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Ortho Imaging 1


Burst Jefferson fx Radiology: C1 lat masses not line up vertly w/ C2 sup articular facets; distance btw dens & C1 lat masses is asymmetric
Hangmans Fx: alignment: vert body of C2 is normally aligned w/ C1 & dens; post elements of C2 are normally aligned w/ C3
Wrist Radiographs AP, Lateral, Oblique
Wrist Radiographs: clenched fist: to see: Scapholunate dissociation
Wrist Radiographs: Scaphoid Ulnar deviation
Wrist Radiographs: Carpal Tunnel: may see: Hamate, pisiform injuries
Wrist Radiographs: Comparison views to see Growth plate injuries
Wrist Radiographs: Lateral View: Check 2-20 degree palmar tilt of articular surface of radius; dorsal aspect of distal radius is smooth; capitate sits in lunate
Wrist Radiographs: PA View: Check radius lies distal to ulna; radial border of Scaphoid is intact; No more than 2mm of intercarpal joint space; no abnormalities of radius or ulna cortex;
Wrist Radiographs (PA): Impact fx may only show: increased density at radial metaphysis
Wrist Radiographs: beak, bulge or density at fused epiphyseal line is: not a fracture; IS a physeal scar
CTS: Anatomy: 10 structures pass through carpal tunnel (9 tendons, 1 (median) n.)
Scaphoid Fx: Imaging: AP, Lat, oblique, scaphoid views; MRI; Bone scan 72 hrs post injury
Knee Films (views) AP, Lateral; Merchant; Tunnel view (look for OCD)
Knee Films: AP/ Lateral: can show: Tumors; Fx; DJD; Surgeries/ Hardware
Knee Films: Merchant view Patella (Instability; DJD; Chondral lesions)
Knee DJD: Fairbanks Changes Flattened tibial plateau; decreased joint space; osteophytes; subchondral cysts
MRI: excellent for: soft tissue
MRI in ortho: for: ACL ( >95%); Menisc (>85%); chondral lesion (cannot quantify size); MCL,LCL,PLC,PCL; Bone Contusions/ Edema; tumors; fx?
CT: excellent for: fracture characterization
CT: not good for: evaluating soft tissue injuries
Patellar Dislocation: Radiographs: AP/Lat, Merchant view
ACL: dx tests (imaging) MRI to R/O other injuries
HNP: Evaluation: MRI / CT
HNP: MRI/CT: asymptomatic disc herniation found in what percentage? 17-36%
Lumbar Spinal Stenosis: Xray: may show: narrowing of the IVD, old burst fx; MRI demonstrates stenosis
Spondylolisthesis: xray shows: Lateral film shows slip
Osteoarthritis: X-ray shows: joint narrowing, sclerosis, osteophytes
Ankylosing Spondylitis: X-ray shows: Erosion & sclerosis on plain films
LBP: Imaging: when Plain films approp: trauma/ longstanding sx ; if conservative Rx fails
LBP: Imaging: Order: AP / Lateral; Obliques; Flex & Ext
LBP: MRI study of choice for: discopathy
LBP: Tc 99m bone scan for: primary tumors, metastatic disease, or infection
Reading Spine Films: looking for: Fx; Disc space changes; Arthritic changes; Listhesis; Tumors
Spine Film: Frontal View: each vert resembles: an owls head, straight on; each eye = pedicle; beak = spinous process
Spine Films/ Frontal: Horizontal displacement may = fx or dislocation
Spine Films/ Frontal: Decreased intervertebral space = Fx, DDD, HNP
Spine Films/ Frontal: Vert body (owl head) for: Missing eye (destrn); pedicle
Spine Films/ Frontal: Vert body: crack in owls eye: in = Chance fx (seat belt fx)
Spine Films/ Frontal: Vert body: increased space btw owls eyes: in = Burst fx
Shoulder imaging: Standard views: AP and axillary
Imaging: Can get Y view if: suspected dislocation or scapular fx (trauma)
Best imaging for RCT CT arthrogram good, but MRI is better (invasive)
CT is good for: bone abnormality; tumors
MRI for RCT: S&S 95% sensitivity & specificity in detecting RCT
MRI good for: RCT; SLAP lesions (Arthrogram); Soft tissue
Clavicle Imaging AP, 45 degree cephalic tilt
Clavicle Fx: MOA FOOSH, onto shoulder, direct trauma
Nexus criteria for spinal imaging Image spine if: midline C-spine TTP; AMS +/- EtOH; neuro sx/sx; distracting painful injury
Created by: Abarnard