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X-Ray Diagnosis Rev.
diagnostic facts for conditions
| Question | Answer |
|---|---|
| Mesaurements for scoliosis | Cobb method and Risser-Ferguson method |
| Difference b/c Cobb method and Risser-Ferguson methods | Cobb useds the end plates of the vertebrae while Risser-Ferguson uses the center of the vertebrae. |
| Method of grading rotation in scoliosis | Pedicle Method: + pedicle midway b/w lat border and midline; ++- pedicle touches midline; +++-pedicle sits in midline; ++++- pedicle crosses midline |
| Definition of Achondroplasia | Most common of congenital dwarfism, autosomal dominant disturbacne in the epiphyseal chondroblastic growth and maturation |
| Characteristics of Achondroplasia in the spine | 1. Narrowing of the spinal canal (narrowed interpedicular dist) 2. bulletnosed vertebrae 3. Posterior scalloping of vertebral bodies |
| Characteristics of Achondroplasia in the Skull | 1. Base of the skull is small, often stenotic foramen magnum 2. Basilar impression frequent 3. Prominent frontal bones, small nasal bones |
| Characteristics of Achondroplasia in the pelvis/thorax | 1. Entire pelvis is small 2. Ilia are shortened caudally and flattened, with small sciatic notches 3. Champange glass pelvis |
| Characteristics of Achondroplasia in the extremities | 1. Symmetric shortening of all long bones 2. Trident hands |
| Definition of Cleidocranial Dysplasia | Faulty ossification of the intramembranous bones, especially the clavicle, skull and midline |
| Characteristics of Cleidocranial Dysplasia in the spine | 1. Biconvex vert bodies 2. Spina bifida occulta esp in the cerv and upper thor spine 3. Neural arch defects 4. Hemivertbra |
| Characteristics of Cleidocranial Dysplasia in the Skull | 1. Multiple wormian bones 2. persistent metopic suture 3. "hot cross bun" appearance (widening of sag and coronal sutures) 3. small face due to underdeveloped facial bones 5. Delayed and defective dentition 6. Deformed large foramen magnum 7. "Light bulb" |
| Characteristics of Cleidocranial Dysplasia in the Pelvis/Thorax | 1. Anomalous clavicular development (10% completely absent) 2. Often small, winged or absent scapulae 3. Early coxa valgus develops into coxa varus |
| Characteristics of Cleidocranial Dysplasia in the Extremities/Ribs | 1. Ribs are normal but chest is narrow and cone-shaped 2. Elongated second metacarpal 3. Distal phalanges are hypoplastc and often pointed: "Crayon" appearance |
| Basic characteristics of Infantile Cortical Hyperostosis | 1. Presents before age 5 months 2. Likes the mandible, clavicle and ribs 3. Symmetrical involvement 4. AKA Caffey's Disease |
| Characteristics of Infantile Cortical Hyperostosis in the Spine | 1. Periosteal new bone formation within soft tissue swelling adjacent to the cortex 2. Laminating appearance of new bone |
| Characteristics of Infantile Cortical Hyperostosis in the Skull | 1. Thickening of the calvarium or destructive lesions 2. Mandible usually involved |
| Characteristics of Infantile Cortical Hyperostosis in the Pelvis/Thorax | 1. Clavicle, mandible and ribs are the most commonly involved bones |
| Characteristics of Infantile Cortical Hyperostosis in the Extremities/Ribs | 1. Cortical hyperostosis is most prominent in the lateral arches of the ribs 2. Epiphyses spared when long bone involvement occurs 3. Likes the ulna |
| General Definition of Marfan's Syndrome | Problem with collagen formation that involves three systems: skeletal, ocular and cardiovascular (dissecting aneurysm) |
| Characteristics of Marfan's in the Spine | 1. Tall Vertebrae 2. Severe scoliosis or kyphoscliosis 3. Widened spinal canal(>50%) especially the lumbosacral region 4. Posterior scalloping of vertebral bodies 5. Thinning of pedicles and lamina |
| Characteristics of Marfan's in the Pelvis/Thorax | 1. Acetabular protrusion, unilateral or bilateral (50%) 2. Pectus excavatum iwth elongated ribs |
| Characteristics of Marfan's in theExtremities/Ribs | 1. Elongation of the extremities; esp tubular bones of hands and feet (arachnodactyly) 2. No osteroporosis 3. thinned cortices |
| Characteristics of Fibrodysplasia Ossificans Progressiva | 1. Fibrous tissue becomes ossified; ossification of striated muscle 2. Hereditary, idiopathic |
| Characteristics of Fibrodysplasia Ossificans Progressiva in the spine | 1. Vertebral and apophyseal joint fusions 2. Intervertebral discsare hypoplastic and become calcified |
| Characteristics of Fibrodysplasia Ossificans Progressiva in the Extremities/Ribs | 1. Digits anomalous at birth 2. Microdactyly of the first toe (75%) 3. Microdactyly of the thumbs 4. hallux valgus |
| Clinical Criteria for Osteogenisis Imperfecta | 1. Osteoporosis 2. Blue Sclera 3. Abnormal Dentition 4. Premature otosclerosis |
| Two forms of Osteogenisis Imperfecta | 1. Congenita (high rate of still borns and infant mortality) 2. Tarda (normal life expectancy) |
| Characteristics of Osteogenisis Imperfecta in the Spine | 1. Diffuse decrease in bone density 2. Pencil-thin cortices 3. Multiple fractures, esp of lower extremities 4. Kyphoscoliosis common from ligamentous laxity 5. Biconcave vertebrae 6. Premature DJD |
