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170 Cards in this Set
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Burst fracture of Atlas
MOI Imaging |
Jefferson Fracture
axial loading-compression APOM |
http://handbook.muh.ie/trauma/spinal/Images/Cx_Jefferson_Peg.jpg
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50% of all atlas fractures
usually bilateral MOI Imaging |
Posterior Arch of Atlas
hyperextension cervical lateral projection |
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Uncommon less than 2% of cervical fractures
hyperextension cervical lateral projection CT for diagnosis |
Anterior arch of atlas
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Persistent pathological fixation of atlantoaxial joints
M/C in children "cock Robin", torticollis imagining |
Rotary subluxation of atlas
APOM |
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traumatic spondylolisthesis, Bilateral avulsion of neural arches from vertebral body considered unstable
Hyperextension Lateral neutral projection |
Hangman's FX
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avulsion of tip of dens by alar ligament
DDX OS Terminale of Bergman |
Type 1 odontoid fracture
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m/c odontoid fracture 60%
fx thru base of dens may remain united unstable DDX Os Odontoideum |
Type II odontoid fracture
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most often occur C2
triangular fragment at anterior portion of vertebral body hyperflexion most unstable fx of cervical spine |
teardrop fx
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m/c seen at c6-7
ct best moi: hyperextension w/ lateral flexion/rotation |
articular pillar fx
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AKA root pullers
avulsion fx of SP of C7 Hyperflexion injury double spinous sign |
clay shovelers
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acquired congenital damage to transverse ligament
"guillotine effect to cord" hyperflexion increase in atlantodental interval |
atlanto axial dislocation
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stable lesion moi hyperflexion w/ rotation c4-c7
"bow tie sign" abrupt rotation of vertebrae fanning of SP's |
unilateral facet dislocation
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unstable lesion moi hyperflexion c4-c7
narrowed disc space abrupt rotation of vertebrae fanning of SP's cord damage common anterolisthesis |
bilateral facet dislocation
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m/c fx of thoracolumbar spine T11-L2
hyperflexion w/ slight axial compression typically osteoporosis wedge deformity step defect abdominal ileus can occur |
compression fracture
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severe axial loading w/flexion
neurological deficits d/t retropulsion of fragment unstable middle column involved |
burst fx
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zone of impaction
band of radiopacity beneath endplate |
line of condensation
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transverse fx thru SP and neural arch that extends into and possibly thru vertebral body
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seatbelt fx
aka fulcrum fx or chance fx |
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2nd m/c fx of lumbar spine L2-3
stable multiple levels avulsion fm hyperextension w/lateral flexion ddx; bowel gas overlying |
TVP FX
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displacement of one vertebral segment in relation to the segment inferior
interruption of lamina at pars interaraticularis w or w/o slippage "scotty dog" Napolean's inverted hat sign bowline of brailsford |
spondylolisthesis
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usually result of fall on buttocks or direct trauma
suicidal jumper's fracture affecting S1-S2 fm high fall |
horizontal (transverse) sacral fx
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usually result of indirect trauma
greater than 50% suffer pelvic organ damage ped. mva's, skiing seen on frontal views |
vertical sacral fx
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Iliac wing
direct force in lateral manner stable fx |
Duverney's fx
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double vertical fx superior and inferior pubic rami w/fx/dislocation of ipsilateral SI joint
M/C pelvic fx rupture of diaphragm and bowel high mortality |
Malgaigne fx
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double vertical fx of the superior and inferior pubic rami with fx/dislocation of the contralateral S/I Joint
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Bucket handle Fx
See book for drawing |
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avulsed sartorius muscle
relieved by hip flexion ages 16-20 common in sprinters |
ASIS avulsion fx
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less common than ASIS
contractrion of the rectus femoris hip flexion painfully limited rugby and soccer players |
AIIS avulsion fx
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avulsion of the secondary growth center from the hamstring muscle group
acute or chronic frequently bilateral cheerleaders, hurdlers, horse back riders |
Rider's bone (fragment name)
Ischial Tuberosity |
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usually follows blow to knee while leg is in flexion and adduction
occurs with posterior hip dislocation 1/3 of all acetabular fxs |
Posterior rim fx AKA dashboard fx
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divides the innominate bone into superior and inferior halves
in transverse type bisects ischial spine in oblique type extends posterosuperiorly into sacrosciatic notch often w/central femoral head dislocation AKA explosion fx |
central acetabular fx
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comminuted fxs of the pubic arches
