Clinic Entrance: Radiology

List the possible pelvic avulsion fractures. What are the three most common?

-*ASIS: Sartorius* -*AIIS: Rectus Femoris* -*Ischial tuberosity: Hamstrings* -Iliac crest: Abdominal musculature -Pubic symphysis: Adductors -Greater trochanter: Gluteal muscles -Lesser trochanger: Iliopsoas

What is sail sign?

-+ Fat pad sign. -Sign of capsular effusion. -Lucency between humerus and posterior soft tissues representing water density of elbow joint effusion. -Highly sensitive for elbow injury.

What are the characteristics of lower rib fractures?

-10-12 not likely to fracture, but if they do kidney evaluation is necessary. -Cough (post-tussive) fracture: stress fracture of lower (M/C 6th-7th) anterior rib.

What are the characteristics of a subtrochanteric fracture?

-2 inches below the lesser trochanter. -Uncommon. - Pathologic fractures often occur here. Paget's, mets, bisphosphonate use (Fosamax).

What are the characteristics of a posterior dislocation of the GH joint?

-2-4% of glenohumeral dislocations. -M/C missed traumatic injury in the ER. -Follow epileptic convulsion, electric shock, or extreme trauma (triple E). -Rarely occur bilaterally (seizure induced). -Difficult to identify radiographically. -Widened joint space (>6mm= rim sign), double articular surface due to reverse hill sach's (trough line sign), lack of humeral head- glenoid fossa overlap (loss of the half-moon shape)/ lack of close contact at the anterior joint margin (vacant glenoid sign), cystic appearance of the head (tennis racquet sign/lightbulb sign), superior displacement. -Rarely, avulsion injury of the post labrum may occur.

Describe calcaneal fractures.

-25% involve the various processes of the bone. -75% involve the subtalar joint and body of the calcaneus. -Two types are compressive and non-compressive/avulsive. -Aka Lover's fracture (jumping out window) due to falling from a height and landing on the feet. -10% are bilateral. -10% associated w/ T/L junction vertebral body compression fracture. -Decreased Boehler's angle from its normal 28-40 degrees and offers a reliable prognostic indicator of the treatment outcome (the smaller the decrease, the better the outcome).

What are the characteristics of a triquetrum fracture?

-2nd M/C carpal to fracture (#1 Scaphoid). -Usually avulsion from the dorsal surface at the attachment of the radiocarpal ligament. -AKA Fisher's fracture. -Pooping duck sign. -Usually after hyperflexion. -Presents as displaced flake of bone on lateral.

What are the characteristics of talus fractures?

-2nd M/C tarsal bone to fracture after calcaneus. -Usually avulsion fracture of anterior surface of the talar neck at the capsular insertion.

Describe transverse process fractures in the lumbar spine.

-2nd most common fracture of the lumbar spine. (1st is compression fx). -Occur via avulsion of paraspinal musculature during hyperextension and lateral flexion. -Most common at L2-3. -Renal damage is possible, maybe causing hematuria. -Radiographs show jagged fracture margins, inferior displaced TPs. -Rule out old fracture vs un-united secondary ossification center.

What is an infraction?

-A form of impaction. -It is a minor localized break in the cortex leaving minimal deformity.

What is a Golfer's fracture?

-A golfer may inadvertently strike the ground rather than the ball. -Abrupt termination of swing may precipitate rib fracture usually at lateral margin.

What are the characteristics of a greater tuberosity fracture?

-AKA Flap fracture. -Typically seen in osteoporotic females. -Avulsion by the connecting tendons. -Associated w/ anterior dislocations. -Older pts show a smaller separated fragment than younger ones. -Optimal view = external rotation of the shoulder because it puts the greater tuberosity out in profile. -Displacement > 1cm= associated w/ rotator cuff tear.

What are the characteristics of a Rolando fracture?

-AKA comminuted Bennett's. -Least common of all 1st metacarpal injuries. -Difficult to treat.

What are the characteristics of a Chauffeur fracture?

-AKA: Backfire fracture, Hutchinson fracture. -Fracture of the radial styloid. -Used to be result of backfire occurring when attempting to start engine.

What are the characteristics of a tibial plateau fracture?

-AKA: Bumper/Fender Fracture. -Tibial plateau fracture from impact of the femoral condyles into weaker tibial plateau. -Pts are usually >50yo; common especially in osteoporotic pts. -5-10% involve medial plateau; 10-15% are B/L; 80% involve the lateral plateau. -Depression of the lateral tibial joint surface, w/ or w/out a vertical radiolucent split. -Fracture line is difficult to visualize on non-displaced fractures on an AP => do obliques (internal/external rotation). -CT is valuable. -MRI visualizes extent of ST injury. -Ligament injury in 10-12%: MCL/LCL, ACL/PCL. -FBI sign

What is a sprung pelvis?

-AKA: Open Book Pelvis. -Severe injury. -Complete separation of the symphysis pubis and one or both of the sacroiliac joints. -Severe pelvic basin visceral damage may occur (ie: rupture of the urethra).

What is a Galleazi fracture dislocation?

-AKA: Peidmont fracture, Reverse Monteggia fracture. -Fracture of distal 1/3rd of radius. -Dislocation of distal ulna which then often self reduces.

What are the characteristics of a smith fracture?

-AKA: Reversed Colle Fracture. -Fracture of distal radius with anterior angulation of distal fragment. -Fall on hyperflexed wrist.

What are the characteristics of a gamekeeper's fracture?

-AKA: Skier's Thumb. -Small avulsion fracture at ulnar side of 1st proximal phalanx base. -Secondary to severe abduction of 1st MCP joint.

What are the radiographic features of SCFE?

-AP and frog leg -Post medial slippage of the epiphysis. -Apparent widening of the growth plate. -Reduced epiphyseal height. -Medial epiphyseal "beaking." -Widened teardrop space. -Medial femoral neck periosteal buttressing. -Abnormal Klein's Line.

What complications are associated with scaphoid fracture?

-AVN (aka is Preiser disease). 1-15% (closer to 30%). Dual blood supply. The proximal pole is the least perfused. -Non-union in about 30%. Requires surgical screw w/ Herbert screw.

How are talus fractures classified?

-Accodring to the anatomic site. -Body: Transverse or oblique plane via inversion/eversion. -Neck: "Aviator" fracture, predisposes to AVN. Shown in pic. -Head: Infrequent -Hawkins sign

What are the characteristics of odontoid process fractures?

-Account for 50% of all C2 fractures. -1/3 have an associated cervical spine fracture. -Classified based on location (Types I, II, III).

What are the characteristics of anterior dislocation of the GH joint?

-Accounts for 95% of glenohumeral dislocations and can be subglenoid, subcoracoid (M/C),or subclavicular. -MOI: forceful abduction and external rotation. -In 60% = Hill-Sachs lesions (aka hatchet defect); 15% HAGL lesions (humeral avulsion of the glenohumeral ligament); less frequently Bankart lesion (at inferior glenoid tubercle). -Reoccurrence is common in young pts; in pts >40 the reoccurrence rate is 4%. -10-20 fold increase in incidence of arthritis.

What are the characteristics of an acromioclavicular joint separation?

-Acromioclavicular joint and coracoclavicular ligament. -Accounts for 10% of all shoulder injuries. -5x more common in males. -Most common in athletes playing contact sports. -MOI: Most common -direct blow to acromion with abducted shoulder. -Inspection: +/- Observable deformity, Swelling, Bruising. -Radiography: Standard AC Projections - AP (Bilateral). Additional Projections - AP with 10-15 degrees cephalic angulation, Lateral, Axial.

What is a cotton fracture?

-Affects the posterior lip of the tibia (third malleolus). -Often found w/ tibiotalar dislocations. -Result of external rotation of foot (lateral and posterior displacement).

What are the characteristics of shoulder girdle injury?

-Ages 20-40: shoulder dislocation, AC joint separation, and clavicle fractures predominate. -Elderly: shoulder dislocation and humeral surgical neck fractures more common. -Perform thorough radiographic examination. Shoulder: AP, Internal Rotation, External Rotation, Baby Arm. Consider AC, scapula, clavicle film if clinically indicated.

Describe a clay shoveler's fracture. Aka?

-Aka Coal miner's fracture, root-puller's fracture. -Avulsion fracture of the distal 1/3 of the spinal process. -Occurs via abrupt head flexion with pull of trapezius and rhomboid muscles on the spinous process or direct blow. -Most common at C7, can go all the way up to C2. -It is stable, with no neurologic deficits. -Double spinous process sign.

Describe an iliac wing fracture. Aka?

-Aka Duverney's fracture. -Direct force from a lateral direction results in splitting of the wing. -Best seen on an oblique view. -Stable because the surrounding large muscle attachments prevent separation of the fracture fragments. -Can be comminuted. -More common in osteoporosis.

Describe a Salter Harris type I injury.

-Aka Epiphysiolysis -Only seen in skeletally immature patients (slipped capital femoral epiphysis). -Partial or complete separation of epiphysis from shaft of bone. -Shearing/avulsive force. -Good prognosis because not going through the epiphysis (secondary growth center). -Includes SCFE.

What is a passion fracture? Aka?

-Aka bear hug fracture. -Presence of osteopenia may predispose elderly to these fractures.

Describe the posterior rim fracture.

-Aka dashboard fracture. -Due to blow to the knee with leg in FADD. -Often has posterior dislocation of the hip. -Accounts for 1/3 of acetabular fractures.

Describe the central acetabular fracture.

-Aka explosion fracture. -Divides innominate into superior and inferior halves. -In the transverse type it bisects the ischial spine. -In the oblique type it extends posterior and superior to the sacrosciatic notch. -Obturator internus sign may be the only finding. -Central dislocation of the femoral head may occur. -Most common acetabular fracture.

What is a Hill-Sachs lesion?

-Aka hatchet defect. -Impaction fracture that occurs while dislocating.

What is atlanto-occipital dislocation? Aka?

-Aka internal capitation. -It is dislocation of C0-C1. -It is a rare and usually fatal injury due to hyperextension and distraction. -Prevalent in pediatric patients. Children survive this injury more than adults.

What is a chance fracture? Akas?

-Aka lapbelt, seatbelt, or fulcrum fx. -Three different patterns of injury. -Vertebral body is under a compressive force but the neural arch is under a tensile stretch. This results in horizontal splitting of the neural arch. -Hyperflexion over a fulcrum. -15% have neurologic deficits and visceral damage is possible. -Radiographs AP shows empty vertebra sign and lateral shows lucent split through neural arch.

What are pseudofractures? Akas?

-Aka looser's lines, milkman's syndrome, increment fractures, umbauzonen (German for construction zone). -They are discreet regions of unmineralized osteoid that show up as linear lucencies at 90 degree angles to the cortex. -Seen in bone softening conditions like Paget's, rickets, osteomalacia, and fibrous dysplasia.

How do you describe the spatial relationships of a fractured bone?

-Alignment is a description of the positon of a distal fragment in relation to the proximal fragment. -Apposition describes the closeness of bony contact at the fractured site. -Rotation describes a twisting deformity with rotational malposition of the fragments. -Pic: Need to have two views to see fracture. Distal segment has gone anterior. Distal segment has been displaced medially. Apposition is poor, maintaining approximately 40% contact with distal fragment.