| Characteristics of Osteogenisis Imperfecta in the Skull | 1. Persistent Wormian bones 2. Enlarged Sinuses 3. Calvarium is thin and lucent 4. Platybasia frequent; basilar impression 5. Abnormal dentition |
| Characteristics of Osteogenisis Imperfecta in the Pelvis/Thorax | 1. Protrusio Acetabuli 2. Shepard Crook's deformity |
| Characteristics of Osteogenisis Imperfecta in the Extremities/Ribs | 1. Bowing deformities secondary to multiple fractures which are usually transverse and in the lower extremities 2. Multiple rib fractures |
| Definition of Hurler's Syndrome | Autosomal recessive deficiency of Alpha-L iduronidase, leads to excessive lipid accumulation in the CNS and other viscera |
| Clinical characteristic's of Hurler's Syndrome | 1. Dwarfism 2. Mental Retardation 3. Decreased life span 4. Osteoporosis 5. Otosclerosis 6. Hepatosplenomegaly |
| Characteristics of Hurler's Syndrome in the Spine | 1. Thoracolumbar kyphosis secondary to vertebral body hypoplasia 2. Beaked Vertebrae |
| Characteristics of Hurler's Syndrome in the Skull | 1. Macrocephaly 2. Frontal bossing 3. Premature closing of the sagittal and lambdoidal sutures 4. Hydrocephalus 5. Enlarged, J-shaped sella turcica 6. Small facial bones, widened mandible |
| Characteristics of Hurler's Syndrome in the Pelvis/Thorax | 1. Flared Ilia 2. Coxa Valga or Vara common 3. Widened diaphyses of tubular bones |
| Characteristics of Hurler's Syndrome in the Extremities/Ribs | 1. Ribs are overly wide: paddle ribs 2. Trident hands |
| Definition of Morquio's syndrome | A lysosomal storage disease caused by defects in one of two enzymes involved in the degradation of keratan sulphate that leads to severe dysostosis and keratosulfauria (Normal mental capacity, life span 40-50 yrs) |
| Characteristics of Morquio's syndrome in the Spine | 1. Slightly rounded vertebrae with small anterior beak seen early in infancy 2. Platyspondyly with central beaking is PATHONOMONIC by age 2-3 3. Disc spaces normal or increased 4. Atlanto-axial instability due to hypoplastic or absent odontiod |
| Characteristics of Morquio's syndrome in the Pelvis/Thorax | Acetabuli and capital femoral epiphyses are hypoplasic and the hips are often unstable 2. Wide femoral necks; hip dislocation 3. Coxa Vara or Valga common 4. Pectus Craniatum 5. Wine glass pelvis |
| Characteristics of Morquio's syndrome in the Extremities/Ribs | 1. Long tubular bones are short and thick, esp upper extremity 2. Hands and feet are deformed 3. Bowing deformities 4. Excessive callus formation |
| Definition of Melorheostosis | Rare condition of cortical thickening of unknown etiology most commonly seen in the long bones due to developmental errors of intramembranous and enchondral bone formation |
| Basic Characteristic of Melorheostosis | Hyperostotic "candle wax" appearance |
| Characteristic of Melorheostosis in the Pelvis | Pelvis often involved (dumb answer but need to know) |
| Characteristic of Melorheostosis in the Extremities/Ribs | 1. Cortical thickening in a streaked or wavy pattern 2. Hyperostotic bone protrudes under the periosteum and usually follows along one side of a long bone; medullary cavity spared |
| Definiton of Osteopetrosis | Lack of resorption of normal primitive osteochondral tissue (AKA Albers-Schonberg's disease; Marble bone disease); General symmetric sclerosis of skeleton without trabeculation with pathologic fractures common |
| Characteristics of Osteopetrosis in the Spine | Sandwich Vertebrae |
| Characteristics of Osteopetrosis in the Skull | 1. Calvarial and basilar thickening and sclerosis 2. Poor sinus development |
| Characteristics of Osteopetrosis in the Pelvis/Thorax | Ilium demonstrates multiple, dense curved lines paralleling the iliac crest |
| Characteristics of Osteopetrosis in the Extremities/Ribs | 1. Long bones have flared and elongated metaphyses 2. "Erlenmeyer flask" deformity 3. Hands have a "bone w/in bone" appearance |
| Definition of Osteopoikilosis | Multiple, small, circumscribed round or ovoid areas of increased bone density, widely distributed, caused by condensations of the spongiosa |
| Characteristics of Osteopoikilosis in the Skull | Does not involve the skull! (hehe) |
| Characteristics of Osteopoikilosis in the Pelvis/Thorax | Densities found adjacent to acetabulum in pelvis and glenoid in scapula |
| Characteristics of Osteopoikilosis in the Extremities/Ribs | 1. Multiple small radiopacities (1-10mm) scattered in the epiphyseal and metaphyseal regions 2. Symmetric lesions, esp in long tubular bones, carpals and tarsals |
| Definition of Progressive Diaphyseal Dysplasia | Condition characterized by thickening of the cortex of the mid-shaft area of the long bones, progressing toward the epiphyses, the thickening sometimes occurring also in the flat bones; excessive growth in length of bones of the extremities |
| Areas prone to progressive diaphyseal dysplasia | Femur, Tibia, Radius, Ulna and Humerus |
| Characteristics of Progressive Diaphyseal Dysplasia in the Spine | Sclerosis affects the posterior aspect of the vertebral body and the posterior arches, w/o causing stenosis |
| Characteristics of Progressive Diaphyseal Dysplasia in the Skull | 1. Basilar sclerosis 2. Calvarial hyperostosis less common |
| Characteristics of Progressive Diaphyseal Dysplasia in the Pelvis/Thorax | Pelvic bones usually spared (yeah!) |
