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Basic skeletal radio

Trauma, congenital anomalies, lines and measurements, dysplasias

promptanswer
McGregor’s Line M < 10mm F < 8mm
Chamberlain’s Line < 3mm
Atlantodental Interspace Adult 1-3mm Kids 1-5mm
George’s Line no interruptions
Posterior Cervical Line no interruptions
Sagittal dimension cervical spine canal Min 12-16 mm C1-C7
Atlantoaxial alignment B-P:O-A <1
Cobb Angle <20 degrees
Risser Ferguson <10 degrees
Sacral inclination 30-72 deg
Sacral base angle 26-57 deg
Lumbosacral disc angle 10-15 deg
Lumbar gravity line < 10mm ant to sacrum
Meyerding’s method spondylolisthesis grading
Interpediculate distance >21mm
Eisenstein’s method for sagittal canal measurement not <15
Teardrop distance 6-11mm No greater than 2mm diff. btwn sides
Presacral space Adult 2-20mm Kids 1-5mm
Shenton’s line uninterruprted between pubis and femoral neck
Iliofemoral line symmetrical
Femoral angle 120 -130 deg
Skinner’s line should pass below fovea
Klein’s line should intersect femoral head
Patellar position patellar tendon no more than 20% greater than patella
Heel pad measurement F 19-23mm M 19-25mm
Boehler’s angle 28-40 deg
Glenohumeral joint space 4-5mm
Acromiohumeral joint space 7-11mm
Acromioclavicular joint space F 2.1-3.7mm M 2.5-4.1mm
Coracoclavicular distance (pg. 896) 11-13mm
Axial relationship of the wrist PA radioulnar 72-95 deg Lat radius 79-94 deg
Achondroplasia Pathological hallmark: spinal stenosis
Achondroplasia Pedicles: short and thick
Achondroplasia IPD in the lumbar spine decreases as it descends
Achondroplasia Sagittal canal diameter: narrowed
Achondroplasia Posterior vertebral bodies: scalloped / concave
Achondroplasia Ilia: short , square
Achondroplasia Greater sciatic notch is small
Achondroplasia Ischia: short, broad
Achondroplasia Pubic bones: short, broad
Achondroplasia Sacrum articulates low on ilium
Cleidocranial Dysplasia Skull and clavicle findings: Open Sutures, open Fontanelles, Wormian bones, Brachycephaly
Cleidocranial Dysplasia Foramen magnum: large
Cleidocranial Dysplasia Maxilla/Facial bones: hypoplastic
Cleidocranial Dysplasia Sinuses: small
Cleidocranial Dysplasia Palate: narrow, high arch
Cleidocranial Dysplasia CLAVICLES: Deficiency or Absence
Cleidocranial Dysplasia Pubic symphysis: diastasis
Marfan’s Syndrome is a: Defective collagen disorder (quality not quantity)
Marfan’s CLINICAL MANIFESTATIONS Skeletal, Ocular, Cardiovascular
Marfan’s Extremities: markedly elongated with sparse soft tissue
Marfan’s Height: usually > 6 feet
1/3 of patients with Marfan’s: congenital heart disease (atrial septal defect)
>95% of patients with Marfan’s: death due to complications related to cardiovascular pathology (aortic aneurysm)
Marfan’s RADIOGRAPHIC FINDINGS Skeletal: Arachnodactyly, Osteopenia Acetabular protrusion Pectus excavatum, Slipped capital femoral epiphysis
Marfan’s RADIOGRAPHIC FINDINGS Spine: Tall vertebrae, Posterior scalloping, Widening of the IPD in lumbar spine, Thinning of pedicles, laminae (2* to dural ectasia),Transverse ligament may be lax
Ehler’s-Danlos Syndrome symptoms: Skin fragility/hyperelasticity, Vascular fragility, Articular Hypermobility
Ehler’s-Danlos RADIOGRAPHIC FEATURES Soft tissue findings: Calcified subcutaneous spherules of necrotic fat tissue, Ligamentous laxity
Ehler’s-Danlos RADIOGRAPHIC FEATURES Spinal: Platyspondyly, Posterior scalloping, Scoliosis, Flattening of thoracic curve
Ehler’s-Danlos Cardiovascular complications: dissections, aneurysms
Ehler’s-Danlos other complications: Spontaneous pneumothorax
Ehler’s-Danlos Disc herniations: may produce cauda equina
Ehler’s-Danlos Osseous and soft tissue manipulations may produce: vascular injury, subcutaneous hematoma formation
Osteogenesis Imperfecta is a: Generalized connective tissue disorder, Quantitative and qualitative defect in collagen