How can the glenohumeral joint displace?

-Anterior 95% -Posterior 4% -Inferior/superior

What are the three radiographic indicators for an acute anterior body fracture?

-Anterior body wedging -Step defect -Zone of lucency

Which elbow fat pad is normally visualized on radiograph?

-Anterior is normal, but sail sign indicates fracture. -Posterior is not usually visualized and indicates fracture.

What are some immediate complications of fracture?

-Arterial Injury -Compartment syndromes -Fat embolism -Thromboembolism

Describe a pars interarticularis fracture.

-As a true acute fx (non-stress) it is uncommon, but may result from forceful lumbar hyperextension and is usually unilateral and has rough jagged margins. -As a spondylolysis stress fracture, it is due to microtrauma, is usually bilateral, and has irregular sclerotic margins.

What are the characteristics of an anterior tibial spine fracture?

-Avulsion fracture at origin of the anterior cruciate ligament. -MOI: hyperextension of knee w/internal rotation of tibia. -Most often found in children over half of these injuries occur in a fall from a bicycle. -The radiographic appearance varies with the degree of displacement: Non-displaced fracture exhibits a horizontal fracture line at base of the anterior portion of the tibial spine. With displacement may allow inversion of the fracture fragment and are usually easier to demonstrate radiographically.

What is Segond's fracture?

-Avulsion fracture of bony insertion of the TFL (iliotibial band) a the margin of the lateral tibial condyle. -A small bony fragment is seen adjacent to the lateral tibia. -MRI: high signal intensity at the site of the lateral tibial insertion. -75-100% associated w/*ACL tear*, which results in intracapsular effusion. -70% associated w/ meniscal tears. -Most disrupt the lateral capsule.

What are the extracapsular hip fractures?

-Avulsion fractures of the greater or the lesser trochanter. -Intertrochanteric -Subtrochanteric -Mid-diaphyseal

Describe an extension teardrop fracture.

-Avulsion of a triangular-shaped fragment from the anteroinferior corner of a vertebral body usually due to acute hyperextension. -C2 is the most commonly involved level. -Unstable injury via ligamentous injury and is associated with central cord syndrome; however not as severe as the flexion type.

What are the characteristics of a Jones (Dancer's) fracture?

-Base of the 5th metatarsal transverse fracture. -M/C injury of the foot. -Traction from the peroneous brevis tendon or lateral cord of the plantar aponeurosis when the foot is forcefully inverted and plantar flexed. -Ddx: longitudinally oriented apophysis in children.

What are the radiographic findings of a Jefferson fracture.

-Best seen on APOM view. -Look for spreading of lateral masses (>7-8mm combined para-odontoid space signifies transverse ligament rupture). -Abnormal atlantoaxial alignment. -Evaluate ADI.

What are the characteristics of sternal fractures?

-Blunt compressive impacts such as from steering wheel or belt. -M/C involve the body or manubriosternal junction. -Transverse in nature. -US is more sensitive than plain film, but radiography remains modality of choice in clinical situations and best demonstrates degree of displacement. -Careful evaluation of the T/L spine is necessary (compression fractures). -Rule out cardiac complications and Traumatic brain injury.

What is a Jefferson fracture?

-Burst fracture of C1, usually due to auto accident or diving injury. -Death or neurologic deficit is uncommon because the fragments tend to go out away from neurologic tissue.

Describe a burst fracture.

-Called Jefferson fracture at C1. -Vertical compression of vertebral body propells the nucleus pulposus through the endplate into the vertebral body. -Comminuted vertebral body fracture. -Bony fragments migrate circumferentially. -Retropulsion of bone into canal possible (best seen on CT). -On x-ray, the lateral view shows a comminuted vertebral body and the AP view shows increased inter-pediculate distance. Associated neural arch fracture is common.

What are the characteristics of patellar dislocation?

-Can be Lateral, horizontal or vertical. -M/C = lateral (from trauma or torsional stress w/ fast change in direction). -Relocation is simple and can be done by the patient, but recurrent dislocations are then common. -Patella stabilization braces increase stability in up to 73% of the cases. -Flake fracture = (sliver sign).

Describe unilateral interfacetal dislocation.

-Caused by a flexion-rotation force. -A single articular pillar dislocates into IVF. (jumped facet). -Segment becomes unstable post injury due to capsular ligament damage. -Lateral view shows forward displacement of vertebral body and lack of superimposition of pillars (bow-tie sign).

Describe the circulatory/inflammatory phase of fracture repair.

-Cellular phase (hematoma formation in soft tissue surrounding fractured bone. 1st 5 days). -Vascular phase (network of dilated tributaries forming around periphery of injured area and cause active then passive hyperemia promoting active secretion of osteoid. Elevation of periosteum and granulation tissue formation giving rise to mature callus). -Primary callus formation (muscle, connective tissue, and bone marrow form blastema accounting for 70% of osteoid in a femoral shaft fracture. This occurs 14 days after a fracture).

Describe the three different patterns of Chance fracture.

-Chance fracture: horizontal splitting of the SP and pedicle continuing through into the post VB to involve the sup endplate. -Horizontal splitting fracture: horizontal division of the SP, pedicle, and post VB w/out involvement of the endplate. -Smith injuries: rupture through the interspinous ligaments partially rupturing the IVD (type A), avulsing the post inf corner of the VB (type B), or fracturing the sup articular process (type C).

What are the characteristics of radial head fractures?

-Chisel fracture; fracture line is usually on lateral side; step-off or angulation is common; double cortical sign. -50% of elbow injuries in adults. -FOOSH injuries. -Positive fat pad; injury may be subtle => do multiple oblique views (absence of fat pad does not exclude possibility of a fracture).

What are the phases of fracture repair?

-Circulatory/inflammatory phase (10 days). -Reparative/metabolic phase. -Remodeling/mechanical phase.

What is the garden classification system?

-Classifies subcapital femoral neck fractures. -Stage 1: Impaction of the lateral cortex at the head-neck junction w/out angulation. -Stage 2: Impaction w/ no displacement across the width of the entire neck. -Stage 3: Complete fracture w/ partial displacement w/ surfaces still in apposition. -Stage 4: Complete fracture w/ full displacement w/out apposition.

What is a type 3 AC separation?

-Clavicle dislocation with rupture of AC ligaments and CC ligament. -Upward dislocation of clavicle. -Greater than width of acromion Widened CC interspace (normal is about 12mm).

Define comminuted vs non-comminuted fracture.

-Comminuted fx has multiple intersecting fx lines resulting in bony fracments. -Non-comminuted is a single fx resulting in two fragments.

Define complete vs incomplete fracture.

-Complete fx goes transversely through bones from cortex to cortex. It is the most common form of fracture in *adults*. -Incomplete fx is when the bone is only broken on one side, leaving buckling or bending on the opposite side. Primarily occur in *children* and usually occurs on the convex side.

Describe a torus (buckling) fracture.

-Compression forces the cortex to bulge outward. -Usually occurs in the mataphysis.

Describe a flexion teardrop fracture.

-Considered the MOST *severe* fracture of the cervical spine. -Often causes anterior cervical cord syndrome (motor function, sexual function, sensory if really bad) and quadriplegia. -MOI is severe flexion and compression (Diving head first, MVA deceleration). -Most common at C5-C6. -MRI is the next step in imaging to assess ligamentous structures and more importantly, the cord.

Describe a Salter Harris type V injury.

-Crush injury of the growth plate. -No immediate radiographic signs. -Focal areas of decreased bone growth on follow up films. -Poor prognosis. -Follow-up for 2 years to assure normal growth. -MC cause of premature closure of entire growth plate.

What is kummel's disease?

-Delayed post-traumatic vertebral collapse that occurs months after spinal trauma. -Controversial in existence. -AVN leading to progressive compression deformity. -Intravertebral vacuum (air) phenomenon is present because dead bone often has a vacuum in it.

What are the two types of impaction fractures?

-Depressed fx is the inward collapse of the outer bone surface. Typically occurs at the tibial plateau and the frontal bone. -Compression fx is a decreased volume of bone due to trabecular collapse/telescoping. Usually occurs in vertebral bodies.

How do lumbar burst fractures differ from lumbar compression fractures?

-Differ from compression fractures because the middle column is affected. -If posterior body height is maintained, then patient can walk to hospital. If not, then they are being transported on a spinal board. -Posteriorly displaced fragments may cause neuro compromise of the spinal cord, conus medullaris, and cauda equina. -Due to axial compression and flexion (same as compression fx). -Radiographic features include loss of vertebral body height, retropulsion, and widening of the interpediculate distance.

What is a bedroom fracture?

-Direct blow to toe. -Striking an object with a bare foot.

IVOC (Intervertebral Osteochondrosis) found in OA =

-Disc narrowing -Disc calcification (intercalary bone). -Vacuum phenomenon

Define diastasis.

-Displacement or frank separation of a syndesmosis. -Can occur at the pubic symphysis, skull, or distal tibiofibular syndesmosis.

Describe a lateral mass fracture.

-Disruption of lateral masses are uncommon. -CT for definitive diagnosis.

What are the characteristics of a distal radius fracture?

-Distal radius fractures: one of most common sites of wrist fracture. -Fracture may be subtle and obscure. -Close observation of pronator quadratus fat pad. Seen on lateral wrist as a linear lucency paralleling radius anteriorly. Anterior displacement, bowing, blurring, irregularity or obliteration are signs of swelling.

What is a nightstick/parry fracture?

-Distal ulnar shaft. -Direct trauma from arm being raised to protect head during an assault w/ club or hard object.

What are the characteristics of a perilunate dislocation?

-Dorsal displacement of all carpal bones except lunate. -Best seen on lateral (often missed on AP). -On PA capitate overlies lunate. -Numerous complications => open or closed reduction. -Complications: chondrolysis, carpal instability and traumatic arthritis.

What are the characteristics of metatarsal fractures?

-Dropped heavy objects may be the cause. -M/C shaft or neck. -M/C 2nd and 3rd metatarsal. -Fracture line may be oblique, spiral or transverse.

What is a stress fracture? What are the types?

-Fatigue fx is caused by repetitive microtrauma to bone. It is the gradual formation of microfractures that eventaually interruption in bone and represents actual fatigue failure of the bone. -Insufficiency fx is a stress tracture through diseased bone.

What are differences between male & female pelvises?

-Female= Sacrum titled back. Larger pelvic outlet. Ilia spread wider. -Male= sacrum tilted forward, smaller pelvic outlet, and ilia closer together.

What are the characteristics of Bennett's fracture?

-Fracture dislocation; avulsion injury at the base of the 1st metacarpal (forced abduction). -Follows injury where there is a grip applied to an object such as a ski pole or handle bar. -Intra-articular fracture. -Usually dorsal and radial displacement of the shaft.

What are the characteristics of a supracondylar humeral fracture?