unstable fx displaces posteriorly-superiorly bladder rupture and urethral tear in 20% double vertical fxs, superior & inferior pubic rami bilaterally |
Straddle fx
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shearing separation of pubic articulation
normal adult (non-preagnant) 8mm normal child 10mm associated w/unilateral SI joint dislocation |
pubic diastasis
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any fx proximal to the trochanters
avn an incidental fm 8-30% depending on degree of displacement nonunion occurs as high as 25% of displaced fxs |
intracapsular femur fracture
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involving junction of femoral neck/head
m/c femoral neck fx maybe difficult to visualize readily overlooked d/t lack of displacement |
intracapsular subcapital
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outside joint capsule
AVN and nonunion uncommon trochanteric -avulsion of greater trochanter m/c in elderly after fall Lesser trochanter avulsion m/c in kids and young athletes most Lesser are pathological secondary to metastatic lesions |
extracapsular femur fx
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avulsion of greater trochanter most often in elderly after fall
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extracapsular trochanteric fxs
greater trochanter |
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avulsion lesser trochanter m/c in children and adolescent athletes
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extracapsular trochanteric fx
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found in region 2 inches below lesser trochanter
overall uncommon common in women taking boniva (bisphosphanate) (osteoporosis) |
extracapsular subtrochanteric fx
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aka adolescent coxa vara, epiphyseal coxa vara
salter harris I injury/fx slipping of femoral neck on the head as the head remains in the acetabulum peak ages 13 yrs m 12yrs f blacks>whites Left hip>right hip M>F bilateral in females Must include both ap and frog leg views bilaterally |
Slipped Capital femoral epiphysis (SCFE)
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result of severe trauma
usually MVAs 85% occurs when hip flexed following blow to knee may cause posterior rim fx in 90% |
Posterior hip dislocation
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caused by forced abduction and extension of femur
femoral head usually lies caudal and medial near obturator foramen |
anterior hip dislocation
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most injuries occur as a result of axial loading w/ valgus/varus stress and rotation
commonly transverse or sl oblique injury to popiteal artery may occur occur above the condyles of the femur |
supracondylar distal femur fx
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intra-articular extension in distal femur
supracondylar combined w/vertical component y or t shaped |
intercondylar distal femur fracture
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sagittal coronal fracture lines isolated to region of a single condyle
usually oblique fragment may result in intra-articular loose body |
condylar distal femur fx
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direct or indirect trauma
indirect usually related to contraction of quads transverse m/c 50-80% indirect trauma longitudinal 25%-direct trauma stellate or comminuted 2nd m/c-direct trauma 25-30% Ischemic necrosis complication |
patellar fxs
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aka bumper's fx
impaction of femoral condyle reinforced into tibial plateau Lateral plateau m/c 80% elderly osteoporotic pts' motorcycle, ped MVA, falling in bathroom ligamentous injuries depression w or w/o vertical radiolucency |
Proximal Tibia Fracture
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site of origin of anterior cruciate ligament
hyperextension of knee w/internal rotation of tibia m/c children falling fm bike |
avulsion of anterior tibial spine
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occurs w/other injuries
m/c adolescent boys knee flexed w quad tendon contracted Osgood Schlatter's can contribute |
avulsion fx of tibial tuberosity
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occur in younger children 2-10yrs
fm jumping on trampoline' |
proximal tibial metaphysis aka trampoline fracture
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avulsion fx of bony insertion of tensor facia latta at the margin of the lateral tibial condyle
small bony flake lateral to tibia ACL tear 75-100% medial meniscus tear in 70% abnormal varus stress w/internal rotation of tibia |
segond fx
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isolated fxs rare
usually involve injuries to knee, lateral tibial plateau or ankle avulsion of biceps femoris or lateral collateral ligament may damage common peroneal nerve "ligamentous peroneal nerve syndrome" |
proximal fibula fx
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* Mixture of blood and fat in a joint cavity following trauma
* Fat from the marrow space enters the joint through intra-articular fracture * Fat is less dense than blood; therefore it layers above blood. * On x-ray, fat is less dense than blood; therefore it can be seen as different density using radiography and CT * Horizontal beam of x-ray needs to be parallel to the fat-blood interface, to be able to demonstrate the interface. * Described in intra-articular fractures of the knee, shoulder, hip and elbow. However, it is not seen in all cases of intra-articular fracture. On the other hand, it is helpful for the diagnosis of an occult fracture. |
Lipohemarthrosis
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dislocation anterior m/c results fm hyperextension of knee with tearing of posterior cruciate ligament and capsule