| Characteristics of Progressive Diaphyseal Dysplasia in the Extremities/Ribs | 1. Symmetric distribution with widening of the diaphyseal portions of long bones; metaphysis and epiphysis spared 2. Carpal and tarsal bones usually spared |
| Definition of Tuberous Sclerosis | Multi-system disorder of neuroectodermal origin that is a genetic disorder that causes benign tumors to form in many different organs, primarily in the brain, eyes, heart, kidney, skin and lungs (AKA Bourneville's Disease) |
| Clinical Triad of Tuberous Sclerosis | 1. Mental Retardation 2. Epileptic Seizures 3. Skin lesions |
| Characteristics of Tuberous Sclerosis in the Spine | 1. Osteoblastic deposits of varied size and contour in vertebral bodies and pedicles 2. Scoliosis |
| Characteristics of Tuberous Sclerosis in the Skull | 1. Intracranial calcifications in 50-80% of patients 2. Generalized thickening and hyperostosis of the cranial vault |
| Characteristics of Tuberous Sclerosis in the Pelvis/Thorax | Pelvis: Osteoblastic deposits of varied size and contour |
| Characteristics of Tuberous Sclerosis in the Extremities/Ribs | 1. Irregular subperiosteal new bone formation and nuodules are common 2. Small, well-defined cysts are seen in the small tubular bones of the hand 3. Periosteal warts: cortical excrescences on the tibia |
| Types of Fractures of the skull (limited answers for this question, there could be more that are not listed, think general) | Linear, Depressed, Mandible |
| Most common skull fracture | Linear Fracture |
| Where do Linear fractures occur? | Usually in the parietal and temporal bones (Fxs cross the sutures) |
| Etiology of Depressed Fracture | Results from a high-velocity impact by a small object (Usually produces multiple fragments, displaced inward) |
| Most common site of Mandible Fx? | Body of the mandible (Mandible is the slowest healing bone in the body) |
| What is a Jefferson's Fx? | Fracture throught the anterior and posterior arches of the atlas due to forceful blow to the vertex of the skull which transmits through the occipital condyles to the lateral masses of atlas. |
| What is the result of a Jefferson Fx? | Alters the atlanto-axial alignment and increases the paraodontiod space |
| What is the most common Fx of the Atlas? | Post arch Fx of atlas (50% of all atlas Fxs); it is a bilateral vertical Fx through the neural arch |
| What is the mechanism for a Post Arch Fx of the Atlas? | Sever Hyperextension injury |
| What is the mechanism of an Ant Arch Fx of the Atlas? | Usually horizontal segmental avulsions from hyperextension at the attachment of the anterior longitudinal ligament and longus colli muscle |
| What is a Hangman's Fracture? | Bipedicular fracture of the axis |
| What is the mechanism of a Hangman's Fracture? | Hyperextension with rotation and results in a Traumatic Spondylolysis (Type IV) |
| What is a Type 1 Odontoid process Fx? | Avulsion of the tip of the odontoid prosess as a result of apical or alar ligament stress (Differentiate from Os Terminale) |
| What is a Type 2 Odontoid process Fx? | Fracture at the junction of the odontoid process and the body of axis (**most common odontoid process fx) |
| What is a Type 3 Odontoid process Fx? | Fx below the base of the attachment of the odontiod process to the vertebral body (Almost as common as Type 2, heals more readily) |
| What is a Clay shoveler's Fx? | Avulsion of lower cervical segment spinous process (MOI: hyperflexion injury) |
| What is the radiographic "sign" seen with a Clay shoveler's Fx? | "Double Spinous Process" sign (Must Differenciate from a non-union defect) |
| What is a Teardrop Fx? | A displaced, triangular fragment from the anteroinferior body corner (MOI: Hyperflexion @C3,4,5 or Hyperextension @ C2) **Differenciate from a limbus bone |
| Where is a Teardrop Fx most common? | C2 |
| What is Wedge Fx? | Compressed anterior vertebral body fx (MOI:hyperflexion, "whiplash") **Differenciate from path fx |
| What is the MOI with a compression Fx? | Hyperflexion or axial compression |
| Most common type of Fx of the thoracic spine? | Compression Fx |
| What characteristics will be present in a compression fx if it is due to a pathology? | decrease in posterior and anterior body height |
| What characteristics will be present in a compression fx if it is due to a trauma? | decrease in anterior body height and anterior cortical offset |
| What condition can a compression fx be a major cause of? | Osteoporosis |
| What is a chance/seat belt fx? | Horizontal fx through a single body and posterior arch |
| Radiographic finding of chance/seat belt fx? | "empty vertebrae sign |
| What are some radiographic findings of an acute lumbar compression fx? | step defect and linear zone of impaction |
| What is the MOI of a transverse process fx? | LF and hyperextension |
| What is the most common type of Sacral fx? | Horizontal-usually b/w the third and fourth sacral tubercle |
| What might cause a vertical sacral fx? | indirect trauma |
| What are some commone findings in a Coccyx fx? | Usually transverse and results in anterior displacement of the coccyx |
| What is the most common fx of the pelvis? | Malgaigne fx |
| What is a Malgaigne fx? | Fx of the inferior pubus with ipsilateral dislocation of the SI joint due to a shearing force |
