Front
- Back
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hangman's fracture
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pars fracture of C2
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burst fracture
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communuted fracture with retropulsed fragments in the neural canal
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How are burst fractures treated differently from compression fractures?
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They require surgical decompression of the nural canal fragments to avoid SC injury; compression fractures are treated conservatively.
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Name some CT views of the spine
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Axial slice
Sagital reformation |
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Lytic bone tumors come mainly from what 3 sites?
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lung, thyroid, kidney
LyTiK |
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Main source of blastic bone lesions
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prostate in men
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What sites cause lytic bone lesions that can turn blastic with therapy?
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breast
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What is the best initial survey for bone mets? Why?
What is its limitation? |
Bone scan, because it covers the entire body.
It is sensitive but not specific. If it finds hot spots CT or MRI may be needed to determine what they are. |
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Primary bone malignancies by age:
children 10-25 over 40 |
children: Ewings
10-25 osteogenic sarcoma over 40: chondrosarcoma |
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characteristics of giant cell tumor
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epiphyseal
abuts articular surface eccentric location in bone sharply defined border not sclerotic |
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Main source of blastic bone lesions
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prostate in men
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What sites cause lytic bone lesions that can turn blastic with therapy?
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breast
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What is the best initial survey for bone mets? Why?
What is its limitation? |
Bone scan, because it covers the entire body.
It is sensitive but not specific. If it finds hot spots CT or MRI may be needed to determine what they are. |
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Primary bone malignancies by age:
children 10-25 over 40 |
children: Ewings
10-25 osteogenic sarcoma over 40: chondrosarcoma |
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characteristics of giant cell tumor
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epiphyseal
abuts articular surface eccentric location in bone sharply defined border not sclerotic |
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expanding cartilaginous tumor in metaphysis of long bones of hand or ribs
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enchondroma
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bone tumor in young male, intense bone pain, responds to aspirin
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osteoid osteoma
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What color is meniscus on MR? What color is tear?
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dark
light |
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fish vertebrae
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(biconcave)
osteoporosis |
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Describe the appearance of osteoporosis on plain film.
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plain film: greater lucency, thinned cortex, disc spaces "lozenge" shaped (vertebrae are biconcave)
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How does compression fracture appear on MR?
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bright signal b/c of marrow fat signal (T1) from hemorrhage
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Where do radiologists most often miss fractures?
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pelvis
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normal intercarpal distance
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3 mm
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What should you see on a lateral view of wrist?
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smooth articulation radius/lunate/capitate/3rd metacarpal
scapholunate angle 30-60 degrees |
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What is the "Terry Thomas" sign?
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scapholunate widening (gap-tooth)
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What is the most common ligamentous injury of wrist?
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scapholunate dissociation
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What are the 3 radiographic signs of scapholunate dissociation from FOOSH?
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1. scapholunate dissociation
2. signet ring sign, density at top of scaphoid b/c of rotation 3. on lateral, scapholunate angule > 60 |
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What is perilunate dissociation?
How do you get it? What are complications? |
PA: smooth arc of capitate disrupted
lat: capitate not aligned with lunate and radius. from hyperextension median nerve injury, SLAC |
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What is the most commonly fractured bone of wrist?
second most? |
radius
second: scaphoid |
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Snuffbox tenderness but normal xray. What should you do?
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spica cast anyway; scaphoid fracture often doesn't show up
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Complications of scaphoid injury?
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avascular necrosis
SLAC: scaphoid/lunate AVN and collapse |
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What two lines can check elbow alignment?
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anterior humeral: lateral view, bent elbow, line along anterior humerus should bisect capitellum, or at least run through middle third.
radiocapitellate line: on both lateral and AP, line through midshaft radius should bisect capitellum. misalignment suggests supracondylar fracture. |
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signs of occult radial head fracture from FOOSH?
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posterior fat pad, anterior fat pad sail sign
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What should you do if a sail sign + pain is seen?
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sling elbow
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** What are the six lines to check in the normal anatomy of the pelvis?
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iliopectineal
ilioischial teardrop acetabular roof anterior lip posterior lip |
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At what pelvic line should you look for sacral fractures?
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arcuate
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Disruption of iliopectineal line suggests fracture of ?
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anterior column of acetabulum
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Disruption of ilioischial line suggests fracture of ?
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posterior column of acetabulum
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Disruption of teardrop suggests fracture of ?
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medial aspect of acetabulum
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What is the most commonly missed hip fracture?
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femoral neck fracture
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t/f Elderly patients can sometimes weight bear on a femoral neck fracture.
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true
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What is the xray sign of sacral alar fracture?