posterior 2nd m/c popliteal artery (25-50%) damage Peroneal nerve involvement |
femortibial joint dislocation
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direct blow or exaggerated contraction of quads
lateral displacement m/c predisposing factors patella alta,defiecient hgt of lateral femoral condyle, genu valgum, muscular weakness MRI beneficial |
patellar dislocation
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fracture below tibiotalar joint
no syndesmosis treated by close methods stable |
Danis-Weber Type A
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fracture occurs at level of tibiotalar joint
typically oblique fx requires internal fixation unstable |
Danis Weber type B
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fracture occurs above level of tibiotalar joint
typically spiral fx requires internal fixation unstable |
Danis Weber C
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m/c in either oblique or spiral fxs
result of external rotation of foot medial oblique projection |
Lateral malleolus
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fracture of both med and lat malleouli
fracture on one side typically transverse and opposite is oblique or spiral |
bimalleolar
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fx of both malleouli
fx on oneside typically transverse the opposite is usually oblique or spiral |
bimalleolar fx
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affects posterior lip of tibia plus medial and lateral malleouli
external rotation of foot fx on third "malleolus" best seen on lateral often w/ tibiotalar dislocation |
trimalleolar AKA Cotton's fx
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fx of fibula w/in 6-7cm above the lateral malleolus and rupture of distal tibiofibular ligaments of ankle
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pott's fx
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fx of distal fibula w/rupture of distal tibiofibular ligaments, diastasis of syndemosis, lateral dislocation of talus and displacement of foot upward and outward
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Dupuytren's fx
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proximal fibular fx
inversion and external rotation of ankle rupture of inferior tibiofibular syndesmosis rare to have pain in region of fx |
Maisonneuve's fx
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fx thru medial malloleus w/diastasis of distal tibiofibular syndesmosis
creates avulsion fx of ant tubercle of tibia and a fx of lateral malleolus 6-7 cm proximal to distal end of fibula |
tallaux's fx
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fx thru medial malloleus w/diastasis of distal tibiofibular syndesmosis
creates avulsion fx of ant tubercle of tibia and a fx of lateral malleolus 6-7 proximal to distal end of fibula |
tallaux's fx
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nondisplaced spiral fx of the tibia 9mos-3yrs
fall or getting foot stuck in crib |
Toddler's fx
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distal diaphyseal or methaphyseal spiral fx of tibia and fibula in an adult
adjacent to top of high boots bb fx |
boot-top fx
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m/c tarsal bone to fx
generate crushing injury falling and landing on feet 10% bilateral typically comminuted Boehler's angle is crucial in absence of visualized lines 28-40 degrees normal |
compressive calcaneal fx
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typically avulsion and spares the subtalar joint
anterior process m/c superior portion of tuberosity (beak FX) Sustenaculum tali medial/lateral surfaces |
noncompressive calcaneal fx
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2nd m/c tarsal fx
m/c avulsion fx classified by location: Talar body, talar neck, talar head complications: AVN -the more anterior the fx the more incidence |
talus fx
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linear radiolucency beneath cortex of dome good prosticator of intact blood supply
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hawkins sign
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vertical fx
2nd m/c talar neck fx impaction of anterior lip of tibia m/c cause MVA m/c complication AVN |
Aviator's fx
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involve shaft and neck of toe
vary fm oblique, transverse, spiral m/c 2nd and 3rd |
metatarsal fractures
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stress fx of metatarsals (2nd or 3rd)
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March fx
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fx at base of 5th metatarsal
one of m/c fx in foot transverse fx at proximal end of 5th MT traction fm peroneus brevis tendon or lateral cord of plantar aponeurosis |
Jones fracture aka dancer's fx
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fracture of any phalanx fm direct force hitting toe (stubbing) 1st & 5th m/c
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bedroom fx
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medial hallux sesamoid m/c
pain and swelling localized to plantar surface |
sesamoid fx
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lateral displacement of MT base as it articulates with tarsals
associated w/fx esp. at base of 2nd metatarsal divergent- lat dislocation of 2-5 w/med dislocation of 1 convergent-lat dislocation of 1-5 |
tarsometatarsal dislocation-fx
AKA lisfrancs dislocation |
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midtarsal dislocation open
separate foot at talonavicular and calcaneocuboid distal foot m/c displaces medially |
Chopart's dislocation
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uncommon in childhood
age after 30 m/c difficult to see multiple oblique projections necessary fx line may mimic other overlapping structures callus formation EXTRAPLEURAL sign pneumothorax pleural effusion subcutaneous emphysema |