| What is a Duverney's fx? | Splitting of the iliac wing due to a direct force from a lateral direction |
| What is a bucket handle fx? | Fracture of the superior and inferior pubic rami with fx/seperation of the contralateral SI joint |
| What are the two types of acetabular fxs? | Posterior rim and explosion fxs |
| What is the most common adolescent athlete fx? | Avulsion fx due a longitudinal force |
| What is a sprung pelvis? | Separation of the pubic symphysis and both SI joints |
| What types of intracapsular fxs are seen in the hip? | Subcapital (most common), Midcervical, Basicervical |
| What types of extracapsular fxs are seen in the hip? | Intertrocanteric (most common), Trocanteric, Subtrochanteric |
| What is the most common dislocation of the hip? | Posterior dislocation due to an A-P force into a flexed knee |
| What is the MOI of a anterior dislocation of the hip? | P-A force through an abducted and extended leg |
| What is slipped capital femoral epiphysis | Type I Salter Harris fx that can be evaluated with Klein's line; usually affect overweight adolescent males |
| What is the MOI for a bumper/tibial plateau fx? | Femoral condyles are forced into the tibial plateau |
| What is the MOI for a avulsion fx of the tibial tuberosity? | Force through a flexed knee with contracted quads and can be associated with infrapatellar tendon rupture;most common in adolescent males and may be associate with Osgood-Schlatter's |
| What radiographic sign can be seen with an avulsion fx of the tibial tuberosity? | FBI sign (radiolucent line on top of water density) seen with cross table lateral view; indicates intraarticular fx |
| What are the most common types of patellar fxs? | Transverse (through the waist) or slightly oblique |
| What do you need to differenciate with a patellar fx? | whether is is bipartite (which usually occurs superolaterally) or tri-multipartite |
| Which direction does the patella usually dislocate? | Laterally |
| What position is the fracture of the medial malleolus usually seen? | transversely |
| What position is the fracture of the distal fibula/lateral malleolus usually seen? | Usually obliquely |
| What is a bimalleolar fx? | Oblique fracture through the lateral malleolus and a transverse fx through the medial malleolus |
| What is a trimalleolar fx? | Fx of both malleloi and the posterior aspect of the tibia |
| What is a maisonneuve's fx? | Proximal fibula fx due to an inversion and external rotation injury of the ankle |
| What is a toddler's fx? | Distal diaphyseal/metaphyseal spiral fx of the tibia of an infant |
| What is a boot top fx? | Distal diaphyseal/metaphyseal spiral fx of the tibia and fibula in an adult |
| What is the most common tarsal to fx? | Calcaneal fx usually diagnosed when Boehler's angle is less than 28 degrees |
| What is a Jones'/Dancer's fx? | Fx of the base of the fifth metatarsal |
| What is a Bedroom fx? | Usually occurs in the first and fifth phalanges (walking around in the dark and stubbing a toe) |
| What is a Lisfranc's dislocation? | displacement of the second through fifth metatarsal cones with associated fractures |
| What are some radiographic findings of a rib fx? | 1. Radiolucent fracture line 2. Cortical offset 3. Altered rib orientation |
| What are some complications seen with a rib fracture? | Pneumothorax and subcutaneous emphysema |
| What is the most common fx of childbirth? | Clavicle fx |
| In what area of the scapula is a scapula fx usually seen? | 80% in the neck and body |
| What is a Flap fracture of the humerous? | Avulsion fx of the greater tuberosity; often a complication of an anterior glenohumeral dislocation |
| What is the most common site of a proximal humeral fx? | Surgical neck of the humerus |
| What is the most common direction of a shoulder dislocation? | 95% are anterior/inferior due to the orientation of the joint |
| What are some complications of a Shoulder dislocation? | Hill-Sachs deformity, flap fx of the humerus, Bankart sign |
| Grade I A/C joint seperation | stretching of the A/C ligament |
| Grade II A/C joint seperation | rupture of the AC ligament and stretching of the coracoclavicular ligament |
| Grade III A/C joint seperation | Rupture of the A/C and coracoclavicular ligaments; requires surgery |
| What is the most common elbow fx in children? | supracondylar fx o the humerus |
| What is little leaguer's elbow/avulsion fx of the elbow? | Avulsion fx of the medial condyle |
| What is the second most common fracture of the elbow in an adult? | Comminuted fx of olecranon process |
| What is the MOI in a comminuted bx of the olecranon process? | direct trauma or an acute flexion avulsion from the triceps insertion |
| What is the the most common fractue of the elbow in an adult? | Chisel fx of the radial head |
| What is radiographic finding of a chisel fx of the radius? | Fat pad sign:posterior fat pad is visible |
| What is the MOI for a nightstick fracture? | direct blow to the ulna |
| What is a monteggia's fracture? | Fx of the proximal 1/3 of the ulnar shaft associate with displacement of the radius in any direction |
| What is a galeazzi's fracture? | Fx of the radius at the junction of the middle and distal thirds, with dislocation of the distal radioulnar joint |