What other views should you get? |
broken alar lines
pelvic outlet CT |
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What (old) view helps with acetabular fracture?
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Judet
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What is the main mechanism of tibial plateau fracture?
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valgus force + axial load
(car bumper vs knee) |
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What views should you always obtain for blunt trauma to knee?
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obliques added to ap and lateral (4 views)
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What extra view for patellar fracture?
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sunrise view (bent knee, shin on plate)
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What is a Segond fracture?
ass w? |
small lateral tibial avulsion fx
ass w/ ACL tear |
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What alignment should you check in the foot (PA)?
(oblique)? |
2nd metatarsal, 2nd cuneiform
3rd mt, 3rd cuneiform |
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What lines do you check on the lateral view of the foot?
what does abnormality suggest? |
Bohler's angle
line across top of calcanus + line across subtalar surface normally 20 40 degrees, if < 20, suggestive of occult calcaneal fracture |
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What is a Lisfranc injury?
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fracture of 2nd metatarsal and avulsion of 2nd metatarsal base from 2nd cuneiform
mts 2-5 can thus be displaced, but needn't be |
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What is a complication of Lisfranc injury?
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compartment syndrome
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How do you diagnose an occult calcaneal fracture?
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Bohler's line < 20- degrees
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** What is the most important view to diagnose an elbow fracture?
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lateral
(to see fat pads) |
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acute anterior wedging: what is first step? second step
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localize pain
then get MRI |
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What are three patterns of bone destruction, from most benign to worst?
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geographic: discrete delimited area
permutive: edges blended motheaten: edges blended, plus holes |
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What is a "fallen fragment"?
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geographic area of destruction in bone, + fragment from a bone cyst
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What are the three compartments that spinal tumors can occur in?
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extradural
intradural - extramedullary intradural - intramedullary |
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What is the most common type of extradural spinal tumor?
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mets (prostate, breast, lung)
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What is the most common type of intradural-extramedullary spinal tumor?
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nerve sheath tumor (schwannoma > neurofibroma)
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What is the most common type of intradural-intramedullary spinal tumor in adults?
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ependymoma
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What is the most common type of intradural-intramedullary spinal tumor in kids?
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astrocytoma
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Where do spinal meningiomas occur?
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thoracic spine
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multiple meningiomas are ass w what condition?
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neurofibromatosis type 2
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t/F schwannomas usually invade the nerve.
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false
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t/f schwannomas are encapsulated.
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true
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t/f neurofibromas usually invade the nerve.
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true
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Besides initial diagnosis, what are four other indications for a bone xray for fracture?
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post-reduction and immobilization
1-2 week follow up to assess soft tissue swelling 6-8 week followup to assess callus after any cast change |
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Name three examples of geographic bone destruction.
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Non-ossifying fibroma
Chrondromyxoid fibroma Eosinophilic granuloma |
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Name three types of moth-eaten bone destruction.
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Myeloma
Lymphoma Metastases Ewing’s Sarcoma |
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Name five types of permutive bone destruction.
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Lymphoma
Leukemia Ewing’s Sarcoma Myeloma Neuroblastoma |
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A well-defined non-sclerotic border suggests what kind of tumor?
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fast-growing, benign
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What is butressing?
what does it indicates? |
a thick single layer of periosteal reaction
indicates slow growth or benign tumor |
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What do spiculated margins indicate?
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rapid growth
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What are two types of spiculated margins?
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"hair on end" (perpendicular)
"sunburst" (divergent) |
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What is Codman's triangle?
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triangle between elevated periosteum and adjacent cortex
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What does a sunburst pattern indicate?
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osteoid production due to extraosseous tumor
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What does hair on end pattern indicate?
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mets, osteosarcoma
often seen in Ewings sarcoma |
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What does Codman's triangle indicate?
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process lifiting periosteum away from bone
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What is the difference in matrix between benign and malignant tumors?
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Matrix more likely to be central in malignant chondroid and osteoid tumors, more likely to be peripheral in benign lesions.
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Four types of tumor matrix?
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osteoid (dense, homogeneous, cloudlike)
chondroid (arcs, circles) intermediate (ground glass) cellular (radiolucent) |
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Which type of matrix does not always mineralize? Which has diffuse uniform mineralization (ground glass)?
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osteoid does not always mineralize
intermediate has diffuse mineralization |
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Which type of matrix does not always calcify?
Which type of matrix has no calcification? |
chondroid does not always calcify
cellular has no calcification |
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In general, in what kind of tissue do primary tumors arise?
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in areas of rapid growth
(distal humerus, proximal tibia, humerus) |
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In general, mets arise in what kind of tissue?
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well vascularized
spine, iliac wings |
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What are the identifying characteristics of osteoid osteoma?