rib fractures
ribs 1-3 backpacking, weightlifters ribs 4-9 m/c flail 2 fxs in same rib golfer's lateral ribs passion- rcving hug ribs 10-12 uncommon- coughing |
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m/c
SCM tends to pull medial segment up while arm weight pulls lateral segment down need ct |
middle clavicular fracture
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fracture may displace, be undisplaced, or have intraarticular extension
must determine if coracoclavicular ligament is intact |
Lateral clavicular fracture
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usually severe trauma
80% associated w/other injuries most fxs occur on neck or body (80%) avulsions can occur |
scapular fracture
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avulsion of triceps attachment on labrum following a GH dislocation
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bankhart lesion
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fracture classified by how many fragments are present
80% part 1 10% parts 2 threshold of separation 1 cm 45 degrees of fragment rotation |
humeral fractures
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impaction of head during a GH dislocation
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hill-sach deformity AKA hatchet
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impaction of head during GH dislocation
posterior dislocation anterior medial |
trough sign
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greater tuberosity may be avulsed during GH dislocation
older pts displacement >1cm requires open reduction |
flap fracture
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bilateral AC joints for comparison
a difference of 2-3mm is widening bilatterally symmetric coraclavicular distance 11-13mm norm No more than 5mm difference between sides |
ACROMIOCLAVICULAR SEPARATION
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total displacement w/marked superior displacement of distal clavicle
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AC separation type 5
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moderate sprain
widening of ac joint slight elevation of clavicle |
type II AC separation
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50% of fxs involve radial head in adults
60% of fxs in kids are supracondylar remember critoe |
elbow fxs
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95% extend to articular surface
m/c in children distal fragment may displace posteriorly use anterior humeral shaft line |
supracondylar fx
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extends between condyles and into supracondylar region
looks like a Y or T 50% of distal humerus fractures if line extends thru both condyles horizontally its transcondylar fx |
intercondylar distal humerus fx
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comminuted fxs of distal humerus associated w/ ulnar and radial fx
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sideswipe or baby car fx
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shearing off of a single condyle fm angular forces
osteochondral fragment may be sheared off the convex surface of capitellum |
condylar fracture aka Kocher's fx
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usually avulsion injuries fm traction of flexor or extensor tendons and collateral ligaments in elbow
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epicondylar
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avulsion flexor/pronator tendons
common among young baseball players from throwing pain, hesitation or catching during ROM |
Little Leaguers elbow
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20% of adult elbow fxs
2nd m/c elbow fx in adults fall on semiflexed supinated forearm m/c cause direct trauma or avulsion usually transverse seen on lateral elbow view |
Olecranon process fx
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FOOSH are the majority
radial head m/c in adults difficult to see look for fatpad sign (posterior) sail sign (anterior) 3 types: I small/nondisplaced, II larger/displaced, III comminuted |
proximal radius fx
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fracture oriented with the long axis of the bone
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chisel fracture
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comminuted fx of radial head in combo with dislocation of distal radioulnar joint
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essex-lopresti fx
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3rd m/c location in adults
m/c in children posterior m/c in almost all both radius and ulna are displaced 50% associated fxs |
elbow dislocation
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children btwn 2-5yrs
sudden jerk or pull on a toddler's pronated elbow may cause dislocation of prox radius w/ entrapment of annular ligament |
pulled elbow aka nursemaids elbow
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fx of distal radius w/dislocation of distal radioulnar joint
axial load is placed on hyperpronated arm anterior interosseous nerve palsy may develop loss pinch strength of thumb and index finger |
galeazzi aka piedmont, reversed Monteggia
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involves the proximal ulna w/ dislocation of radial head
anterior dislocation m/c both kids and adults (poor outcome) |
Monteggia
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fx of distal third or middle third of ulnar shaft
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nightstick fx aka parry fx
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direct trauma
nondisplaced fx of the radial styloid |
chauffeurs fx aka backfire, hutchinson
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distal radius fx w/posterior displacement of fragment