| Waht is a Colle's Fx? | Fx of the radius with posterior dislocation of the fthe distal fragment |
| What is a Smith's Fx? | Fracture of the distal radius with anterior angulation of the distal fragment |
| What is the most commonly dislocated carpal bone? | Lunate |
| What radiographic sign is seen with a lunate dislocation? | "Pie" sign:lunate appears triangular with the apex pointing distally on the posterior to anterior view |
| What is a barroom fx? | Fourth or fifth metacarpal fx with anterior displacement of the head |
| What is a chauffer's fx? | Fx of the radial styloid |
| What is the most common fx of the wrist seen in 6-10 year olds? | Torus Fx |
| What is the most common carpal fx? | Scaphoid (MOI-FOOSH) |
| What complications can be seen with a Scaphoid fx? | avascular necrosis or non-union defect |
| What is a Bennett's fx? | Intraarticular fx throug hthe base of the first metacarpal, with dorsal and radial displacement of the shaft |
| What is a Rolando's fx? | comminuted Bennett's fracture |
| What is a boxer's fracture? | Fracture of the second or third metacarpal neck with anterior displacement of the head |
| What is the MOI of a Pisiform Fx? | FOOSH |
| How do you evaluate wrist alignment on a P-A view of the wrist? | Use the three wrist alignment lines to evaluate |
| What is gamekeeper's thumb? | Avulsion fx of the proximal phalanx of the thumb (MOI:strong abduction stress) |
| What is a March Fx? | A stress fx of the second or third metatarsal due to repetitive stress |
| What is the radiographic finding of a March Fx? | solid periosteal response |
| How is a calcaneal stress fx presented? | In the posterior superior portion |
| What is the radiographic hallmark of a child suffering from Battered Child Syndrome? | multiple fractures in different stages of healing |
| What are some radiographic findings of a child suffering from Battered Child Syndrome? | 1. Multiple closely-approximated fractures 2. Metaphyseal corner fxs 3. Epiphyseal displacements 4. Periosteal new bone |
| What is Myositis Ossificans? | Heterotrophic bone formation in the soft tissues following trauma to the area |
| What are two commons areas where Myositis Ossificans are seen? | Biceps and quadriceps |
| What is Prussian's disease? | Ossification of the adductor magnus |
| What are some early radiographic features seen in Myositis Ossificans? | 1. hazy soft tissue mass 2. cloudy ossification |
| What are some later radiographic features seen in Myositis Ossificans? | 1. Round or Linear 2. smooth, dense outer boarder 3. Relatively lucent center 4. no connection with adjacent bone |
| What is a Type I Salter-Harris Fx? | Fx through the physis (growth plate) |
| How could a Type I Salter-Harris fx be clinically relevant? | Can complicate metabolic diseases |
| How does a Type I Salter-harris fx usually present radiographically? | appears normal with Dx made from teh clinical findings of tenderness over the epiphyseal plate and soft tissue swelling |
| What is a Type II Salter-harris fx? | Fx through the physis and metaphysis |
| How does a Type II Salter-harris fx usually present radiographically? | a metaphyseal fraagment called the "Thurston-Holland" sign is seen |
| What are the most common sites for a Type II Salter-Harris fx to occur? | distal radius (50%), tibia, fibula, femur and ulna |
| What is the prognosis of a Type II Salter-Harris fx? | favorable |
| What is a type III Salter-harris fx? | Fx through the epiphysis and physis |
| Where is a Type III Salter-harris fx usually seen? | Distal tibia |
| What is a type IV Salter-Harris Fx? | Fracture through the epiphysis, physis and metaphysis, with or without displacement |
| Where are Type IV Salter-Harris Fxs commonly seen? | Lateral condyle of the humerus in patients under 10 and distal tibia in patients over 10 |
| What is a Type V Salter-Harris Fx? | compression injury to the physis w/o fracture |
| Most common location for a skull fx | parietal and temporal bones(linear fx) |
| Most common location for an atlas fx | posterior arch |
| Most common location for an odontoid fx | base of the dens (type 2) |
| Most common leve for a clay shoveler's fx | C7 |
| Most common thoracic spine compression fracture | T11/12 |
| Most common levle for degenerative spondylolysis | L4 (usually females) |
| Most common type of spondylolysis | isthmic |
| Most common lumbar spine fx | compression fx of T12/L1 |
| Most common sacral fracture | horizontal at level of third and fourth sacral tubercles |
| Most common pelvic fracture | Malgaigne fx |
| Most common intracapsular fx of the femoral head | subcapital |
| Most common extracapsular fx of the femoral head | intertrocanteric |
| Most common patellar dislocation | lateral dislocation |
| Most common patellar fx | Transverse (through the waist) |
| Most common tarsal fx | calcaneus |
| Most common fx of childbirth | clavicle, especially middle third |
| Most common shoulder dislocation | subcoracoid |
| Most common proximal humerus fracture | surgical neck |
| Most common fx of the adult elbow | radial neck and head |
| Most common fx of the child's elbow | supracondylar |
| most common dislocated carpal bone | lunate |
| most common fractured carpal bone | scaphoid |