-Fracture line extends transversely or obliquely through the distal humerus above the condyles. -M/C fracture of the elbow in children (60%). -Due to FOOSH injury with slight elbow flexion. -Usually fracture fragment displaces posterior. -If difficult to visualize do line along anterior cortex of humerus on lateral; it should intersect 40-50% of condyles; if not => fracture. -Abnormal Anterior Humeral Line.

What are the radiographic features of a rib fracture?

-Fracture line:transverse or oblique. DDX: bronchial shadow. -Cortical offset: sharp step effect when present. -Rib orientation: Sharp deviation. If distal end appears hook-like (costal hook sign)=> it may indicate flail segment. -Callus formation: Local increase in density and bulbous expansion -Pleural deflection: (extrapleural sign). Localized hematoma displaces pleura inward. Seen as opaque density convex toward lung.

What are the characteristics of a Colles fracture?

-Fracture of distal radius with posterior angulation of distal fragment. -MOI: fall on outstretched hands (FOOSH). -Dinner fork deformity of wrist Incidence of fracture increases with age. Osteoporosis an influencing factor. -Functional outcomes are good with appropriate treatment, but complications are common and may be severe.

What are the characteristics of Barton's (posterior) rim fracture?

-Fracture of the distal radius w/ associated proximal dislocation of the carpus. -MOI forceful hyperextension. -Fracture of anterior rim= reversed Barton's.

What is a straddle fracture?

-Fracture of the pubic arches. -Most common unstable fracture of the pelvis. -Double vertical fractures involving both superior pubic rami and inferior ischiopubic junction. -20-40% of patients sustain bladder rupture and/or urethral tear (Diagnose via urethrography and cystography).

What is a pathologic fracture?

-Fracture through a bone weakened by localized or systemic disease processes. -Usually has a transverse fracture orientation in long bone.

What are the characteristics of a boot top fracture?

-Fracture through both tib and fib near midshaft. -Only the tibia is pinned.

Describe a Salter Harris type IV injury.

-Fracture through growth plate, metaphysis, and epiphysis. -Vertically oriented splitting force . -Requires immediate open reduction and realignment to prevent growth arrest or joint deformity. -Guarded prognosis. -Most common cause of premature partial closure of the physis.

What is a Pott's fracture?

-Fracture through the distal fibula, 6-7 cm above the lateral malleolus. -Rupture of the distal tibiofibular ligaments.

Describe a Salter Harris type III injury.

-Fracture through the growth plate and epiphysis. -Minimal displacement. -Intra-articular extension of the fracture. -May require open reduction.

What are the characteristics of a hamate fracture?

-Fractures in various locations. -Commonly at the hook. -Fractures of the dorsal surface often accompanies posterior dislocation or subluxation of 4th or 5th metacarpal. -Seen as an oblong-shaped bone fragment near the articulation. -Tangential view w/ the wrist in hyperextension or a 30 degree tilted lateral projection w/ palmar abduction of the thumb. -CT: most accurate. -Non-union is common.

What are common types of incomplete fractures?

-Greenstick (hickory stick) fracture. -Torus (buckling) fracture.

What are the characteristics of an ischial tuberosity avulsion fracture?

-Hamstring muscle attachment. -Avulsion of the secondary growth center (apophysis) via forceful muscular attachment. -Can be acute or chronic injury. -Rider's bone.

Xray findings of Gout

-Haphazard distribution (no pattern -ddx). -Normal bone density -Soft tissue swelling -Lumpy bumpy sign

Describe talar dislocations.

-Has the potential to dislocate at three joints: Talotibial, talocalcaneal (subtalar), or talonavicular (Chopart fracture dislocation). -May occur in combination. -May precipitate AVN.

Describe intracapsular hip fractures.

-High incidence of non-union (25%) and AVN (30%) 3 months - 3 years later. -They are named according to the fracture location. -Nasocervical and midcervical fractures are uncommon. -Subcapital femoral neck fractures are most common proximal location for an intracapsular fracture. -Classified via the garden classification system.

What are the types of sacrum fractures? How do they happen and what else should you look for?

-Horizontal is the most common. -Vertical -Occur via fall on buttocks, direct trauma, or in assocaition with other pelvic fractures. -Look for other fractures in the pelvis.

Labs for SLE

-Increased ESR -RF+ -Anti-nuclear antibody test + -Anti-DNA test +

What is pie sign?

-Indicates lunate dislocation. -Seen on PA view of wrist. -Triangular shape of lunate owing to anterior lunate dislocation.

What is post-traumatic ostrolysis of the distal clavicle?

-Injury response peculiar to the clavicle. -Resorption of distal segment. -Initiating injury may be relatively minor. -Becomes radiologically visible 2-3 months post injury. -1-3mm is normal and never > than 2-3cm; commonly overlooked; apparent 2-3 months postinjury. -Possibly because of synovial hypertrophy. -Common in weightlifters

What is lipohemarthrosis?

-Intra-articular fractures create a fat-fluid level secondary to lipohemarthrosis. -Bone marrow extrudes into the joint fluid=> fat floats on sup surface => FBI sign (fat, blood, interface). -Cross table lateral of the knee is necessary to demonstrate the fat-fluid accumulation in the suprapatellar bursa.

How are proximal femoral fractures classified?

-Intracapsular (subcapital, midcervical, basocervical). -Extracapsular (intertrochanteric, trochanteric, subtrochanteric).

What are the characteristics of proximal fibula fractures?

-Isolated fractures of proximal fibula are rare. -Usually found associated with ligamentous injuries of knee, fractures of lateral tibial plateau or ankle. -Force from messing up a foot can be transmitted up the fibula and fracture is proximally. -Impacted vs comminuted vs avulsion. -May see common peroneal nerve injury.

Describe the characteristics of a transverse ligament rupture.

-Isolated rupture is rare. -The odontoid usually breaks before the ligament completely ruptures. -Common in association with Jefferson's fracture and inflammatory arthritis (RA, AS, PA, RxA). -Wide ADI on lateral cervical radiographs. -Flexion is best to stress the ADI and see if there is a problem.

Define dislocation (luxation).

-It is a complete loss of contact between articular components of joint. -If fracture is also present then it is described as a fracture dislocation. -At extremity: describe position of distal in relation to proximal. -At spine: describe position of upper segment upon lower.

What is atlantoaxial rotatory fixation? (atlantoaxial dislocation)

-It is a unique condition of upper cervical complex almost always seen in kids. -Pathophysiology is unknown. It is underdiagnosed and poorly understood. -Spontaneous , trauma, upper respiratory tract infections, oral infections, and inflammatory arthritis have been documented causes, with oral surgery being the MC. -Patient presents with "cock robin" position. -4 types that we don't need to know.

Describe the reparative/metabolic phase of fracture repair.

-It is basically progression of calluses. Buttressing -> Sealing -> Bridging -> Uniting -> Union. -Buttressing callus: adjacent to outer surface of cortex and formed by periosteum and surrounding musculature. -Sealing callus: fills the medullary cavity and arises from the marrow to " seal" it from the fracture site. -Bridging callus: unites the gap between two buttress ends. -Uniting callus: joins the cortical portions of the fractured bone. -Clinical union: sufficient callus to allow weight bearing or similar stress.

What is a Malgaine fracture?

-It is the most common fracture of the pelvis, accounting for 1/3. -Ipsilateral double vertical fracture of the superior pubic ramus and ischiopubic ramus, with fracture or dislocation of the SI joint. -Superior and posterior displacement of the hemipelvis with fracture of the L5 TP may be present. -Result of vertical shearing forces to the pelvis. -Unstable with high morbidity and mortality rate. -Complications include rupture of diaphragm and bowel.

What are some C1 fractures?

-Jefferson -Posterior arch -Anterior arch -Lateral mass

Xray findings with SLE

-Joint hypermobility with normal joint spaces. -Reversible deformity of hands (via ligament laxity). -Soft tissue atrophy (but no Ca+); -Bouteneirre -Swan neck -Subluxation in bilateral symmetrical pattern. -Juxta-articular osteoporosis

What are you looking for when evaluating cartilage on an x-ray?

-Joint shape -Joint size -Radiographic density -*Normal cartilage cannot be visualized on plain film but rather is represented by the space that it occupies.*

Why is coracoclavicular ligament integrity important?

-Large factor in AC joint stability. -Integrity influences treatment. -Clinical grading is best determined by MRI. -Grades 1 and 2 can be treated conservatively using a sling, ice, and immobilization for 3-7 days. -Grade 3 management is controversial. -Grades 4-6 need surgical treatment.

What complications are associated with knee fracture/dislocation?

-Ligamentous tears (MRI). -Meniscal injury (MRI). -Osteochondral fracture (x-ray, MRI, CT).

Distinct signs associated with Synovial Chondromatosis.

-Loose bodies -Joint mice -Osteochondral fragments

What are the characteristics of an inferior shoulder dislocation?

-Luxatio Erecta -Rare -Severe hyperabduction trauma. -Humerus locks into hyperabduction position.

What are the characteristics of lunate dislocation?

-M/C carpal to dislocate following hyperextension. -Best seen on lateral view. -Pie sign

What are the characteristics of a scaphoid fracture?

-M/C carpal to fracture. -15-40 yo -Rare in children. -MOI: differs, but usually consists of hyperextension and radial flexion. -Often overlooked, leading to a high incidence of complications. -M/C site for occult fracture, although only 30% of fractures initially taken for occult are really of this nature. -70% involve waist; 20% proximal pole: 10% distal pole. -Optimum view: ulnar deviation. -90% will have fat strip displacement in the radial compartment of the wrist (navicular fat stripe sign). -Healing occurs w/out callus; fracture line just disappears. The more distal the fracture the faster the healing and vice versa. -Healing time: 6-20 wks.

What are the characteristics of lateral malleolus fracture?

-M/C fracture : oblique or spiral fracture extending from the inferior and anterior margin upward and backward to the posterior margin of the shaft of the distal fibula. -Result of outward or external rotation of the foot. -Medial oblique projection shows radiolucent oblique line w/ adjacent soft tissue swelling. -Talar dome osteochondral defects may exist.

What are the characteristics of a humeral surgical neck fracture?

-M/C site for humeral fractures. -Aka hidden fracture. -Narrowest point of humerus. -Fractures tend to be comminuted involving adjacent tuberosities. -Anteromedial displacement of the shaft distal to the fracture often occurs because of pull of pectoralis muscle. -Injury of the axillary nerve and artery may complicate fracture.

What are the characteristics of clavicle fracture?

-M/C skeletal injury during birth and childhood. -S-shape and overlap w/ upper rib cage renders it difficult to evaluate. -Do 15 degrees cephalad for optimal visualization. -15% of all fractures; 44% of shoulder fractures. -2/3 of all pts are males. -Middle clavicle= M/C fractured (75-80%); lateral (15-20%); medial (5%). -When middle is fractured, the medial fragment displaces superiorly because of action of SCM. -When lateral is fractured, must evaluate integrity of the coracoclavicular ligament. -Prior to skeletal maturity fractures of the clavicle are more common than AC injury, but symptoms may be similar.

Where does spinal column injury most commonly occur? What is the most common mechanism of injury?

-MC at C1-2, C5-7, and T12-L1. -MC due to flexion injuries, typically from auto accidents and sports.

