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125 Cards in this Set
- Front
- Back
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What is the normal distance between the acromion and the clavicle?
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3-8 mm
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What is the normal distance between the corocoid and the inferior aspect of the clavicle?
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10-13 mm.
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What are the two coro-clavicular Ligaments?
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Conoid and Trapezoid
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What is a Type I ligament disruption?
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The ligaments are intact holding the fracture in place
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What is a Type IIA ligament disruption?
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The fracture site is medial to the ligaments.
The ligaments hold the distal fragment in place. The proximal fragment has no ligimentous attachment and is displaced superiorly. |
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What is a Type IIB ligament disruption?
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The fracture site is between the two ligaments.
The conoid ligament is ruptured and the trapezoid remains attached. The proximal fragment is significantly displaced because of the loss of downwards restraint on the medial fragment. |
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What displaces the proximal fragment of a middle 1/3 clavicle fracture cranially?
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The sterno-cleno mastoid muscle.
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What displaces the distal fragment of a middle 1/3 clavicle fracture caudally?
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The weight of the arm.
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What is the most common site for a clavicle fracture?
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Middle 1/3
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Describe the radiographic appearance of an anterior shoulder dislocation.
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The humeral head moves inferiorly and medially losing congruity with the glenoid cavity.
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What are the complications of an anterior shoulder dislocation?
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Hill Sachs Lesion, Bank Hart Lesion
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What is a Hill Sachs lesion?
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A hatchet defect occurs at the post lateral aspect of the humeral head.
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What is a Bank Hart lesion?
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A compression fracture of the anterior aspect of the inferior rim of glenoid.
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Describe the radiographic appearance of a posterior shoulder dislocation
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The humeral head moves superiorly leaving an empty glenoid sign. The internal rotation of the humerus causes a light-bulb appearance.
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What are the complications of a posterior shoulder dislocation?
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Trough Sign, Bank Hart lesion
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What is a Trough Sign?
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A compression fracture of the anterior medial aspect of the humeral head.
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What Bank Hart Lesion occurs from a posterior dislocation?
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A compression fracture of the posterior aspect of the glenoid rim.
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Which area of the humerus is most commonly fractured?
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The midshaft
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Describe positive fat pads
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When posterior fat pads are visible, this is indicative of a joint effusion which is when blood and fat leaves the bone entering the joint. This is suggestive of a fracture which is not always visible. An occult fracture can be called.
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Describe a normal anterior humeral line.
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The humeral condyles are normally anteriorly placed by a 1/3 with respect to the humeral shaft.
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Describe a normal radio-capitellar line
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This line bisects the proximal radial shaft to intersect the capitellum.
If this is not the case, it is evident of radial head dislocation. |
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In a childs elbow, what are raised fat pads evident of?
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A supracondylar fracture.
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In an adults elbow, what are fat pads suggestive of?
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A Radial head fracture
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What is a Galeazzi fracture?
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A fracture of the radial shaft at the junction of mid/distal 1/3. The distal fracture fragment is usually oblique with angulation.
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What is a Colles fracture?
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A transverse (impacted) fracture of the distal radius, the distal fracture fragment is usually radially and dorsally displaced. There is usually an ulnar styloid avulsion fracture.
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What is a Smiths fracture?
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A reverse colles fracture.
A fracture of the distal radius which sometimes extends into the radio-carpal joint. The distal fracture fragment is usually angled volarly. |
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Which portion of the scaphoid is most commonly fractured?
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The waist
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What complications arise from a waist of scaphoid fracture?
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The blood supply to the proximal pole enters at the waist. Hence a fracture here disrupts blood flow. If left untreated, this can lead to avascular necrosis.
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What is the 2nd most commonly fractured carpal bone?
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Triquetral
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What is the uniform distance between carpal bones?
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2mm
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What shape is the trapezoid seen as in a PA image?
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Lunate
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Describe a lunate dislocation.
