77 | Lower Extremity Fractures

Front 1

two views you must obtain in radiography

Back 1

orthogaonal and AP/Lateral

Front 2

stress view is important in evaluating this in radiography -

Back 2

ligamentous tears

joint stability

Front 3

ultrasound is used to evaluate -

Back 3

soft tissue, ligaments, tendons, muscle, and nerves

Front 4

CT is used to evaluate -

Back 4

complex fractures of the spine, pelvis and scapula

Front 5

one advantage of CT over conventional radiography is that -

Back 5

excellent contrast and 3D reconstruction

Front 6

bone scintigraphy involves -

Back 6

injection of radioactive material into vein and it travels through blood to bone/organs. gives radiation detected by camera.

Front 7

bone scintigraphy is useful in detecting -

Back 7

occult fractures or those that are too subtle to be seen on normal xray

Front 8

bone scintigraphy is helpful in distinguishing -

Back 8

non-infected and infected fractures

bone cancer

Front 9

angiography

Back 9

radio-opaque agent into blood vessel and image with x-ray

Front 10

angiography is used to evaluate

Back 10

arteries ad veins

Front 11

MRI used for

Back 11

spinal imaging, ligament assessment, tendon, muscle, bone, soft tissue tumors

Front 12

MRI is used more preferentially then --- because it --

Back 12

CT

no ionizing radiation.

Front 13

classes of bone -

Back 13

long

short

flat

sesamoid

irregular

Front 14

examples of each class of bone -

Back 14

long - femur

short - carpals

flat - sternum

sesamoid - patella

irregular - vertebrae

Front 15

long bone fractures are described by referring to -

Back 15

the direction of the fracture line in relation to the shaft of the bone.

Front 16

Back 16

long bone fracture

transverse fracture

Front 17

transverse fracture is described as -

Back 17

perpendicular fracture across the bone shaft

Front 18

Back 18

oblique long bone fracture

Front 19

oblique long bone fractures are -

Back 19

fractures passing at an angle oblique to the shaft of the long bone.

Front 20

Back 20

spiral long bone fracture

Front 21

spiral long bone fracture is -

Back 21

from a twisting injury

line spirals along shaft of the long bone.

Front 22

Back 22

sagittal plane fracture of the tibia

Front 23

sagittal plane fractures of long bones are described as -

Back 23

fracture passing along the shaft of a long bone.

described in reference to the plane in which it passes.

Front 24

fractures of irregular bones require -

Back 24

description determined by direction through the bone

Front 25

in irregular bone fractures, this is commonly seen -

Back 25

fracture seen passing through many directions.

Front 26

Back 26

coronal and axial fracture of irregular bone

Front 27

comminuted fracture

Back 27

fracture resulting in more than two separate bone components

Front 28

Back 28

comminuted fracture

Front 29

butterfly comminuted fracture

Back 29

two oblique fractures forming what looks like a butterfly fragment

Front 30

Back 30

comminuted butterfly fracture

Front 31

segmental comminuted fracture

Back 31

segments of bone have separated from both proximal and distal portions of shaft

Front 32

Back 32

segmental comminuted fracture

note: prox and distal portions of fibular and tibial shaft

Front 33

fracture displacement is defined in terms of -

Back 33

defined in terms of the abnormal portion of distal fracture fragment in relation to the proximal bone

Front 34

fracture displacement is defined AS -

Back 34

loss of alignment or displacement

accompanied by some degree of angulation, rotation or altered bone length

Front 35

Back 35

fracture displacement- combined.

-oblique fracture of the humerus

-midshaft

-lateral displacement

-shortening

-valgus angulation

-internal rotation

Front 36

shortening with a fracture occurs when -

Back 36

proximal migration of the displaced bone occurs (displaces to the side and up)

Front 37

this fracture is more readily shortened -

Back 37

oblique as compared to transverse

Front 38

can a fracture be displaced without shortening?

Back 38

YES

Front 39

angulation of a fracture -

Back 39

break and then moves left or right but stays in the same general place e-

Front 40

medial angulation can be termed -

Back 40

varus

Front 41

lateral angulation can be termed -

Back 41

valgus

Front 42

fracture rotation occurs -

Back 42

when one part of the bone rotates compared to the other - heart to pick up without landmarks

Front 43

fracture distraction occurs -

Back 43

increased overall bone length due to widening of space between bone parts

Front 44

fracture impaction occurs -

Back 44

when shortening of bone without loss of alignment - components driven into each other.

Front 45

most bones develop from -

Back 45

cartilaginous ossification centers

Front 46

diaphysis

Back 46

shaft

Front 47

epiphysis

Back 47

end

Front 48

during growth ----- separates the diaphysis and epiphysis

Back 48

epiphyseal plate

Front 49

metaphysis

Back 49

zone adjacent to the growth plate on the diaphyseal side

Front 50

sesamoid bone

Back 50

bone that ossifies within a tendon.

Front 51

largest sesamoid bone

Back 51

patella

Front 52

sesamoid bones are common here -

Back 52

metatarsophalangeal joint (big toe)

metacarpophalangeal joint (thumb)

Front 53

apophysis

Back 53

normal developmental outgrowth of a bone which arises from a separate ossification center.