What is the most common cause of AVN in adults? Other causes?

-MC is corticosteroids. -STARS pneumonic: Sickle cell anemia, Trauma, Autoimmune, Radiation therapy and RA, Steroids.

What is MRI best for viewing? CT?

-MRI is best for soft tissues. -CT is best for fractures/dislocations.

Describe a simple anterior column fracture.

-May terminate anywhere along the pubis or ischiopubic junction. -AP view shows a loss of continuity of the iliopubic line and medial displacement of the teardrop. -Best view is internal oblique.

Describe a wedge fracture.

-Mechanical compression of the involved vertebra due to forceful hyperflexion. -Stable due to IVD, ALL, and PLL intact (only involves 1 column). -2/3 occur from C5-7. -On x-ray there will be sharply demarcated anterior vertebral body wedging and retropharyngeal soft tissue swelling (>20mm). ->3mm anterior vertebral body height loss compared to posterior is diagnostic (loss of 25% is also diagnostic).

What is Chopart's dislocation?

-Mid-tarsal fracture/dislocation. -Rare injury that separates the foot at the talonavicular and often the calcaneocuboid joints.

What are the characteristics of distal phalange fractures?

-Middle finger is M/C. -4 types: transverse, longitudinal, comminuted, chip. -Longitudinal may split it in ½ and extend all the way to the joint. -M/C comminuted; usually distal tip. -Chip involve the post or ant corners of bases. -A post chip fracture inactivates extension of distal IP joint => flexion deformity (mallet or baseball finger).

What are the characteristics of compression fractures in the lumbar spine?

-Most common are T12-L1. -Due to flexion and axial compression. -Predisposing factors are trauma, osteoporosis, corticosteroid use, hyperthyroidism, and malignancy. -Exclusively involves anterior aspect/column of the vertebral body. -May cause paralytic ileus.

Where are the characteristics of compression fractures in the thoracic spine?

-Most common at T11-12. -Wedge shaped vertebral body. -Few cases of neurological deficits. -Paraspinal hematoma is an indirect sign of injury.

Describe fracture dislocation of the spine.

-Most common at the T/L junction anteriorly without lateral displacement after a flexion injury. -Complication includes cauda equina syndrome with complete luxation and lateral shift of the spine. -Ligament rupture and fracture of the posterior arch are common. -Naked facet sign on axial CT.

Describe a posterior arch fracture of C1.

-Most common fracture of C1. -50% of all atlas fractures. -80% have an additional cervical spine fracture. -Rare to be unilateral because it is a hyperextension injury, which is usually symmetrical.

Describe an oblique fracture orientation.

-Most common shape. -Typically occurs at the shaft of a long bone, 45 degrees to the long axis. -Margin orientation is usually only seen at one plane.

Describe a Salter Harris type II injury.

-Most common type of salter harris fracture (75%). -Fracture through the growth plate and metaphysis. -Metaphyseal fragment is called a Thurston Holland fragment. -Good prognosis.

Describe the horizontal sacral fracture.

-Most common, typically around S3-4 near the lower end of the SI joint. -Difficult to ID. -Use AP, lateral, and sacral base tilt (35 degrees). Look at foraminal lines on AP, disrpution of anterior cortex and anterior angulation of distal fragment on lateral. -Complications are sacral roots and plexus compromise. -Suicidal jumper's fracture.

Describe acetabular fractures in general.

-Most commonly occur from auto or pedestrian accidents and are a result of indirect injury (foot, knee, greater trochanter) position at impact. -Usually have soft tissue indicators on xray (Glut med, *obturator internus sign*, capsular fat pad, and psoas fat pad). -Check for capsular distention and widening of teardrop space.

Describe coccygeal fractures.

-Most commonly they are transversely oriented. -They are seldon seen on the AP film and need lateral views. -Fracture line is usually oblique. -Slight anterior displacement may be seen. -DDX developmental variations.

What are the characteristics of medial malleolus fracture?

-Most distal portion of tibia. -Fractures are usually transverse or oblique caused by angular forces from movement of talus against medial malleolus. -Fractures distal to the ceiling of the tibiotalar joint line (plafond) are more stable than the proximal ones.

What are the characteristics of Lisfranc's fracture-dislocation?

-Named after a surgeon in Napoleon's army, not for description of the injury, but for his method of foot amputation through the same region (the tarsometatarsal junction). -Dorsal dislocation of the metatarsal bases in relation to the opposing tarsals, in combination w/ fracture at various locations (mc at 2nd metatarsal). -There may be an associated lateral displacement of the metatarsals. -CT is useful. -M/C accompanying fractures: base of the 2nd metatarsal and lateral cuboid surface. -May predispose to development of secondary OA. -Surgical reduction w/ fixation gives a better prognosis when compared to conservative treatment. -Were common w/ equestrian accidents, now occur more in MVA's and industrial accidents.

What other tarsal fractures may occur?

-Navicular: Avulsion at dorsum= most common. DDX: os tibiale externum. Due to hyperplantarflexion. -Cuneiform: Isolated fracture is rare. Involved in Lisfranc (tarsometatarsal) fracture-dislocation. -Cuboid: Unusual. DDX: accessory ossicles (os peroneum, os versalium).

What are the complications associated with hip dislocations?

-Nerve injury in 10% of adults and 5% of children. -Sciatic nerve paralysis (usually peroneal branch) from posterior. -Myositis ossificans and AVN of femoral head in up to 10%. -Post-traumatic degenerative arthritis.

What complications are associated with ankle fractures and dislocations?

-Non-union (most common at medial malleolus). -Traumatic degenerative osteoarthritis. -Ligamentous instability. Ligament tears can occur without fracture and go undetected. Lateral ankle ligaments are most commonly torn. MRI has 95% accuracy in ligament tears.

How are costal cartilage injuries visualized?

-Not discerned on plain film. -Require nuclear bone scan and CT.

What are the characteristics of a lesser tuberosity fracture?

-Not vulnerable to isolated fractures. -Usually occurs with a proximal humeral fracture.

What are the types of fracture orientation?

-Oblique -Spiral -Transverse

Describe a transverse fracture orientation.

-Occur at 90 degrees to the long axis of bone. -Uncommon through health bone. -Usually only occurs with some pathology.

What is flail chest?

-Occurrence of 2 fractures of the same rib, isolating a segment of the rib. -Usually more ribs are involved the isolated rib fragments move in opposite directions (paradoxical motion). -This reduces ventilation and can be life threatening. -X-ray: isolated rib section rotates and exhibits a hook-like distal end on A-P view.

What is a trampoline fracture?

-Occurs in young children (2-10yo), who jump on a trampoline w/ another person. -Impaction between the descending child's leg and the upward-moving mat. -Proximal tibial metaphysis fracture.

Describe a greenstick (hickory stick) fracture.

-Occurs mostly in infants and children. -Tension on the convex side results in a transverse fracture, but the concave side remains intact.

What are the characteristics of wrist fracture/dislocation?

-One of M/C sites for fractures, not so much dislocations. -Point tenderness and decrease grip strength >20%= strong indicators for fractures. -Complex anatomy so requires adequate examination.

Define open vs closed fracture.

-Open fx penetrates the skin. It is susceptible to infection. -Closed fx does not penetrate the skin.

What are the characteristics of an AIIS avulsion fracture?

-Origin of rectus femoris muscle. -Active flexion painfully limited (acute). -Long term disability uncommon. -Commonly seen in rugby, soccer, and football players.

What are the characteristics of an ASIS avulsion fracture?

-Origin of sartorius muscle -Pain classically relieved by hip flexion (acute). -Chronic disability is uncommon -Treatment: Open reduction and internal fixation.

What are some intermediate complications of fracture?

-Osteomyelitis -Hardware failure -Reflex sympathetic dystrophy (Aka chronic regional pain syndrome. Chronic fight or flight mode in an area that you have previously fractured. Increased blood flow causes osteopenia. Sudeck's atrophy, which is disuse atrophy is also seen in the muscle.) -Myositis ossificans -Synostosis -Delayed union

What are some delayed complications of fracture?

-Osteonecrosis -Degenerative joint disease -Osteoporosis -Non-union -Malunion

What are the characteristics of patella fractures?

-Patella is located w/in the substance of the quads tendon. -Susceptible to fracture from direct or indirect trauma fractures are described by the fracture line orientation. -M/C is transverse or slightly oblique and it involves the midportion of the patella. -Transverse fractures = 60%. Stellate AKA comminuted = 25%. Vertical fractures = 15%.

Xray findings of RA

-Periarticular ST swelling -Subcutaneous ST mass -Uniform loss of joint space -Marginal erosions -Deformity -Whittled odontoid

What other visceral complications may show up on radiograph due to thoracic trauma?

-Pneumonia: May complicate the immobility of the chest owing to inactivation of the normal lung fluid-clearing mechanism. -Rupture of spleen, diaphragm, tracheobronchial tree, esophagus, kidney, heart, aorta, lung, thoracic spine. -Elderly have a high morbidity from rib fractures due to these complications.

What are the possible complications of clavicle fracture?

-Pneumothorax -Heal w/out sequelae in 95%. -Neurovascular damage: subclavian artery and vein, brachial sympathetic chain. -Non-union: 5% of cases. If lack of callus w/in 6 wks and gap > 1.5 cm= non-union. -Malunion: w/ fragment overlap. -Osteoarthritis of acromioclavicular joint. -Post-traumatic osteolysis of the distal clavicle.

With severe slippage, SCFE will result in what?

-Positive trendelenbure test. -Waddling gain

What are the types of acetabular fractures?

-Posterior rim fracture -Central acetabular fracture -Simple anterior column fracture -Simple posterior column fracture

What is a Monteggia fracture dislocation?

-Proximal ulnar shaft fracture. -Associated w/ dislocations of the radial head. -In children ulnar component of this lesion is often a greenstick fracture.

What is pubic/pelvic diastasis?

-Pubic diastasis represents a shearing separation of the pubic articulation. -Normal distance between the pubic bones should not exceed 8 mm in non-pregnant adults or 10 mm in children. -Often, associated unilateral dislocation of the sacro-iliac joint is overlooked.

What are the characteristics of a superior shoulder dislocation?

-Rare dislocation requiring considerable force. -Could occur via rotator cuff tear.

The first sign of scleroderma is ____________ and then ______________.

-Raynaud's dz -Puffy painful swelling of the extremities.

Describe the remodeling/mechanical phase of fracture repair.

-Realignment and remodeling of bone and callus along lines of stress (Wolff's law). -Restoration of medullary cavity and bone marrow. -The less disturbance of the hematoma the better the healing process. -Can proceed for years and needs maintaining of viable bone. -The spotty appearance of some of the carpals in the radiograph is indicative of regional osteoperosis. This is due to disuse ostropenia from being in a cast. It will go away as soon as they start to use it.

Describe the vertical sacral fracture.

-Result of indirect trauma to the pelvis. ->50% siffer pelvic organ damage. -No evidence on lateral view. Sacral base tilt or CT may be needed. -Fracture line usually runs the entire length of th esacrum. -Examine neural foramina. -Mid-sagitally oriented fractures have low incidenc of neuro compromise.