| What is a Type I spondylolisthesis/spondylolysis? | Characterized as DYSPLASTIC, it accompanies a congenital abnormality in the upper sacrum or neural arch of L5, you will not see a break in the pars with a anterior displacement of the L5 vertebrae on the sacrum |
| What does a Type II Spondylolisthesis/spondylolysis involve? | involves alteration to the pars |
| What are the three types of Type II Spondylo? | 1. A lytic or stress fx of the pars 2. Elongated but intact pars 3. Acute fx of the pars |
| What is a Type II Spondylolisthesis/Spondylolysis? | Secondary to long-standing degenerative arthrosis of the lumbar zygopophyseal joints and discovertebral articulations, w/o a pars seperation; usually occurs at L4 |
| What are the three "F's" of degenerative spondylolisthesis? | 1. Female 2. Four (L4) 3. above Forty |
| What is a Type IV spondylolisthesis/spondylosis? | Traumatic due to a acute, severe injury that creates a fx of a portions of the neural arch other than the pars |
| What is a Type V spondylolisthesis/spondylosis? | generalized or systemis disorders of bone may ffect the neural arch of the spine and allow spondyloslysis to develop |
| What measurement may be performed to diagnose a spondylolisthesis of L5 on S1? | Ullman's line: draw a perpendicular to teh sacral base line from teh sacral promontory |
| What are some radiographic findings of a Grade 3,4,5 spondylolisthesis? | 1. inverted napolean's hat 2. bowline of Brailsford. |
| What is the method used to grade a Spondylolisthesis? | Meyerding's grading method |
| What is the most common form of arthritis? | DJD (aka osteoarthritis) |
| Age/Sex for DJD? | 40 and over/female 10:1 |
| Common sites of DJD? | C5-7, T2-4, T9-T12, L4-5 |
| What are the common radiographic findings in DJD? | 1. ASSYMETRIC distribution 2.NON-UNIFORM loss of jt space 3. osteophytes 4. subchondral sclerosis 5. Geoges 6. joint mice 7. art. deformities 8. jt sub 9. non-marginal traction spurs 10. Heberden's (DIP jts) and Bouchard's (PIP jts) nodes |
| What is erosive osteoarthiritis characterized by? | Episodic and acute inflammation of the distal and proximal interphalangeal joints of both hands in a symmetric manner. |
| What age group is most common with erosive osteoarthritis? | Females 40-50 years old |
| What location is erosive osteoarthritis most commonly seen? | DIP and PIP joints |
| What are the radiographic findings of erosive osteoarthritis? | 1. Ankylosis 2. Gull-wing defomity 3. Osteophytes 4. Periostitis 5. Sclerosis |
| How do you differenciate b/w erosive osteoarthritis and rheumatoid arthritis? | Erosive osteoarthritis is seronegative |
| What is DISH (Diffuse Idiopathic Skeletal Hyperostosis)? | A generalized spinal and extraspinal articular disorder that is characterized by ligamentous calcification and ossification. |
| What structure associated with the spine is predomintant involved in DISH? | Anterior Longitudinal Ligament |
| What is DISH also known as? | Forestier's disease |
| What age and gender is common in those who have DISH? | males over 50 |
| What area of the spine is DISH commonly seen? | Thoracolumbar junction |
| What is neurotrophic arthopathy? | Destructive articular disease that occurs secondary to a loss or impairment in joint proprioception. Involved joint undergoes premature and excessive traumatic degenerative changes that lead to severe destruction and instabiliy due to lack of pain |
| What conditions can predispose a person to neurotrophic arthopathy? | Diabetes, syphilis, syringomyelia, myelomeningocele and others |
| Where is hypertrophic neurotrophic arthropathy seen? | Weight bearing joints |
| Where is Atrophic neuropathic arthopathy seen? | Non-weight bearing joints of the upper extremity |
| What are the 6 D's of a hypertrophic charcot's joint? | 1. Distension 2. Density increase 3. Debris 4. Dislocation 5. Disorganization 6. Destruction |
| What radiographic appearance can be seen with a hypertrophic charcot's joint? | "Bag of bones" appearance |
| What are the radiographic findings in an atrophic charcot's joint? | 1. Resorbed articular surface 2. "licked candy stick" appearance |
| What is synoviochondrometaplasia? | Benign arthropathy char. by synovial tissue undergoing metaplastic transformation to produce foci of cartilage resulting in multiple loose bodies within the joint and clincial findings ranging from the comp absence of Sxs to acute joint locking and pain |
| What gender and age group is prone to develop synoviochondrometaplasia? | Males 30-50, males by 3:1 |
| What locations in the body is synoviochondrometaplasia usually seen? | Knee, hip, ankle, elbow, wrist...rarely seen in the spine |
| What are the radiographic findings of synoviochondrometaplasia? | 1. multiple loose bodies 2. DJD 3. extrinsic extraarticular pressure erosions |
| What is Rheumatoid Arthritis? | systemic disease, occurring more often in women, which affects connective tissue; arthritis is the dominant clinical manifestation, involving many joints, especially those of the hands and feet, accompanied by thickening of articular soft tissue |
| What is Rheumatoid Arthritis? | chronic disease, mainly characterized by inflammation of the lining, or synovium, of the joints that can lead to long-term joint damage, resulting in chronic pain, loss of function and disability. |