dinner fork deformity or silver fork FOOSH m/c women 60% have ulnar styloid fxs |
colle's fx
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less common
fall w/ hyperflexion of wrist distal radius fx w/anterior displacement of fragment garden spade deformity |
smith's fx aka reversed colle's
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intraarticular fx of posterior rim of distal radius
carpal's deviate posterior |
barton's fx AKA rim fx
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intraarticular fx of the anterior rim of the distal radius
M/C than Barton's |
reversed Barton's
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m/c fx in carpals
15-40yrs occult fx complications AVN, non-union, carpal instability, degenerative chgs 3 regions: distal pole, waist (m/c), proximal pole xray sign: fx line, scaphoid fat stripe |
scaphoid fx aka carpal navicular
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2nd m/c fx in carpals
typically dorsal avulsion of radiotriquetral ligament or lunotriquetral ligament hyperflexion lateral wrist |
Triquetrum fx aka fischer's fx
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2nd m/c wrist bone to dislocate
terry thomas sign signet ring |
scaphoid dislocation
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Metacarpal fxs 5th is m/c fx
MOI jab or roundhouse punch transverse fx of neck 2-5th |
AKA boxer/ bar-room fx
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m/c 3rd and 4th digit fx
MCP |
shaft fx
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fracture-dislocation
intraarticular fx of the MCP base w/dorsal and radial displacement of shaft gripping handlebars |
bennett's fx
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comminuted bennetts
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rolando fx
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shaft m/c
avulsion of volar plate of middle phalanx |
volar plate or chip fx
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1st MCP joint
avulsion of ulnar collateral ligament |
gamekeeper's thumb aka ski pole fx
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uncommon
seen on external oblique projection on frontal, medially displaced ilioischial line separated fm teardrop |
Simple Posterior column fx
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best visualized on internal oblique view
loss of continuity of iliopubic line & medial displacement of teardrop terminates anywhere along pubis or ischioppubic junction |
simple anterior column fx
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major adductor mm causing tearing of bone fm superior & inferior pubic rami near articulation
soccer players |
Symphysis pubis avulsion fx
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severe injury
complete separation of symphysis pubis & one or both SI joints visceral damage can occur |
sprung pelvis AKA open book pelvis
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uncommon in young or middle aged pts
predisposing factors: Paget's Osteoporosis, Osteomalacia polyostotic, F>M 2:1 Avg age 70 many die w/in 6mos fm pulmonary or cardiac complications |
Proximal femor fxs
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fx through midportion of femoral neck
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Mid-cervical Intracapsular proximal femoral fx
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m/c pathological
traversing base of femoral neck & junction w/trochanters |
Basocervical Intracapsular proximal femoral fx
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Proximal femoral
usually comminuted oblique fracture line splits trochanters |
Extracapsular Intertrochanteric fx
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Radiographic features of SCFE
1.Medial epiphyseal "beaking" 2.lateral buttressing of femoral neck 3. metaphysis lateral to acetabulum 4.curved contour deforms head/neck junction |
1. parrot's beak appearance
2. herndon's hump 3. Capener's sign 4. pistol grip deformity |
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considered osteochondrosis secondary to abnormal stress
M/C boys 11-15 yrs unilateral but 25% bilateral pain and tenderness at tibial tuberosity, soft tissue swelling at site |
Osgood-Schlatter's
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unusual injury
anterolateral m/c fall or twisting injury skydiving, horseback riding,parachuting peroneal nerve injury appear after |
proximal tibiofibular dislocation
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Suppination-adduction (SA)
Suppination-external rotation (SER) Pronation-abduction (PA) Pronation-external rotation (PER) |
Lauge-Hansen System of ankle fractures
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Less than 15% of routine ankle series demonstrate fxs so use these rules: ankle pain & one of following: bone tenderness along distal 6 cm of tibia or tip of medial malleolus
bone tenderness alongdistal 6cm of fibula or tip of lateral mallelous instability to bear wght for four steps both immediately and in clinic |
ottawa ankle rules
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usually transverse or oblique
fxs distal to tibiotalar line ( plafond) more stable seen on AP xrays |
Medial Malleolus
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Fx involving both tibia and fibula or radius and ulna
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BB fx (both bone fx)
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usually accompanied by malleolar fxs
talus may dislocate 1,2,or 3 of its articulations |
ankle dislocation
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results fm force that displaces tibia posteriorly on a fixed foot
all ligamentous attachments are torn foot slightly dorsiflexed appears elongated anteriorly may have absent dorsal pedis pulse |
anterior ankle dislocation