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nidus < 2 cm surrounded by sclerotic cortex
usually in femur or tibia, or hands/feet pain worse at night, relieved by aspirin |
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What is the course and treatment for osteoid osteoma?
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no malignant potential
NSAIDs, percutaneous RF ablation |
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* What is the most common MALIGNANT PRIMARY bone tumor in young adults and children?
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osteosarcoma
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* What is the 5 year survival for osteosarcoma?
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41%
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* Osteosarcoma comprises what percent of all primary bone malignancies?
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20%
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* What are the two types of osteogenic sarcoma?
Which has the worse prognosis? |
conventional OSA (85%)
telangiectatic (5%) --worse prognosis |
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* Describe a telangiectatic osteosarcoma.
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purely lytic
cystic cavities filled with blood and necrosis poor prognosis |
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* Describe a conventional osteosarcoma.
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poorly defined intramedullary mass extending through cortex
aggressive periosteal reaction --Codman's, sunburst may have soft tissue mass, possibly with calcification |
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* What are three areas that a secondary osteosarcoma can arise?
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any pre existing bone lesion, e.g.
Paget's prior radiation bone infarct |
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* T/F Osteosarcoma is usually located in the spine.
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False. Usually in tubular bones like femur (esp knee), tibia, humerus
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* What is the main imaging modality for assessing osteosarcoma?
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CT (XR for presumptive dx)
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* Why would you use MRI to assess osteosarcoma?
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to stage
bone scan also used |
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* Why would you use CXR for osteosarcoma?
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to look for mets
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* What is the usual clinical presentation of enchondroma?
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usually asymptomatic
may present as painless swelling or fracture |
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What is the epidemiology of enchondroma?
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10-30 years
gender? |
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* What is the usual location of enchondroma?
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tubular bones of HAND AND FOOT,
then femur/tibia/humerus |
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* Describe an enchondroma.
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lytic lesion with chondroid matrix
well-defined border rings and arcs from calcification cortex expands without breaking no soft tissue mass |
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* Does an endochondroma have a soft tissue mass?
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no
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* T/F Endochondromas have "rings and arcs."
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true
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* T/F Endochondromas have periosteal reaction.
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false
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* How are endochondromas treated?
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if asymptomatic - no treatment
if symptomatic (malignant) - curettage |
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* T/F If an endochondroma is painful, it is likely malignant.
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true
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* What is Ollier's disease?
What is the risk of malignant transformation? |
multiple endochondromas.
Risk of malignant transformation (to chondrosarcoma) is 25% |
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Describe an osteochondroma.
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bony projection on exterior of bone, covered by cartilage, slow-growing;
stops growing with skeletal maturity |
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What is the epidemiology of osteochondroma?
What are its clinical features? |
< 20 years
slow growing, painless |
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What are the usual locations of osteochondromas?
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TIBIA, femur, humerus
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What are the two types of osteochondroma?
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peduncular and sessile
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What is the chance of malignant transformation of osteochondroma?
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1%
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Fragment of epiphyseal growth plate grows through periosteal cuff.
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osteochondroma
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medullary cavity is replaced with fibrous material, woven bone, and spindle cells
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fibrous dysplasia
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T/F Fibrous dysplasia is a developmental anomaly which does not spread.
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true
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Associations of fibrous dysplasia
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hyperthyroidism
hyperparathyroidism MC CUNE ALBRIGHT |
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Most fibrous dysplasia is [monostotic, polyosteoic].
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mono 85%
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What are the usual locations of fibrous dysplasia?
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femur and tibia.
monostotic also occurs in ribs polyostotic also occurs in craniofacial bones, pelvis |
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What are the complications of fibrous dysplasia?
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fractures
limb deformity sarcomatous transformation |
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What are the radiographic features of fibrous dysplasia?
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ground glass
well defined sclerotic margins EXPANSILE MEDULLARY LESIONS bowing deformities (Shepherd's crook) sclerotic base of skull |
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Shepherd's crook deformity
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fibrous dysplasia
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Sclerotic base of skull
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fibrous dysplasia
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Medullary lesions
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fibrous dysplasia
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Most common LYTIC bone mets:
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LyTiK to Bone:
Lung thyroid kidney breast (not in that order) kidney lung thyroid breast |
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Most common SCLEROTIC bone mets
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Prostate, Breast
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ivory vertebrae
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Hodgkin's lymphoma
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Intramedullary fluid filled lesion, benign
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unicameral bone cyst
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Do bone cysts have periosteal reaction?
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only if there is a fracture caused by cyst growth
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Acutely painful benign lesion, blood filled cystic cavities
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aneurysmal bone cyst
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