Front 54

apophysis usually does not -

Back 54

form direct articulation with another bone at the joint

Front 55

apophysis will often form -

Back 55

insertion point for tendon or ligament

Front 56

apophysis is most common in -

Back 56

children

Front 57

bone is made of -

Back 57

outer cortex and inner medulla

Front 58

cortex is -

Back 58

denser and whiter

Front 59

medulla is -

Back 59

less dense and darker/radiolucent

Front 60

most joints are considered -

Back 60

synovial

Front 61

most joints are composed of -

Back 61

articulating bones lined with hyaline cartilage and contained by synovial capsule

Front 62

approach to looking at x-rays

Back 62

patient and image data

bone and joint aligment

joint spacing

cortical outline

bone texture

soft tissues

Front 63

when looking at images, the first thing you want to do is to

Back 63

check to make sure you are looking at the correct images.

Front 64

loss of bone alignment can be due to -

Back 64

bone fracture

joint dislocation

Front 65

Back 65

loss of bone alignment at middle toe metatarsophalangeal joint due to dislocation

Front 66

joint space may be narrowed due to

Back 66

cartilage loss

Front 67

joint space may be widened due to

Back 67

dislocation or dissociation

Front 68

Back 68

longstanding foot pain

osteoarthritis of 1st MTP joint

large osteophytes sign of osteoarthritis

Front 69

Back 69

fractured ring finger

boxer's fracture

Front 70

trabeculae

Back 70

fine matrix of white lines

Front 71

distortion of trabecular pattern may indicate

Back 71

abnormality!

Front 72

joint effusion

Back 72

contains fat and blood that has leaked from bone following trauma

Front 73

lipohaemarthrosis

Back 73

fat and blood

Front 74

Back 74

tibial plateau fracture

note fat and blood

Front 75

Back 75

twisting injury

unable to bear weight

lat malleolus tender

olbique fracture of distal fibula and level of ankle joint

Front 76

Back 76

irregular outline of cortical right femoral head

groin pain post fall

shortened, ext rotated right leg.

fractured neck of right femur

Front 77

fractures of proximal femur are common in -

Back 77

eldery osteoporotic patients

Front 78

if a fracture is not displaced, these might not show -

Back 78

shortened and externally rotated leg.

Front 79

shenton's line

Back 79

formed by medial edge of femoral neck and inferior edge of superior pubic rams

Front 80

loss of contour of shenton's line indicates -

Back 80

fracture neck of femur

Front 81

fractures of femoral neck do not always cause -

Back 81

loss of Shenton's line

Front 82

Back 82

Front 83

proximal femoral fractures either involve -

Back 83

bone enveloped in ligamentous hip joint capsule or bone below the capsule

Front 84

intracapsular vs. extracapsular

Back 84

proximal femoral fracture

intra - enveloped by joint capsule

extra - below capsule

Front 85

intracapsular fractures

Back 85

subcapital

transcervical

basicervical

Front 86

extracapsular fractures

Back 86

intertrochanteric

subtrochanteric

NO INVOLVEMENT OF FEMORAL NECK!

Front 87

subcapital intracapsular fracture

Back 87

disrupted shenton's line.

increased femoral neck density - overlapping impacted bone.

prominent lesser trochanter

Front 88

Back 88

subcapital intracapsular fracture

Front 89

garden classification system

Back 89

assesses severity of femoral neck fractures.

more displaced, more likely blood supply is compromised.

Front 90

Back 90

garden IV complete fracture

no shentons

total displacement.ext

Front 91

extracapsular fractures do not involve

Back 91

femoral neck

Front 92

Back 92

extracapsular fracture

intertrochanteric

Front 93

intertrochanteric fracture

Back 93

runs between trochanters

comminutin and separation of lesser trochanter

NO FEMORAL NECK

Front 94

Back 94

subtrochanteric fracture

Front 95

subtrochanterc fracture

Back 95

distal to trochanters

femoral neck in tact.

Front 96

femoral shaft fractures are typically from -

Back 96

high force impact

Front 97

femoral shaft fractures result in -

Back 97

highly displaced fractures that are easily recognized.

Front 98

fracture of femoral shaft without history of high force trauma, think -

Back 98

pathology

Front 99

Back 99

femoral shaft fracture

Front 100

knee fractures viewed in the --- view because it -----

Back 100

AP view

allows for effusions to be visualized in supra patellar pouch

Front 101

Back 101

Front 102

this view is useful for visualizing knee fractures

Back 102

horizontal beam lateral view

Front 103

knee joint effusion is indicated by -

Back 103

widening of fat pads or increased density in the area.

Front 104

Back 104

Front 105

sunrise view

Back 105

patella view

Front 106

sunrise view is only necessary if -

Back 106

standard views are normal but patellar fracture is still suspected.

Front 107

sunrise view can only be done if -

Back 107

knee flexion can be tolerated.