What are the characteristics of middle rib fractures?

-Ribs 4-9 M/C fractured. -MOI is usually lateral and it makes them difficult to visualize (blunt thoracic trauma). -Extrapleural collection of hematoma. -Fractures of middle to lower anterior ribs should stimulate close scrutiny of spleen and liver for injury.

How are ankle fractures assessed?

-Routine radiographic examination: AP, Lateral, Medial Oblique. -CT: has excellent bone detail and is useful in assessment of complex ankle articulations. -MRI: has superior soft tissue contrast and multiple imaging planes. Best for viewing tendons, cartilage, soft tissue, ligaments.

What is a type 2 AC separation?

-Ruptured AC ligaments, sprained CC ligament. -Widened AC joint space. -Greater than 6mm in Females and 7mm in Males is abnormal. Or greater than 2mm compared to uninjured side. -50% Upward displacement of clavicle relative to acromion w/wo weighting.

(Reactive arthritis) Spine & SI joint findings.

-Same as Psoriatic arthritis. -Asymmetrical sacroilitis. -Non marginal syndesmophytes.

What are the characteristics of carpal instability?

-Scapholunate dissociation (rotary subluxation of the scaphoid). -Follows acute dorsiflexion. -Pain, crepitus, weakness. -Disruption of scapholunate ligament (+ others). -Scapholunate dissociation (Terry Thomas sign). -Foreshortening of the scaphoid (ring sign) signet ring sign. -DDX: wide scapholunate joint in 50% of lunotriquetral coalition. -May need to do views different than the standard ones.

What are the characteristics of a pubis symphysis avulsion fracture?

-Severe acute or chronic recurrent injury. -Attachment of major adductor muscles. -Avulsion at superior or inferior pubic rami. -Common in soccer players.

What is bilateral interfacetal dislocation.

-Severe hyperflexion injury most common at C4-7. -Significant injury due to soft tissue damage (PLL, disc, ALL, and capsular ligaments all involved). -Complete bilateral facet joint dislocation. -Naked facet sign and Reverse hamburger sign. -Radiographic findings include divergend spinous processes, disarticulation of both facet joints at a single level, chip fractures from the tips of articular pillars, and paraspinal edema. -Treat with distraction relocation.

What are the characteristics of scapula fracture?

-Severe trauma. -80% have other associated injuries; need special views such as true anteroposterior view of the scapula, axillary view and true lateral view (Y-view) to demonstrate glenoid fracture. -Majority involve body and neck (80%). -If coracoid or acromion fracture it is usually in the midportion or the narrowest region.

What are you looking for when evaluating bone on an x-ray?

-Shape -Size -Cortical integrity -Internal matrix (trabeculation) -Radiographic density -Specific structures

What are you looking for when evaluating soft tissues on x-ray?

-Shape -Size -Position -Radiographic density

HADD is most common at the __________, especially the ________.

-Shoulder -SITS mm (supraspinatous)

Systemic involvement of scleroderma.

-Skin (hands, wrists) -GI tract -Heart -Kidneys -Musculoskeletal system

What is SCFE?

-Slipped capital femoral epiphysis. -Salter Harris I injury. -Occurs in 2 out of every 100,000 children. -Higher incidence in children who are obese and growing rapidly (Frolich body type), especially boys 11-15 and African American. -20-30% of the time is bilateral. -Limp with hip pain referred to knee possibly necause of irritation of the genu branch of the obturator nerve. -This radiograph shows the pistol grip deformity and beak-like appearance.

What is a chip fracture (phalangeal)?

-Small fracture of phalangeal articular surface. -Hyperflexion/hyperextension.

Xray findings for scleroderma

-Soft tissue Ca+ (subcutaneous) -Distal tuft resorption -Normal joints

What are you looking for when evaluating alignment on an x-ray?

-Spatial relationship of structures -Look for offset of articular margins -Evaluate structures for proper position (i.e. trachea should be midline.) -Make pertinent specific measurements.

What is a type 1 AC separation?

-Sprained AC ligaments, intact CC ligament. -Radiographs are normal. -MRI demonstrates partial AC ligament tear.

What are traumatic articular lesions?

-Subluxation -Dislocation (luxation) -Diastasis

What is a bucket handle fracture?

-Superior pubic ramus and ischiopubic junction on the side opposite the oblique force of impact to the pelvis with a fracture or dislocation of the SI joint on the side of impact. -Inward and superior displacement of pubic component of the fracture. -Result of auto or pedistrian accidents and may be associated with injuries to the head, thorax, and abdominal viscera.

AS targets ___________ joints, __________ joints, and ___________.

-Synovial (SI) -Cartilaginous (outer annular fiber syndesmophytes) -Entheses

AKAs for Synovial Osteochondromatosis.

-Synovial Chondromatosis -Osteochondromatosis -Synoviochondrommetaplasia (SCM)

What complications are associated with SCFE?

-There may be permanent coxa vara deformity. -Femoral neck broadening and shortening. -AVN of the femoral head = uncommon unless but more likely if there is operative reduction or if wedge osteotomies of the femoral neck is performed (35%). For this reason reduction is usually done in situ. -Acute cartilage necrosis (chondrolysis). -Osteoarthritis (M/C)

Describe articular pillar fractures.

-They are among the most frequently missed cervical spine fractures because pillars are not seen well on standard views. -CT is definitive. -Most commonly occurs from C4-7, with 40% at C6. -MOI is hyperextension and lateral flexion. -Horizontal facet sign.

What are the characteristics of a bar room fracture?

-Transverse fracture involving the neck of the 4th or 5th metacarpals. -MOI: "roundhouse" type of blow from inexperienced fighter. -There is usually anterior angulation of the fractured fragment.

What are the characteristics of a boxer's fracture?

-Transverse fracture of the neck of the 2nd or 3rd metacarpal. -MOI: straight, jabbing type of blow w/ the fist.

What pleural complications may occur with trauma to the thoracic cage?

-Traumatic pneumothorax -Hemothorax complications -Chylothorax complications

What is a Hangmen's fracture?

-Traumatic spondylolisthesis of C2, usually from forceful hyperexteision in high speed auto accidents. -Bilateral C2 pedicle fracture, commonly with concurrent anterolisthesis. -Retropharyngeal soft tissue swelling via prevertebral hemorrhage. -Accounts for 40% of C2 fractures.

What is a trimalleolar fracture?

-Trimalleolar fractures affect the posterior lip in addition to the medial and lateral malleoli. -Often found with tibiotalar dislocation. -These fractures are the result of external rotation of the foot and are, therefore, laterally and posteriorly displaced. -Third malleolus fracture best seen on the lateral radiograph. Fracture fragment being displaced posteriorly and/or superiorly.

(AS) Three vertical linear regions of increased radiopacity seen on AP lumbar d/t facet joint & interspinous/supraspinous ligaments

-Trolley track (facets) -Dagger sign (supraspinous & interspinous).

What are the types of spondylolisthesis?

-Type I: Congenital aka dysplastic. -Type II: Isthmic. Pars (football, gymnastics). -IIA: fibrous tissue formed between pars break. Most common. Anterolisthesis. -IIB: Elongated pars because it repaired. -IIC: Acute fracture of the pars. Very rare. -Type III: Degenerative. Females over forty at L4. Degenerative. -Type IV: Traumatic spondylytic spondylolisthesis. Fractured pedicles. -Type V: Pathologic. Fractured pedicles due to tumors. -Type VI: Iatrogenic (during surgery).

Describe a simple posterior column fracture.

-Uncommon -External oblique projection. -On AP view, the ilioischial line is displaced medially and separated from the teardrop.

What are the characteristics of proximal femoral fractures?

-Uncommon in young-middle aged patients. Severe forces necessary to fracture. -Sharp increase in incidence in geriatric patients. Mild to moderate trauma to fracture osteoporotic bone. -Predisposing pathologies include Paget's disease, fibrous dysplasia, benign/malignant bone tumors, osteoporosis (one of the MC causes), osteomalacia, radiation induced osteonecrosis. -2:1 Female-male ratio. -5:1 Female-male ratio with intracapsular fracture. -Major health hazard to elderly. -Many elderly who fracture proximal femur die within 6 months of original injury secondary to pulmonary and cardiac complications. -CT, MRI and Isotopic bone may be useful.

What is a Toddler's fracture?

-Undisplaced spiral fracture of the tibia. -Children 9 mos to 3 years; often too young to verbalize pain. -Fall or child gets a foot caught between the slats of the crib and then rolls over. -Adult form: boot-top fracture; if both bones fracture=> BB fracture for both bones.

What is rider's bone?

-Unexplained overgrowth of avulsed apophysis (ischial tuberosity). -Most commonly seen in cheerleaders and hurdlers. -Named for chronic stress producing lesion in horseback riders.

What are the characteristics of an upper rib fracture?

-Upper 3 ribs rarely fracture because of supporting mm. -Presence suggests severe trauma w/ possible injuries to trachea, aorta, great vessels, brachial plexus or spine. -Weightlifters may incur fracture of the 2nd rib during heavy bench pressing. -Stress fractures of the 1st rib can occur in throwing athletes.

What are the characteristics of an intertrochanteric fracture?

-Usually comminuted. -Oblique fracture line usually splits the trochanters.

Describe a spiral fracture orientation.

-Usually involves a high energy trauma and involves torsion + axial compression + angulation forces. -Seen in multple planes. -Sharp pointy margins.

Describe posterior hip dislocations.

-Usually occur w/ hip in flexion and adduction of the thigh followed by direct blow to knee. -Assoc. fracture: Posterior lip of acetabulum found in up to 90% Aka dashboard fracture (posterior rim fracture). Small anterior femoral head fracture found in up to 13%. -Fracture fragments are rarely visible and CT is required for identification. -Femur lies cephalad and lateral to acetabulum. -CONTRAINDICATIONS: adjusting in side posture on either side.

Describe anterior hip dislocations.

-Usually occur with hip in forced abduction and extension. -Femoral head usually lies caudal and medial to the acetabulum and near the obturator foramen. -Femur lies caudal and medial to acetabulum.

Describe the characteristics of a tibial tuberosity avulsion fracture.

-Usually occurs in association w/ a comminuted or subcondylar fracture of the proximal end of the tibia. -M/C in adolescent boys. -May be predisposed by the presence of Osgood-Schlatter. -An associated disruption of the patellar tendon may occur. -Usually takes place during athletic activities w/ knee flexed and the quads tendon contracted and firmly resisting further flexion.

What are the characteristics of hip dislocations?

-Usually the result of severe trauma such as MVA. -Account for 5% of all dislocations. -15% go anterior, 85% posterior. -Associated acetabulum fracture is common.

What is a bimalleolar fracture?

-Usually transverse on one side because of tensile forces and oblique or spiral on the opposite side. -Diffuse ST swelling may be present.

What are the characteristics of phalangeal dislocation?

-Usually via acute hyperextension. -Posterior dislocations (MC). -Anterior dislocations are rare. -May see small volar plate fractures associated with the dislocation.