| What is the first stage of Rheumatoid Arthritis? | swelling of the synovial lining, causing pain, warmth, stiffness, redness and swelling around the joint |
| What is the second stage of R.A.? | rapid division and growth of cells, or pannus, which causes the synovium to thicken |
| What is the third stage of R.A.? | inflamed cells release enzymes that may digest bone and cartilage, often causing the involved joint to lose its shape and alignment, more pain, and loss of movement |
| At what age is R.A seen in patients? | B/w 20-60, peak age is 40-60 (Under 40-females 3:1; Over 40, males=females) |
| At what location in the body will you see R.A.? | Hands and feet, symptoms usually progress proximally; the spine is rarely affected early, but later the cervical spine is involved in 80% of patients |
| What are some radiographic findings seen with R.A.? | 1. Bilateral and symmetrical 2. Uniform loss of joint space 3. Haygarth's nodes-occur at MCP joints 4. Most common cause of Protusio Acetabuli 5. Rat bite lesions 6. Boutonniere deformity 6. Swan neck deformity 7. Lanois deformity 8. Ulnar dev of MCP jts |
| What is associated with Felty's Syndrome? | 1. Leudopenia 2. Splenomegaly 3. R.A. |
| What is Juvenile Rheumatoid Arthritis? | chronic inflammatory arthritis in children. JRA is a general term for the most common types of arthritis in children |
| What is the seronegative form of JRA? | Still's disease |
| What areas of the body do you commonly see JRA? | 1. cervical spine (fusion of C2-4) 2.Wrist 3. Hands 4.Knee 5. Ankles 6. Feet |
| What are the radiographic findings of Juvenille FA? | 1. soft tissue swelling bilateral and symmetrical 3. Periosteal response |
| What is Ankylosing Spondylylitis? | chronic inflammatory disease that affects the joints between the vertebrae of the spine, and the joints between the spine and the pelvis. |
| What can ankylosing spondylitis be categorized as? | Enthesopathy (inflammation of ligamentous or tendonous insertion |
| At what age is a personm most prone to develop A.S? | 15-35, males 10:1 |
| What locations in the body is A.S mostly seen? | 1. Axial skeleton 2. Symphysis pubis 3. Sacroiliac joints |
| What radiographic findings are seen with A.S.? | 1. Bilateral and symmetrical 2. "Ghost joints"-ankylosed SI joints 3. Shiny corner sign 4. Marginal syndesmophytes 5. Bamboo spine 6. Romanus lesions 7. Dagger sign 8. Trolley track sign 9. Osteoporosis 10. Fluffy periostitis |
| What is psoriatic arthritis? | arthritis that is associated with psoriasis of the skin (15% of psoriasis patients develop psoriatic arthritis) |
| What is psoriatic arthritis difficult to diffenciate from? | Reiter's syndrome |
| What is the age range and predominant gender of patients with psoraic arthritis? | B/w 20-50; male=female |
| What radiographic findings can be seen with the effects of psoriatic arthritis? | 1. Assymtrical 2. non-marginal syndesmophytes 3.pannus formation 4. marginal erosions and tapered bone ends; "pencil in cup" deformity 5. "mouse ear" appearcece 6. Widened joint space followed by uniform loss of jt space |
| What is Reiter's Syndrome? | Reiter's syndrome is a group of symptoms consisting of arthritis (inflammation of the joints), urethritis (inflammation of the urethra), conjunctivitis (inflammation of the lining of the eye), and lesions of the skin and mucous membranes. |
| What is the age range and sex preference for those with Reiter's Syndrome? | B/w 18-40, Males>Females 50:1 |
| What locations in the body will you see the remnants of Reiter's Syndrome on radiographs? | 1. Likes lower extremities (knees, ankles, feet) 2. Unilateral sacral joint 3. Thoracolumbar junction |
| What are the radiographic findings seen in Reiter's syndrome? | 1. Assymetric 2. Non-marginal syndesmophytes 3. Uniform loss of joint space 3. ST swelling 4. Osteoporosis 5. Periostitis 6. Heel spurs: "lover's heel" |
| What conditions give positive lab findings for HLA-B27? | AS, Reiter's Syndrome, Psoriatic Arthritis, Enteropathic Arthritis, Juvenile RA (referred to as Seronegative Arthropathies) |
| What is enteropathic arthritis? | Enteropathic arthritis occurs in combination with inflammatory bowel diseases (IBD) such as Crohn's disease or ulcerative colitis. It also can affect the spine and sacroiliac joints. |
| How long does it typically take Enteropathic Arthritis to resolve? | 2-3 months |
| What is the age range for a person with Enteropathic Arthritis? | Young adults |
| What locations in the body can radiographic evidence of enteropathic arthritis be seen? | 1. SI joints 2. Knees 3. Ankles 4. Elbows 5. Wrists |
| What are the radiographic findings of Enteropathic arthritis? | 1. Bilateral and symmetrical 2. Marginal syndesmophytes **Findings in spine and pelvis are indistinguishable from those of AS** |
| What is Systemic Lupus Erythematosus (SLE)? | Systemic lupus erythematosus (SLE) is a chronic, inflammatory autoimmune disorder. It is a generalized CT disorder involving multiple organ systems. |
| What is the pathognomonic sign of SLE? | Butterfly rash |
| What age/sex is commonly seen with SLE? | Population predominately made up of women of childbearing age |
| What locations in the body are radiographic findings commonly seen in individual with SLE? | 1. Hands 2. Long bones 3. Chest |