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The lunate axis is angled away from the distal
radial articular surface but still maintains contact. The Capitate remains in normal alignment with the radius. The lunate appears triangular on the PA image, with the apex pointing distally. |
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Describe a peri-lunate dislocation.
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The lunate and the distal radius are in normal alignment.
The capitate is dislodged (usually dorsally). There is a possible tilt of the lunate. PA image shows overlapping of both rows of carpal bones. |
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Describe a transcaphoid-peri-lunate dislocation.
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The lunate and distal radius are in normal alignment.
The capitate is dislodged dorsally from the lunate. There is overlapping of all the carpal bones. There is an associated Trans-Scaphoid Fracture. |
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Where is the anterior fat pad located?
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Coronoid Fossa
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Where is the posterior fat pad located?
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Olecranon Fossa
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Where are the collateral ligaments?
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There are inserted radially and ulnarly at the base of the phalanges.
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Where is the extensor tendon?
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Inserted at the base of the phalange on the dorsal aspect.
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Where is the Volar Plate?
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It is at the base of the phalange on the Volar aspect.
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What are the 3 rings of the pelvis?
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The pelvic brim and the two obturator foramen.
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What width are the SI Joints in adults?
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2-4mm
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What width is the symphysis Pubis in adults?
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5mm
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What is considered a low velocity MOI for pelvic injury?
Describe the features of an injury. |
A fall
Soft tissue damage is rare, commonly a pubic rami #. |
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What is considered a high velocity MOI for pelvic injury?
Describe the features of this injury. |
RTA
High level of tissue damage, widenened SI/PS, #s |
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What is the normal angle of the femoral head and neck?
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125-135 degrees
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What is Valgus with regards to the femur?
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The femoral head and neck create an angle of 150 degrees.
The femoral head displaces away from the midline. |
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What is Varus with regards to the femur?
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The femoral head and neck create an angle of 90 degrees.
The femoral head displaces towards the midline. |
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What classification system is used to assess the severity of intracapsular NOF fractures? (Mainly sub capital #s)
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The Garden Classification System (I-IV)
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What are the three intracapsular fractures that affect the NOF?
Superior > Inferior |
Sub-capital, Trans-cervical, Basi-cervical
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What are the two extra capsular fractures that affect the NOF?
Superior > Inferior |
Intra-trochanteric, Sub-trochanteric
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What are the three directions that a MOI can
occur? |
Antero-Posterior compression
Lateral compression (Most common) Vertical force |
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Describe the injuries that occur from an AP compression of the pelvis.
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Mild symphysis pubis disruption
Severe pubic rami fractures If symphysis pubis>2.5-5mm - the SI ligaments avulse the iliac crests. This causes 'sprung' pelvis. |
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Describe the injuries that occur from a lateral compression of the pelvis.
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Compression # of the sacrum.
Horizontal # of the pubic rami. Possible central dislocation of the hip joint. |
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Describe the injuries that occur from a vertical force to the pelvis. E.g. a fall from a height
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The hemi pelvic displaces upwards and towards the midline.
Vertical # of the sacrum Disruption of the SI and SP ligaments. |
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What is considered a stable pelvic fractures?
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Avulsion #
Duverney # Unilateral - Ischiopubic rami # Bilateral - ischiopubic rami # |
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Where can avulsion injuries occur in the pelvis/hips?
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ASIS, AIIS, Ischial Tuberosity, Greater Tuberosity, Illiac Crest.
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What is considered an unstable pelvic fracture?
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Malgaigne #
Straddle # Bucket Handle # Unilateral dislocation Bilateral dislocation |
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What are the three forms of hip dislocation?
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Posterior
Anterior Central |
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Describe a posterior hip dislocation.
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The femoral head moves superiorly.
This is the most common. (80-90%) |
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Describe an anterior hip dislocation.
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The femoral head moves inferiorly.
This accounts for 5-20%. |
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Describe a central hip dislocation.
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The femoral head moves medially.
This accounts for 5% |
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Describe the stages of the Garden Classification System.