Front 108

tibial plateau fractures

Back 108

subtle. varying degrees of displacement or comminution

Front 109

formation of ---- is the only radiological sign of a tibial plateau fracture

Back 109

lipohaemarthrosis

Front 110

lipohaemarthrosis

Back 110

layered effusion of fat and blood which has leaked from bone following a fracture.

Front 111

Back 111

tibial plateau fracture

Front 112

Back 112

Front 113

view patellar fractures most often seen on -

Back 113

lateral view

Front 114

Back 114

Front 115

fabell

Back 115

normal sesamoid bone of lateral head of gastrocnemius tendon. not mistaken for fracture or loose body.

Front 116

Back 116

fabella of knee

Front 117

bipartite patella

Back 117

patella in two parts. injury to the interface is possible.

Front 118

Back 118

bipartite patella

Front 119

tibia and fibula fractures require -

Back 119

high force impact

Front 120

stress fractures can occasionally cause -

Back 120

chronic tibial pain

Front 121

stress injuries due to -

Back 121

repeat low force trauma to normal bone.

Front 122

Back 122

comminuted fracture of tibial and fibular shafts with medial displacement and posterior angulation

Front 123

tibial stress fracture

Back 123

periosteal stress reaction - signs of stress injury.

Front 124

Back 124

periosteal stress fracture

Front 125

Toddlers Fracture

Back 125

spiral tibial fracture in young children

associated with twisting injury.

refusal to bear weight

little/no displacement

subtle fracture line.

Front 126

Back 126

toddlers fracture

Front 127

ankle x-ray is only needed if -

Back 127

pain in alleolar zone +

bone tenderness in A -or- B -or- can't bear weight ASAP and in ED

Front 128

foot x-ray series only needed if -

Back 128

pain in midfoot +

tender in C -or- D -or- can't bear weight

Front 129

mortise view

Back 129

AP ankle view. not true view because it is a bit oblique

Front 130

three bones of the ankle joint

Back 130

tibia

fibula

talus

Front 131

ankle fractures usually involve the -

Back 131

distal tibia

distal fibula

Front 132

Back 132

Front 133

weight bearing portion of ankle formed by -

Back 133

tibial plafond

talar dome

Front 134

Back 134

Front 135

weber fracture

Back 135

classification for ankle fracture.

Front 136

Weber Classification:

A

B

C

Back 136

A = distal to ankle joint

B = at level of ankle joint

C = proximal to ankle joint

Front 137

bimalleolar fracture

Back 137

transverse medial malleolus fracture.

lateral malleolus fracture at level of ankle joint.

joint widened medially due to lateral displacement.

Front 138

Back 138

bimalleolar fracture

Front 139

trimalleolar fracture

Back 139

medial malleolus

lateral malleolus

posterior malleolus

unstable joint and widened anteriorly

talus displaced posteriorly and laterally along medial and lateral malleolus bone fragments

Front 140

Back 140

trimalleolar fracture

Front 141

maisonneuve fracture

Back 141

proximal fibula associated with injury to medial side of the ankle. disrupts tibiofibular syndesmosis.

Front 142

key components of maisonneuve fracture

Back 142

- disruption of medial ankle joint

- disruption of distal tibia-fibular syndesmosis

- no fibular fracture

- talus translation

Front 143

maisonneuve fracture

proximal tibia-fibula

Back 143

spiral fracture of proximal fibula

Front 144

osteochondral fracture

Back 144

fracture of talus bone surface

subtle. assess carefully.

Front 145

calcaneal fractures due to -

Back 145

falling from a height.

they are hard bones to fracture Bo

Front 146

calcaneal fractures are often -

Back 146

comminuted and intra-articular

Front 147

Bohler's Angle

Back 147

severe injury may result in flattening of calcaneus which decreases this angle.

formed by the intersection of two lines -

upper edge of calcanea bone posteriorly to upper edge of posterior articular facet of the calcaneus at the subtler joint then draw to upper edge of anterior process of calcaneus.

Front 148

Bowler's Angle is normally -

Back 148

28-40 degrees.

Front 149

hindfoot is composed of -

Back 149

calcaneus and talus

Front 150

midfoot is composed of -

Back 150

navicular + cuboid + cuneiform

Front 151

forefoot is composed of -

Back 151

metatarsals +phalanges

Front 152

big toe =

Back 152

toe 1

Front 153

lisfranc injury

Back 153

lisfranc ligament - stabilizes mid-forefoot junction.

loss of alignment of 2nd metatarsal base with intermediate uniform indicates injury to this important ligament

2nd metatarsal displaced from intermediate cuneiform

Front 154

phalanx fracture

Back 154

heal quickly w/o much mobilization

buddy taping

2-3 weeks off of running

Front 155

metatarsal shaft fracture

Back 155

oblique fracture of 5th metatarsal shaft

Front 156

5th metatarsal base fracture

Back 156

three types:

- styloid [heals well]

- metaphyseal-diaphyseal junction

- proximal diaphysis

Front 157

jones fracture

Back 157

metaphyseal - diaphyseal junction

does not heal well.

non-union

-avascular zone

Front 158

meta-tarsal stress fracture

Back 158

common in athletes.

fusiform bone expansion

suble periosteal stress reaction of metatarsal.