| What are the radiographic findings in the hands of an individual with SLE? | 1. Bilateral 2. Symmetrical 3. Reversible ulnar deviation 4. Reversible boutonniere/swan neck deformities 5. Osteoporosis 6. Normal joint space 7. Soft tissue atrophy |
| What is Scleroderma? | Scleroderma is a chronic autoimmune disease. term scleroderma means "hard skin," which describes thickening of the skin from increased deposits of collagen. |
| What condition is Scleroderma commonly associated with? | Raynaud's phenomenon |
| What is the age/sex range for individuals with this condition? | Females 30-50; females 3:1 males |
| What locations in the body is scleroderma commonly seen? | 1. Hands 2. First carpometacarpal-phalangeal joint |
| What radiographic findings are commonly seen with scleroderma? | 1. Bilateral selective involvement of the first carpometacarpal joint of the wrist 2. Soft tissue calcification 3. CREST |
| What does the acronym CREST stand for? | C-calcinosis R-Raynaud's phenomenon E-esophageal abnormality S-Scleroderma T-Telangiectasia |
| What is Osteitis Condensans Ilii? | Osteitis condensans ilii is a disorder that results in increased bone density in the iliac bone (ilium) located in the pelvis. It is a bilateral symmetric sacroiliac disorder |
| What is the age/sex range for a person with osteitis condensans ilii? | Multiparous women b/w 20-40 years; females 9:1 males |
| What location in the body is osteitis condensans ilii commonly seen? | Sacroiliac joints |
| What are the radiographic findings of Osteitis condensans Ilii? | 1. Bilateral, dense, triangle shaped iliac subcondral sclerosis involvine the lower half of the joint margin 2. Does not effect the peripheral joints |
| In what conditions will you see Non-marginal syndesmophytes? | 1. Psoriatic Arthritis 2. Reiter's |
| In what conditions will you see Marginal syndesmophytes? | 1. Ankylosing spondylitis 2. Enteropathic arthritis |
| What radiographic findings of DJD will be seen in the hands? | 1. Subchondral sclerosing 2. Decreased joint space |
| What locations will DJD be seen in the hands? | 1. Heberden's nodes-seen in the DIP joints 2. Bouchard's nodes-seen in the PIP joints |
| What is the distribution of DJD in the hands? | Asymmetrical |
| What radiographic findings of RA will be seen in the hands? | 1. Juxtaarticular osteoporosis 2. ulnar deviation of the MCP joints 3. Boutonniere deformity 4. Swan neck deformity 5. Uniform loss of joint space at PIP/MCP jts 6. ST swelling around PIP/MCP jts |
| What locations in the hands will you see the effects of RA? | MCP and IP joints |
| What is the distribution of the effects of RA in the hands? | Bilateral and symmetrical |
| What are the radiographic findings of Psoriatic arthritis in the hands? | 1. Ray pattern: effects all jts of a single digit 2. ST swelling 3. Fluffy periostitis 4. "Pencil in cup" deformity 5. marginal erosions and tapered bone ends |
| What locations in the hand are commonly effected by Psoriatic arthritis? | DIP and PIP jts of the hand |
| What is the distribution of Psoriatic arthritis in the hands? | Asymmetrical with uniform joint loss |
| What are the radiographic findings of SLE in the hands? | 1. Reversible boutonnierre/swan neck deformity 2. Osteoporosis 3. Reversible Ulnar deviation |
| What type of joint destruction is present in the hand as a result of SLE? | None |
| What is the distribution of the effects of SLE in the hand? | Bilateral and symmetrical |
| What are some clinic facts about Ankylosing Spondylitis? | 1. 15-35 yo 2. Males>Females 3. Elevated ESR 4. (+) HLA-B27 |
| What are some radiographic findings of AS? | 1. Hazy margin of sclerosis 2. Erosions and ankylosis 3. Marginal syndesmophytes 4. Affects the hips and shoulders |
| What is the most common location to visualize AS radiographically? | Ilium and sacrum |
| What is the distribution of the effects of AS seen radiographically? | Bilateral and symmetrical |
| What are the clinical findings of Psoriasis? | 1. 20-50 yo 2. Females>Males 3. Elevated ESR 4. (+) HLA-B27 |
| What radiographic findings in the SI joints can be seen as a result of Psoriasis? | 1. hazy, minimal sclerosis 2. Erosions common, ankylosis possible 3. Non-marginal syndesmophytes in the spine 4. Common in the hands and feet |
| What is the distribution of the effects of psoriasis seen radiographically? | Uni/bilaterally and asymmetrical |
| What are some clinical facts about DJD? | 1. 20-50 yo 2. females>males 3. No lab findings |
| What are some radiographic findings in the SI joints as a result of DJD? | 1. Small, hazy sclerosis 2. No erosions or ankylosis 3. Osteophytes in the spine 4. Common in multiple joints |
| What is the distribution seen as a result of DJD? | Unilateral |
| What are some clinical facts about Osteitis condensans ilii? | 1. 20-40 yo 2. Females>males 3. No lab findings |
| What are some radiographic findings seen in the SI joints as a results of Osteitis condensans ilii? | 1. Triangular, sharp sclerosis 2. No erosions, no ankylosis 3. Does not effect the spine 4. Does not affect peripheral joints |
| What is the distribution of Osteitis condensans ilii? | Usually bilateral and symmetrical |
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