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I - Undisplaced, incomplete fracture through the NOF
II - Undisplaced, complete fracture through NOF III - Slightly displaced, complete fracture IV - Severely displaced, complete fracture. |
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Which part of the femur is most commonly fractured?
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The medial 1/3
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Describe the assessment line used at the knee.
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A line runs from the femoral condyle to the tibial condyle.
No more than 5mm of the tibia should lie beyond this line. |
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What MOI is normally associated with a patella #?
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A direct blow
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Which type of # usually occurs in the patella?
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Transverse
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Describe Lipohaemarthosis.
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Visible on a HBL image.
The dark shadowing lies along the top (fat) and the light shadowing (blood) along the bottom of the joint effusion. Indicative of a joint effusion thus a fracture |
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Why is there rarely an isolated fracture in the
tibia/fibula? |
The tibia and fibula form a ring shaped structure so a # tends to cause a 2nd #.
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Describe the webber classification system
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Used to assess the lateral malleolus (distal
fibula). A= # below level of Talar dome (Stable) B = # at the level of Talar dome (Unstable) C = # above Talar dome (Very Unstable) |
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What angle is used to assess the presence of a fracture by the calcaneous?
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The Boehers angle should be 30-40 degrees.
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What review lines are used for the tarsals/MT's.
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1) Medial margin of the 2nd MT should be in line with the medial margin of the intermediate
cuneiform on the DP image. 2) Medial margin of the 3rd MT should be in line with the lateral cuneiform on the DP image. Indicative of dislocation if these are not in alignment. |
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What are the two types of base of MT
dislocations? |
Divergent
Homo lateral |
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Describe a divergent dislocation of MTs. |
There is lateral displacement of 2nd-5th MT and medial displacement of 1st MT.
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Describe homolateral dislocation of MTs.
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All MT's involved are displaced in the same
direction. (normally laterally) |
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Which tendon causes an avulsion of the 5th MT?
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Peronious Brevis.
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What is common MOI for toe #?
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Striking furniture/stubbing toes.
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What is common MOI for dislocating MT's?
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Falling off a horse with feet in stirrups.
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How can a stress fracture be identified?
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Diffuse area of sclerosis and localised
periosteal reaction. |
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Where does a stress fracture normally occur in the lower limb?
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Tibia, Calcaneus, Metatarsals, NOF, Talus
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What are the five alignment lines used? |
1. Prevertebral line - assesses soft tissue. 2. Anterior Spinal line 3. Posterior Spinal line 4. Spino-laminar line 5. Spinous process line. |
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Where does the most common fracture occur in the C-Spine? |
C5/C6 |
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Where in the C-Spine carries the most force? |
C4-C7 |
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What features would class the C-Spine as unstable? |
Vertebral displacement Widening of apophyseal joints Widening of the vertebral canal Widening of the interspinous spaces Disruption of posterior vertebral body lines. |
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What could soft tissue swelling be indicative of? |
Haemorrhage due to the damage of the anterior ligaments. |
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What is the guideline for soft tissue anterior to C1-C4? |
There should be no more than 7mm or 30% of the vertebral body width in front of the spine. |
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What is the guideline for soft tissue anterior to C6? |
There should be no more than 22mm or 100% of the vertebral body width in front of the spine. |
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What is included in the anterior spinal column of the C-Spine? |
Anterior 2/3rds of the body and anterior longitudinal ligament. |
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What is included in the middle spinal column of the C-Spine? |
Posterior 1/3rd of the body and posterior longitudinal ligament. |
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What is included in the posterior spinal column of the C-Spine? |
The pedicles, laminae and spinous processes. |
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Which column is considered crucial in the three-column theory? |
The middle column. When it is intact, the spine is considered stable. When it is disrupted, the spine is considered unstable. |