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occurs more often than anterior
follows blow to posterior aspect of tibia result in plantar flexion of ankle w/ apparent shortening of foot |
posterior ankle dislocation
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acute trauma w/midfoot pain and bone tenderness at base of 5th metatarsal
bone tenderness at navicular inability to bear wght either immediately or at clinic |
ottawa foot rules
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avulsion of dorsal surface m/c
acute eversion DO NOT confuse w/ os tibialis externum (accessory navicular bone) |
Navicular fx
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isolated fxs rare
Associated w/ Lisfranc injuries |
Cuneiform fxs
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isolated fxs are rare
m/c lateral aspect DO NOT confuse with an os peroneum or os versalium |
cuboid fxs
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phalange fxs of the foot
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crush injures-direct force-comminuted
chip fxs- no fx of phalangeal articular margin, m/often hyperextension |
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fx produces stiffness and painful MTP joint
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Hallux rigidus
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medial hallux m/c
pain/swelling localized to plantar surface DDX: Bipartite sesamoid |
Sesamoid fxs
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pleural shadow becomes visible from hematoma deviating towards lung
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pleural deflection aka
Extrapleural sign |
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M/c results fm blunt compressive trauma to chest
mostly transverse ct required |
sternal fx
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minimum survey includes AP w/int and ext rotation
other views:baby-arm, lateral scapula (Y), outlet |
Shoulder girdle radiographs
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scapula radiographic views
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Axillary projections
lateral, trans-scapular "Y" |
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comminuted fractures termed "headsplitting"
uncommon occur w/ other humeral fxs, high AVN |
anatomic neck fx of humerus
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m/c of proximal humerus
distal to tuberosities comminuted mostly injury to axillary nerve may occur |
surgical neck fx of humerus
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m/c occurs w/ other humeral fxs rare in isolation
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lesser tuberosity
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direct trauma m/c cause in humerus
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proximal shaft of humerus
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accounts for 50% of all dislocations in body
M/c around shoulder girdle(85%) |
glenohumeral dislocations
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m/c (95%)
associated w/ fxs Hill-sach's (hatchet), FLAP, Bankhart subdivided:subcoracoid( m/c), subglenoid, subclavicular, intrathoracic (btwn ribs) |
Anterior Glenohumeral dislocation
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uncommon 2-4%
m/c w/seizure or electrical shock difficult to see widening of joint space >6mm "rim" sign double articular surface "trough line sign" |
Posterior glenohumeral dislocation
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severe hyperabduction of GH joint
locks into place |
Inferior glenohumeral dislocation
Luxatio erecta |
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m/c w/ rotator cuff tear
uncommon following direct trauma |
superior glenohumeral dislocation
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mild sprain of ac
clinical diagnosis no xray findings |
type I AC sprain
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CRITOE
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Capitellum 1
radial head 3 internal condyle (med) 5 trochlea 7 olecranon 9 external condyle (lat) 11 |
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line drawn along anterior surface of humerus and sh intersect middle third of lateral condyle ossification center
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anterior humeral shaft line
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m/c at head/neck junction of radius
may only see sharp angulation of anterior surface best seen on lateral |
radial neck fx
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hook m/c site
sports injuries: golf (non-dominate hand), baseball, racquet sports (dominate hand) look for loss of ring, may appear sclerotic, ill-defined or absent |
hamate fx
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m/c dislocation in carpals
hyperextension lateral view "spilled tea cup sign" PA "pie sign" |
lunate dislocation
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m/c site of skeletal injury
distal>proximal |
phalanges of hand
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dorsal chip fx at site of inserting extensor tendon of distal phalanx
flexion deformity |
"baseball" or "Mallet" finger
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torn ulnar collateral ligament of 1st MCP joint displaces superficial to adductor tendon surgical repair
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Stenner's Lesion
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severe sprain
widened AC joint obvious elevation of clavicle widened coracoclavicular distance surgery for repair |
type III AC separation
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fx at base of dens that extends into C2 vertebral body
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type 3 odontoid fx
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