What soft tissue injuries are often associated with pelvic fractures?

-Vascular injuries: (Intrapelvic hemorrhage-most common vascular complication). -Bladder & Urethral: (Seen in injuries with subsequent widening of the pubic symphysis). -Bowel Injures: (Laceration or obstruction are the most frequent bowel complication with pelvic fracture). -Diaphragm Injuries: (Often traumatically ruptured with pelvic trauma).

What are the types of vertebral body compression fractures?

-Wedge fx -Burst Fx

What is an impaction fracture?

-When a portion of bone is driven into its adjacent segment. -The fracture line is usually opaque at the region of impaction. -Two types.

What is whiplash syndrome?

-Whiplash is a general term describing soft tissue neck injuries. -Whiplash syndrome aka acceleration-deceleration, flexion-extension, hyperflexion-hyperextension, sprain-strain injuries. -Symptoms can be minor or incapacitating. -Standard post-trauma serioe includes frontal, lateral, and oblique views. Lateral view is positive for soft tissue findings in 70-90% of cases. -Consider flexion and extension films after fractures are ruled out.

Primary Synovial Chondromatosis

-Young healthy joints. -Formation of cartilaginous intercapsular loose bodies d/t synovial metaplasia.

1= femoral head 2= femoral neck 3= fovea capitis 4= intertrochanteric line 5= greater trochanter 6= lesser trochanter 12= acetabulum 18= Kohler's teardrop

1, 2, 3, 4, 5, 6, 12, and 18

Stages of AS

1. Early: widened joint, frayed margin, sclerosis on iliac side of SI. 2. Rosary bead erosions. 3. Chronic: star sign & ghost joint.

Common radiographic findings of Degenerative Arthritis (non-inflammatory)

1. Osteophytes 2. Subchondral sclerosis 3. Subchondral cysts (geodes)

Acute fractures cause symptoms for ________ days via ________ disruption.

10-14 days via endplate disruption.

Juvenile Chronic arthritis is in RA patients under _______.

16 y.o.

Transverse ligament (so do a lateral cervical flexion/extension X-ray to see if they have one)

20% of people with Down syndrome lack which ligament?

About ____% of all pelvic fractures involve the ________, so you always check it when a pelvic fracture is present.

20%. Acetabulum.

Displaced intracapsular fractures have up to a ____% non-union rate.

25

_____% of psoriasis patients will get arthritis & ____% if they have nail changes.

42 80

M/C Demographic of DISH pts

5th & 6th decades of life Males>

Hypertrophic neuropathic arthritis.

6 D's, bag of bones

The reason you usually can't see Synovial Chondromatosis on xray in early stages is because...

75% of foci of cartilage

Arthritis occurs in ______ of SLE pts.

90%

The acetabular ridge

90% of posterior hip dislocations leading to fractures occurs at?

A

97% of shoulder dislocations are a) Anterior & inferior b) Posterior & inferior

Os acetabuli

?

Paraglenoid sulcus

?

Spondylolisthesis

A break in George's line is the point of ____________________.

Explosion fracture

A central acetabular fracture is also known as an?

Spondylosis

A collection of multiple spondylophytes is called?

What is a chip fracture?

A form of avulsion where a small chip of bone is broken from the parent, usually at phalanx or other short tubular bones.

Spondylolytic spondylolisthesis

A patient has chronic low back pain with no history of acute trauma, but a pars break as shown, what is this condition?

pectus excavatum

A person with these X-rays has a sunken in chest, what is their condition?

Pars on same side so RPO would show the right pars, LPO would show left pars

A posterior lumbar oblique view will show which pars?

What is a butterfly fragment?

A triangular cortical fragment resulting from a comminuted fx.

DISH is ligamentous calcification and ossification primarily at the _________.

ALL

Non-marginal syndesmophytes are best seen with what view?

AP

Enteropathic arthritis is radiographically identical to _______, but also may have the _________ sign.

AS Lead pipe

Sever disease

AVN of calcaneus

Panner diseas

AVN of capitulum

Legg-Calve-Perthes in children or Chandler's disease in adults.

AVN of femoral head

Hass disease

AVN of humeral head

Keinbock disease.

AVN of lunate

Freiberg disease

AVN of metatarsal heatWd

Kohler disease

AVN of navicular

Preiser disease.

AVN of scaphoid

Diaz disease

AVN of talus

Kummell disease

AVN of vertebral body

Acetabular fracture

Acetabular fracture

Hip dislocations

Acetabular fractures are usually associated with what issue, but isn't required?

Chondrocalcinosis with CPPD may lead to ...

Advanced DJD in unusual places.

What is the suicidal jumper's fracture?

Affects the S1 and S2 segments.

Vacuum Phenomenon is ...

Air density within the disc (nitrogenous gas).

How is a general strategy to reading x-rays?

Alignment, anomalies, anatomy. Bone Cartilage Soft tissue.

CT

An acetabular fracture is best seen on which type of imaging?

Pars on opposite side

An anterior lumbar oblique view will show which pars?

AIIS

An avulsion fracture caused by the rectus femoris would occur at which location?

Hamstrings

An avulsion fracture of the ischial tuberosity would involve what muscle(s)?

(AS) In advanced cases, single level becomes mobile resulting in instability and adjacent destruction that simulates infection or neuropathic joint

Anderson's lesion

Which of the three radiographic indicators for an anterior body fracture is permanent?

Anterior body wedging

Children as it is used for a supracondylar fx view

Anterior humeral line is really only for which age?

(RA) Severe polyarticular joint deformity via severe articular destruction

Arthritis mutilans

Psoriatic arthritis has a _________ distribution.

Asymmetric

Joint narrowing with OA is _____________.

Asymmetric (non-uniform).

Common complaint of pt's with Reactive Arthritis.

Asymmetrical painful joint effusion.

Medical: Over 20 Chiro's: Over 10

At what angle does the medical profession consider a lateral curve a scoliosis, and when are Chiropractor's concerned?

1st metatarsophalangeal joints

At what joints do bunions occur?

Due to RA's presence in the cervical spine, it is important to check for ___________.

Atlantoaxial instability

Atlas anterior arch lateral mass transverse process

Atlas structures to know: Anterior arch, anterior tubercle, posterior arch, posterior tubercle, lateral masses, transverse processes, transverse foramina, an d spinolaminar junction

Describe a Type I odontoid process fracture.

Avulsion of dens tip via alar ligament stress, uncommon, stable injury.

Axis dens spinous lamina

Axis/C2: structures to know body, dens, pedicles, articular pillar, lamina, spinous, transverse process

(Neuropathic Arthritis) Palpable signs of advanced neuropathic joint.

Bag of Bones

________ intracapsular hip fractures are the frequent location of ________ fracture.

Basocervical. Pathologic.

Change seen with OA in the AP view at the uncovertebral joints.

Batman to scooby ears.

AKAs for Ankylosing Spondylitis

Bechterew Marie Strumpell

RA patients treated with steroids are predispositioned to ____________.

Bilateral protrusio acetabuli (Otto's pelvis).

AS X-rays will initially show _______________ and the pattern of progression is ___________.

Bilateral symmetric sacroilitis Ascending (up the spine).

What is a hemothorax?

Blood may accumulate in the pleural space from ruptured blood vessels. This can be identified by observing blunt costophrenic sulci, widening of the paraspinal space, and apical "capping."

Atrophic Neuropathic Arthritis

Bone resorption Tapered bone ends

OPLL is best seen with ________.

CT

What is the most commonly fractured tarsal?

Calcaneus

HADD AKA

Calcific tendinosis

CREST =

Calcinosis Raynaud's Esophageal abnormality Scleroderma Telangiectasia

lateral

Capitulum is the _________________ epicondyle

Pneumoconiosis + RA

Caplan's syndrome

(AS) Fracture than occurs through an ankylosed segment to amplify brittleness of spine

Carrot stick/chalk stick fracture.

Neuropathic Arthritis AKAs

Charcot's Joints Neurogenic (osteo-) arthropathy

Physical appearance of neuropathic joint of any cause d/t disorganization, debris, distension.

Charcot's joints

Reactive Arthritis is most commonly caused by ____________.

Chlamydia

Softening & degeneration of patellar cartilage exacerbated by prolonged sitting in confined space.

Chondromalacia Patella (Movie sign/Airplane sign)

What is the most common skeletal injury of birth and childhood?

Clavicle fracture.

Osteophytes that arise from vertebral margins with no gap, stress response but not directly DDD.

Claw osteophyte

(Neuropathic Arthritis) Physical appearance of bilateral non-painful swelling, usually @ knees, d/t congenital syphilis.

Clutton's joints

Scleroderma is an inflammatory CT disorder that deposits _____________.

Collagen protein

An MRI would be helpful with OPLL to see if there is ______________.

Compression myelopathy

(RA) zig-zag deformity

Configuration of the hand in the combination of ulnar deviation & carpal radial deviation.

What do you need to DDX from patellar fracture?

DDX: bipartite or tripartite patella (80% are B/L)=> usually seen on the superolateral portion, a rare site for a patellar fracture.

Most common area for psoriatic arthritis is the _________.

DIPs

90% of OPLL patients will have __________.

DISH

3 D's of DISH

DISH Dysphagia Diabetes Mellitus

Sagitally oriented facets are more prone to _________.

DJD

6 D's

Density Debris Destruction Distension Disorganization Dislocation

Hypertrophic neuropathic arthritis is most common with ____(cause)___ at the ___________ extremity.

Diabetes Lower

Causes of Charcot's joints

Diabetes Syringomyelia Syphilitic Tabes Myelomeningocele

AKAs for DISH

Diffuse Idiopathic Skeletal Hyperostosis Forrestier's Disease (Senile) Ankylosing Hyperostosis

True

Dislocated facets found from George's line would be a contraindication to adjust, T/F

_____ occurs at the ends of the fingers with psoriatic arthritis.

Distal tuft resorption

What is Steele's rule of thirds?

Divides the atlas ring into thirds. 1/3 cord, 1/3 space, 1/3 odontoid.

Describe a crush injury to the phalangy.

Dropping a heavy object on the toe frequently results in a comminuted phalanx, especially the distal phalanx

Lateral Elbow View Labeled

Elbow Anatomy to Know: Radial tuberosity, Radial Neck, Radial head, Coronoid process, Trochlea, Capitellum, Olecronano, Olecranon fossa, coronoid fosssa

AKAs for Enteropathic Arthritis

Enteropathic Arthropathy Enteropathic. Spondylitis

Late stage of JCA X-rays will show ______________.

Epiphyseal overgrowth/ballooning.

Extreme anterior trauma, epileptic seizures or electrocution (The 3 E's)

Even though posterior shoulder dislocations are rare, what can they be caused by?

(RA) Swan neck deformity

Extension of PIP, flexion of DIP.

Psoriasis rashes are worse at ______________.

Extensor surfaces

What is the AKA for the zygapophyseal joints>

Facet joints

DISH spares the _________ & __________, which is a ddx with AS.

Facet joints SI joint

What is the FBI sign?

Fat-blood interface sign. Indicates intracapsular lesion.