5 places affected by Osteogenesis Imperfecta Skeletal, Skin, Sclera, Dentition, Inner ear
2 FORMS of Osteogenesis Imperfecta : Osteogenesis Imperfecta Congenita, Osteogenesis Imperfecta Tarda
4 Major Clinical Manifestations of Osteogenesis Imperfecta 1. osteoporosis with abnormal fragility of the skeleton, 2. blue sclera, 3. abnormal dentition, 4. premature otosclerosis
Radiographic Findings of Osteogenesis Imperfecta: Osteopenia, Gracile bones, Bowing of bones, Multiple fractures
With Osteogenesis Imperfecta, osseous and deep soft tissue manipulation is contraindicated
Osteogenesis Imperfecta decreases posterior fossa leading to: Basilar impression, cerebellar compression, hydrocephalus
Osteopetrosis is a Failure of resorption which replaces: calcified cartilage with mature bone
in Osteopetrosis, Medullary space does not form
Osteopetrosis RADIOGRAPHIC FEATURES: Generalized osteosclerosis of skeleton, Dense homogenous bones – marble bones, “Bone within bone” appearance, “Sandwich” vertebrae, Erlenmeyer flask deformity
Osteopetrosis COMPLICATIONS Leukemia / sarcoma, Hemorrhage, Infection, Blindness, Deafness
Osteopetrosis Persistent hip pain Rule out ischemic necrosis
Osteopetrosis Foramen magnum may be narrowed due to thickening of osseous structures
Osseous manipulation may be contraindicated in Osteopetrosis patients with generalized involvement in skeleton
Majority of OSTEOPOIKILOSIS cases are – asymptomatic
OSTEOPOIKILOSIS 15-20% may experience mild joint pain with or without joint effusion
OSTEOPOIKILOSIS HISTOLOGICALLY: Foci of compact lamellar bone
OSTEOPOIKILOSIS Radiographic Multiple rounded/ovoid radio-opacities scattered in epiphyseal and metaphyseal regions
OSTEOPOIKILOSIS Predilection for long tubular bones, carpals, tarsals
fracture Alignment: position of the distal fragment in relation to the proximal fragment
fracture Apposition: concerns the closeness of the bony contact at the fracture site
fracture Rotation: rotational deformity; inclusion of proximal and distal joints is necessary
Complications to Healing: Delayed Healing, Non- union, Mal- union, Aseptic Necrosis, Disuse Osteoporosis, Reflex Sympathetic Dystrophy, Infection, Traumatic Arthritis, Joint Derangements
Cervicocranial Dislocation is Rarely seen clinically because these patients sustaining these injuries usually do not survive
Cervicocranial Dislocation MECHANISM: a distractive force to the craniocervical joint by hyperextension-flexion
Jefferson’s Fracture MECHANISM: Force is applied through skull vertex through occipital condyles through lateral masses of atlas then bursts.
Jefferson’s Fracture RADIOGRAPHIC FEATURES: Lateral displacement of lateral masses, Increase paraodontoid spaces bilaterally, Prevertebral soft tissue swelling
Jefferson’s Fracture >8 mm total offset: transverse ligament rupture
SIMULATED JEFFERSON FX 4 circumstances: 1. Atlas grows more rapidly than axis (children 4 years of age), Developmental anomalies (eg. Localized lateral mass malformation; spina bifida of atlas both anteriorly & posteriorly), Rotary atlantoaxial subluxation, Torticollis
Neural Arch Fracture MECHANISM: Hyperextension injury-Posterior arch of C1 is pinched between occiput and large spinous process of C2
Neural Arch Fracture present, Look for other cervical fractures
Neural Arch Fracture significance Vertebral artery in close proximity
Stable Pelvic Fractures ASIS, AIIS, Ischial tubes, Transverse sacral, acetabular
Fascial Plane-Superior medial Obturator
Fascial Plane-Superior lateral Glut med.
Fascial Plane-Inferior medial Iliopsoas
Unstable Pelvic Fractures Malgaigne, Bucket-handle Fracture, Dislocation (unilateral and bilateral), Straddle Fracture
Rolando’s- comminuted fx of base of 1st metacarpal
DJD radiologic features (general) non-uniform loss of joint space, intra-articular loose bodies, osteophytes, subchondral sclerosis, subchondral cyst, articular deformities
Created by: stigmatamarty