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Which MOI causes anterior wedging due to force being placed on C4-C7? |
Hyperflexion |
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Which MOI causes tension in the anterior longitudinal ligament of the C-Spine? |
Hyperextension |
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Which MOI causes the intervertebral disc to explode into the vertebral body? |
Axial loading/compression. |
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How does whiplash appear on an image? |
The spine appears straightened due to muscle spasm. There is normally intervertebral disc injury but not fractures or dislocation. |
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Describe a Burst fracture. |
The intervertebral disc explodes into several fragments resulting in a fragment being driven into the spinal canal. |
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How should lateral masses appear on an open mouth AP? |
The lateral masses should overlap C1 and C2. |
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What is a unilateral facet dislocation? |
A shift less than 25%. The dislocation causes one vertebrae to rotate on another, becoming displaced anteriorly. |
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What is a bilateral facet dislocation? |
A shift less than 50%. As distraction increases, the facets become dislocated and there is widening of spaces between spinous processes. |
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What is included in the anterior column of the thoraco-lumbar spine? |
The anterior longitudinal ligament, anterior annulus and anterior portion of the vertebral body. |
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Where should the paraspinal line be visible? |
It is the soft tissue shadow closely applied to the left side of the vertebral bodies. |
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What MOI results in a wedge fracture? |
Compression plus flexion. |
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What MOI causes a chance fracture? |
Deceleration when the victim is wearing a seatbelt. |
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Why is a chance fracture considered highly unstable? |
The fracture line is horizontal which results in disruption of all three columns. |
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What is Spondylosis? |
OA of the lumbar spine, there is narrowing of the intervertebral disc and posterior displacement of the vertebrae above. |
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What is Spondylolysis? |
A defect in the neural arch of the 5th Lumbar Vertebrae. |
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What is Spondylolithesis? |
The spontaneous displacement of a vertebral body under the segment below it. Caused by a congenital defect, a defect or by OA/Spondylosis. |
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How much wedge fractures have associated injuries? |
20% have associated injuries such as calcaneus fracture or sternum fracture. |
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What other modalities are used to assess the spinal cord? |
CT is used to demonstrate body fractures and fragments in the spinal cord. MRI is used to demonstrate any impingements on the spinal cord and its stability. |
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What is lipohaemarthosis indicative in a paediatric elbow? |
A supracondylar fracture |
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What is the mid shaft called in a paediatric bone? |
The diaphysis |
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What are the radiographic appearances in a slipped epiphysis? |
The visualisation of a lucent line and a step in the cortex. The epiphysis and diaphysis will have slipped out of their normal position. |
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What paediatric fracture is most common? |
A complete fracture. |
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What is a tri-plane fracture? |
Fractures seen to affect the epiphyseal plate, epiphysis and metaphysis. |
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What is an epiphysis? |
The epiphyseal plate in the portion of the bone that grows through childhood. Basically consists of cartilage that hardens into bone. |
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What is an apophysis? |
A type of growth plate that occurs at the end of the bone, when there are no bones on the other side. |
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What is the complication of an epiphyseal or apophyseal injury? |
Growth disturbance. |
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What are the two main forces of epiphyseal/apophyseal joint? |
Shearing/avulsion or Splitting/compressive |
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What area of the paediatric bone is the Salter Harris classification used for? |
The involvement of the cartilaginous growth plate and the adjacent metaphysis and epiphysis. |
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Which Salter Harris Grade is the most common? |
Type II affects 75% |
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Describe a Salter Harris Type I. |
A fracture of the growth plate where the epiphysis may slip. |
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Describe a Salter Harris Type II. |
A fracture of the growth plate and the metaphysis above. |
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Describe a Salter Harris Type III. |
A fracture of the growth plate and the lower epiphysis. |
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Describe a Salter Harris Type IV. |
A fracture through the growth plate, metaphysis and epiphysis. |
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Describe a Salter Harris Type V. |
A crush fracture of the growth plate where the epiphysis and metaphysis are rammed together. |
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What is the MOI for a Salter Harris Type V? |
Axial Loading e.g. jumping from a balcony. |