Leukopenia + Splenomegaly + RA

Felty's syndrome

M/C Demographic of Erosive OA pts

Female >50 y.o

RA is most common in ______(gender)____ and at ages _________.

Females 20-40y.o.

Femoral neck fracture

Femoral neck fracture

Atlantodental Interspace (ADI)

Film: Lateral Cervical This is the distance between posterior margin of the anterior arch of atlas and the anterior surface of the odontoid process as measured on the neutral lateral cervical film at 72 inches FFD. The size of the space assists in determining C1-2 stability. ADI is also considered abnormal if it increases during cervical flexion. Increased ADI may be caused by changes in the transverse ligament, such as in rheumatoid arthritis or traumatic injury. Normal: Adult 1-3 mm Child 1-5 mm

Physiological lines of stress (Ruth Jackson's lines)

Film: Lateral Cervical (Flexion, Extension) Procedure: -Draw a line along the posterior margin of the body of Axis.along the posterior margin of the body of C7. -Extend both lines until they meet. Normal: The lines should intersect between C4-5 on the extension lateral and between C5-6 on the flexion lateral. Significance: Marked alterations in the point of greatest stress and strain indicate limitations of motion due to advancing degenerative changes and discogenic spondylosis. Care must also be taken to consider the overall architecture of the spine before placing too much significance on this line. The normal cervical architecture will cause an abnormal finding which will be normal for that individual. Congenital hyperlordosis is the best example of this.

Gravitational line from the Odontoid Process

Film: Lateral Cervical. Procedure: A vertical line is drawn from the apex of the odontoid inferior to the level of C7. Normal: The line should fall within the antero-superior 1/3 of the body of C7. Significance: Anterior to the normal range may indicate hypolordosis while Posterior to the normal range may indicate hyperlordosis of the cervical spine.

George's Line

Film: Lateral Cervical. Procedure: The line is created by drawing a continuous line on the posterior vertebral body surfaces. Care should be taken to not draw the lines connecting the superior and inferior body angles due to the frequency of hypertrophic changes in this area which must not be obscured from view by the pencil line. Normal: The series of short lines should form a smooth, continuous anterior arc. Significance: The line is useful in determining flexion or extension subluxations of the vertebra as these subluxations will alter the smooth flowing line to some degree, depending upon severity. Rotation will tend to give a false positive if care is not exercised in positioning this line. Anterolisthesis and retrolisthesis will also alter this line. Differentiation should be made between a "break" and an"interruption" in George's Line. A "break" refers to a distinct anterior or posterior slippage effectively breaking the continuity of the line while an "interruption" is an alteration of the smooth continuity of the arc caused by flexion or extension subluxations.

Ferguson's Gravitational Line

Film: Lateral Lumbar. Procedure: Draw a line from the center of the body of L3 at 90 degrees to the bottom of the film. Normal: The line should cross the anterior third of the sacral base Significance: When the line falls >I mm anterior to normal it may indicate an increase in anterior shearing stress on the L5-S1 facet joints. Posterior shift in the gravity line may be a sign of increased weight bearing on the lumbo-sacral facets. The line is of little significance when a transitional lumbo- sacral segment is present.

Ferguson's Sacral Base Angle

Film: Lateral Lumbar. Procedure: Draw a true horizontal line from the edge of the film. Draw a line along the sacral base intersecting with the horizontal line. Measure the acute angle formed by the intersection. Normal: 26- 57 degrees. Significance: An increased sacral base angle may exacerbate shearing and compressive forces on the posterior lumbo-sacral joints. Much variation in this angle has been found by the various researchers' studying it. One consistency arises in that almost all attribute an approximate 8-12 degree increase in the standing angle over the supine. The angle is of great significance in analyzing the lumbo-sacral motor unit's stability and strength.

Lumbo-Sacral Disc Angle

Film: Lateral Lumbar.Procedure: Draw a line along the sacral base. Draw a line along the bottom of the body of L5. Extend both lines until they intersect. The resulting angle is measured. Normal: The angle should measure I 0-15 degrees. Significance: Angle > 15 degrees indicates facet impaction which may cause low back pain Angle < I 0 degrees may result from acute disc herniation at L5 Please note that while Ullman's Line is included in the sketches below, it is NO LONGER a required line of mensuration in the Health Center.

(RA) Boutonniere deformity

Flexion of PIP, extension of DIP.

What are the types of teardrop fracture?

Flexion or extension.

Synovial cells under the synovial lining transform to produce _____________. Some of these detach and form __________, which may attract Ca+ and ________.

Foci of cartilage Loose bodies Ossify

-AP view -Incidental -If trauma to knee, can flare up

For bipartite/tripartite/multipartite patellas, what view is it best seen on, is it incidental or worrisome, and is it painful?

Describe a Type III odontoid process fracture.

Fracture deep into C2 body below dens-body junction, slightly less common than type II, heals readily, stable injury.

What is a Tillaux fracture?

Fracture of medial malleolus with diastasis of the distal tibiofibular syndesmosis.

Dancer or Jones fracture

Fracture of the 5th metatarsal is known as?

There is spinal cord injury in 10-14% of what?

Fracture/dislocations -In 40% of cervical spine -In 10% of thoracic spine -In 4% of thoracolumbar junction

How do you tell the difference between a fracture and apophysis?

Fractures are typically transverse/perpendicular to the cortex or transverse in nature whereas the apophysis will be along the long axis.

What is lunotriquetral coalition?

Fusion of the lunate and triquetrum.

(AS) fusion of SI joints with visualization of articular cortex

Ghost joint

________ occurs when Kidneys are not excreting uric acid and deposits of sodium monourate are made in the body.

Gout

Xray sign m/c at DIPs with Erosive OA.

Gull-wing sign

AS has + ________ in 90% of patients.

HLAB27

Labs for EA are non-specific but are RF- and +_________ in about 60% of pts.

HLAB27

What is the hamburger and reverse hamburger sign?

Hamburger sign is normal view of facets. Reverse hamburger sign is seen with dislocation.

What is Hawkin's sign?

Hawkins sign means that the talus has been revascularized and is healing. No AVN.

(RA) Soft tissue periarticular swellings at dorsal MCP joints

Haygarth's nodes

A common location for OA is the DIPs and PIPs, as well as the 1st carpometacarpal joint. Nodes at the DIPs are called ___________ and at the PIPs are called ____________.

Heberdens Bouchards

Subchondral sclerosis at the IVD of lumbar spine is ________ shape.

Hemispherical

What is a bone bruise?

Hemorrhage and bone marrow edema at trabecular microfractures. -Only discovered with MRI. -Pic is a T1 MRI study of a FOOSH injury.

Posterior Hip dislocation

Hip dislocation

Hip dysplasia

Hip dysplasia

(RA) Boutonnière deformity of thumb

Hitchhikers thumb

1) Internal rotation= lesser tuberosity on profile, greater tuberosity on foss (on face) 2) External rotation= greater tuberosity on profile, lesser tuberosity on foss

How can you tell the difference between internal rotation of shoulder and external rotation of shoulder on X-ray?

AIIS avulsion would be more superior than os acetabuli, and patient history.

How can you tell the difference between os acetabuli and an old AIIS avulsion fracture?

Always describe the side of convexity, so Left/Levo or Right/Dextro Convex

How do you describe a scoliosis?

1) Find vertebra level where there is a break in the line-- always choose the higher vertebra above the break to describe 2) Determine whether it is a anterolisthesis or retrolisthesis Ex= Anterolisthesis of C4

How do you describe a spondylolisthesis?

1) Draw line through vertebral body, this separates one side of body to the other 2) Look at marker, which side it is on will tell you which IVF you are looking at

How do you determine if you are looking at right or left IVF's in a oblique cervical?

Bone islands have well-defined sharp margins is a solitary finding usually and the patient is asymptomatic

How do you differential diagnose bone island from osteoblastic metastasis?

Bipartite is always in the superolateral corner of the patella while fractures have different patterns

How do you differentiate bipartite patella and a fracture?

Os acetabuli has smooth cortical margins with trabecular bone inside and it does not look displaced

How do you differentiate os acetabuli and a fracture?

Tangential line along the superior margin of femoral neck

How is Kline's line drawn?

-Tangential line to the lateral obturator margin & pelvic brim -AP hip or pelvis

How is Kohler's line drawn and what view is it seen on?

-Draw a smooth line along the inferior margin of the femoral neck & inferior margin of the superior pubic rami -AP hip or pelvis

How is Shenton's line drawn and what view is it seen on?

-Femoral shaft line, then draw a perpendicular line at the apex of the greater trochanter (Skinner's line skins the top of the greater trochanter) -AP hip

How is Skinner's line drawn and what view is it seen on?

-Draw femoral shaft line, draw a line thru the axis of the femoral neck= femoral angle (measure angle closest to lesser trochanter) -AP hip

How is the femoral/mickulicz's angle drawn and what view is it seen on?

-Draw a smooth line along the ilium & femoral head and neck -AP hip or pelvis

How is the iliofemoral line drawn & what view is it seen on?

-Most medial distance between the femoral head & the outer cortex of the teardrop -AP Hip

How is the teardrop distance measured and what view is it seen on?

Thoracic kyphosis Line thru inferior end plates of T1 and T12, drop perpendiculars and measure angle, using Cobb's angle Normal: Increases with age, and varies by sex

How would you measure the angle of the thoracic curve, what is it called and what is normal?

Anterolisthesis at L4

How would you name this spondylolisthesis?

What is the lightbulb/tennis racquet sign?

Humerus is stuck in internal rotation, so you can't see the tuberosities.

CPPD is crystal deposition at ___________ & ___________.

Hyaline Fibrocartilage

A= Anterior SI joint B= Sacral tubercle C= Sacral Base D= Posterior SI joint E= Anterior sacral foramina F= Posterior sacral foramina

Identify A-F

How do you tell the difference between a T1 or T2 MRI?

If CSF is dark, then it is T1. If CSF is white, then it is a T2.

The Scotty dog always faces the master, the head faces towards the side so look at the marker.

In an oblique view how can you tell which side you are on?

profile

In external rotation the greater tuberosity is on?

Apex of curvature

In relation to the curve of scoliosis, where can hemivertebrae always be found if present?

-Upper facet joints in sagittal plane -Lower facet joints in coronal plane

In what plane are the lumbar articular processes?

Tendon for the lateral head of gastrocnemius

In what tendon does the os fabella occur?

Labs for Erosive OA.

Increased ESR RF-

What is the terry thomas sign and signet ring sign?

Indicates lunate dislocation.

Progression of the skin disorder with Scleroderma: Edema >> _____________, which leads to fibroblasts at the extracellular matrix >> hardening = ___________ >> __________ (skin tight)

Induration Sclerosis Atrophy

Pathogenesis of Reactive Arthritis: Likely a reaction to ____________ of a _____________ or ___________ origin.

Infectious trigger Genitourinary Gastrointestinal

What is the double spinous process sign?

Inferiorly displaced spinous due to avulsion fracture (clay-shoveler's).

AKA for Erosive Osteoarthrits

Inflammatory Osteoarthritis

RA s/sx

Insidious onset Malaise/weakness Joint pain, tender, swelling, stiff (esp in AM) Bilateral & symmetrical peripheral joint involvement palpable soft tissue nodules.

Calcification of outer annular fibers (degenerative finding).

Intercalary bone

(RA) Dot dash appearance

Intermittent absence of articular cortex via erosion & subchondral bone resorption.

What is a traumatic pneumothorax?

Intrapleural negative pressure functions to maintain lung inflation. When the pleura is torn, this pressure is lost, allowing the lung to collapse.

Extraskeletal findings of AS

Iritis Aortitis Renal failure

Classic Triad of Reactive Arthritis

Iritis (Uveitis) Urethritis (Cervicitis) Polyarthritis

What are the characteristics of a lesser trochanter avulsion fracture?

It is considered due to METS until proven otherwise. -Dotted line is an ill-defined lytic lesion.

What is an avulsion fracture?

It is the tearing away of bone by forceful muscular or ligamentous pulling. -Frequently occurs at tuberosities of long bones and cervical spinous processes. -Usually occurs at an *apophysis*. -Especially prevalent in *adolescents* because the muscles are stronger than the bone/cartilage/growth plates.

What is a spontaneous pneumothorax?

It is when part of your lung collapses. It happens if air collects in the pleural space (the space between your lungs and chest wall). The trapped air in the pleural space prevents your lung from filling with air, and the lung collapses.

Joint stiffness that is worse in the morning is called ___________.

Jelling phenomenon

(Neuropathic arthritis )Fragmented appearance of vertebral body d/t multiple fractures.

Jigsaw vertebra

__________ is the gold standard for dx of gout.

Joint aspiration

Interspinous osteoarthritis occurring with closely opposed spinouses, leading to enlargement, flattening & sclerosis of SPs.

Kissing Spinous (Baastrup's dz)

What radiographic line is used to evaluate SCFE?

Klein's line. -Left side is abnormal. Klein's line is used to evaluate for SCFE. Line should pass through some part of the femoral head. The left side is also a little wider and fuzzier. Frog-leg view is the most sensitive view for SCFE.

CPPD can cause DJD in the _______, often at the _______, and at the pubic symphysis.

Knee Meniscus

M/c location of Synovial Chondromatosis.

Knee (70%) Hip Elbow

Facet arthrosis m/c @ _____ (lumbars) (OA).

L4-5

What is the bow-tie sign?

Lack of superimposition of the articular pillars due to unilaterl ainterfacetal dislocation.

(RA) Fibular deviation of digits & dorsal subluxation of MTP

Lanois' deformity

Tapered bone ends at foot with atrophic neuropathic Arthritis

Licked Candy stick

Shenton's line

Line?

1. Air/Gas= Black 2. Fat/oil= Dark Gray 3. Water= Light gray 4. Bone/Calcium= White 5. Metal= white

List structures in order of radiographic densities from most radiolucent to most radiopaque (5 total)

Coracoid: Scapula Conoid= Clavicle Coronoid= Ulna

Location of coracoid vs. conoid vs. coronoid

Common clinical feature of Synovial Chondromatosis is joint ______________.

Locking

-All type A's are unilateral -All type B's are bilateral -Type 1's= Large TP -Type II's= Accessory joint -Type III's= fusion -Type IV= bilateral with 2 different types

Look at the chart to determine the different types of lumbosacral transitional segments, flip to have them described. (sacralization)

(remember posterior obliques show same side pars so these are the right pars)

Look over anatomy on X-ray

(Reactive Arthritis) Erosions & periostitis at the Achilles tensor insertion.

Lover's heel

What is a chylothorax?

Lymphatic fluid may accumulate in the same manner as does blood.

Where do radial neck fractures typically occur?

M/C at junction of head and neck.

RA in the hands favors the ________, and in the foot the ________.

MCPs MTPs

_______ & ________ are characteristically not involved with PsA, while ________ & _______ are preferred.

MCPs MTPs DIPs PIPs

______ is the best imaging to see loose bodies of Synovial Chondromatosis with.

MRI

How can you tell the difference between an MRI and a CT?

MRI has black cortical bone. CT has white cortical bone.

CT better to see bone, which will be white MRI better to see soft tissue, bone will be dark

MRI vs CT?

Acute gout is most common in the ______________ joint.

MTP

Lower thoracic facet arthrosis (OA) with pain referral to lower Lumbar region.

Maigne Syndrome

M/C demographic of Reactive Arthritis

Males 18-40y.o.

Demographic of AS patients

Males > in 20s Females in mid 30s

M/C demographic with Synovial Chondromatosis.

Males> 20-40 y.o.

What type of erosions are present with inflammatory Arthropathies?

Marginal (juxta-articular) erosions.

(RA) Localized loss of intra-articular cortex adjacent to capsular insertion via pannus erosion at anatomical bare area

Marginal erosions (Rate bite erosions)

The _______ part of the knee is especially affect with OA due to __________.

Medial Q angle (weight bearing)

Norgaard projections are used to evaluate the erosions of ___________ & ____________.

Metacarpal heads MCP joints

True

Meyerdig's Method can be used for any slippage or listhesis, T/F

Describe a Type II odontoid process fracture.

Most Common type; dens-body junction fracture, most frequently complicated by non-union; halo immobilization, unstable injury.

Os Acetabuli

Most secondary ossification centers that fail to unite are asymptomatic, what is an exception?

Psoriatic arthritis has fluffy periostitis which is called _______________________ sign.

Mouse ear

-Waldenstrom's sign (phase 1) -Crescent sign (phase 2) -Snow cap sign (phase 2) -Mushroom deformity & sagging rope sign (phase 4)

Name the many name signs associated with Legg-calve perthes Disease AKA Avascular necrosis of femoral head? (5 signs in total and include phases)

Oblique projections allow visualization of cervical ________________.

Neural foramina

A ddx between psoriatic arthritis & RA, and AS, is that PsA has ____________ and __________ sacroilitis.

No hyperemia (normal bone density). Asymmetric

Do you adjust suspected DISH?

No! Not until DISH is ruled out.

AP radiograph with hands obliqued at 45 degrees as if catching a ball

Norgaard projection (Ball Catcher/dorsal oblique).

-Anatomic Neck= Proximal & thicker, where the articular cartilage stops -Surgical neck= distal & thinner

Note location of the anatomical vs. surgical neck of the Humerus

Olecranon is dorsal Coronoid is ventral

On a lateral elbow view which fosa is dorsal and which is ventral?

What is the horizontal facet sign?

On frontal radiographs, a fractured pillar can manifest as a recongnizable joint space owing to rotation of the pillar.

Cobb's Method for determining scoliosis

On the standard antero-posterior film, determine the end vertebra of the curvature, the highest vertebra with its superior border inclined toward the concavity and the lowest vertebra with its inferior border inclined toward the concavity. Extend these on the concave side and draw intersecting perpendiculars. The resultant angle is measured. Generally, a 5-degree increment over the Rissor-Ferguson method will be obtained by this method. The Cobb's Method is this Health Center's preferred method. Angles greater than or equal to 20 degrees is considered scoliosis.

Risser-Ferguson Method for determining scoliosis

On the standard antero-posterior projection, the vertebrae situated at the extreme ends of the curvature, (the highest vertebra at the end of the curve which is the least rotated and lies between the two curves and the lowest vertebra in the curve demonstrating the same positional characteristics), are marked with a dot in the center of the bodies. In the curvature, a similar dot is placed on the apical vertebra at the peak of the curve. Lines are drawn connecting the distal dots and intersecting at the apical point. These are then joined, and their intersecting acute angle measured. When using either the Cobb or Risser-Ferguson Method, the same end vertebrae must be used when measuring comparison films.

Bilateral triangular sclerosis at the iliac aspect of sacrum often present in multiparous females 20-40 y.o. that is self-resolving.

Osteitis Condensans Ilii

False

Osteitis condensans ilii affects the SI joint, T/F

20% of spinal fractures are associated with what?

Other fractures.

(Gout) Corticated/sclerotic erosions.

Overhanging margin sign

Scaphoid

PA wrist with ulnar deviation is the best view to see the ________.

RF- (seronegative inflammatory arthropathies)

PEAR Psoriatic arthritis Enteropathic arthritis Ankylosing spondylitis Reactive Arthritis

Erosive OA is episodes of acute inflammation at the ________ & ________.

PIPs DIPs

In about 50% of DISH patients the ______ ossifies as well as the ALL.

PLL

Define subluxation.

Partial loss of contact between articular components of joint.

Patellar fracture

Patellar fracture

Interesting case of diastasis.

Pathognomonic for pubic symphysis diastasis in an adult is greater than 10mm. This is a traumatic case. There is enlargement of the Right SI joint.

(PsA) Contour change to proximal and distal articular joint margins via marginal erosions.

Pencil in Cup deformity (AKA Mortar & Pestle, Mushroom & Stem).

RA is most common at the __________ and then progresses towards the ________.

Peripheral joints of hands & feet Spine (cervical)

What is avulsion of the calcaneal tuberosity associated with?

Peripheral neuropathy

What is paralytic ileus?

Peristalsis stops secondary to compression fracture because it is so painful. This results in abnormal bowel gas. This image shows small bowel gas also, which is always abnormal in an adult, though it is ok in babies.

(AS) Undulating & segmented appearance of spine d/t uniform & symmetric bridging syndesmophytes at the outer annular rings

Poker spine (AKA Bamboo spine)

DP (dorsiplantar) view of foot

Polydactyly and symphalangism are best seen on what view?

Seropositive Juvenile onset adult type arthritis has the _____________.

Poorest prognosis

_________ gout is more common.

Primary

Overproduction of lack of excretion of uric acid via enzymatic defect.

Primary gout

AKAs for Scleroderma

Progressive Systemic sclerosis CREST syndrome

__________ of the cervical uncovertebral joints is found on the lateral xray with OA and confirmed with the AP xray.

Pseudofracture sign

CPPD AKA

Pseudogout

What is pseudo-spread of the atlas?

Pseudospread of the lateral masses is a normal variation seen in children less than 10 because the atlas grows faster than the axis.

Common skin condition with silver scales & pitted nails.

Psoriasis

_________ & __________ have non-marginal syndesmophytes.

Psoriatic Reactive

Otto's pelvis can be found if the femoral head _________________.

Pushes past the iliopectineal line

R anterior oblique (L posterior oblique) show the _____ IVFs & ____ pars.

R L

AP Elbow View

Radial head-capitellar line is best seen on Lateral Elbow view but can also be seen on?

(PsA) fusion of MCP, PIP & DIP in one digit.

Ray's sign

Xray findings for Psoriatic arthritis are identical to ___________.

Reactive arthritis

What is a Bankart lesion?

Refers to a tear of the labrum and attached joint capsule along the lower front quadrant of the glenoid.

RF+ (seropositive inflammatory arthropathies)

Rheumatoid Arthritis SLE Sjoren's syndrome

Autoantibody against the Fc portion of IgG

Rheumatoid Factor

(RA) Soft tissue accumulation of inflammatory cells

Rheumatoid nodule

What is the most common cause of extrapleural sign?

Rib metastasis

Ischial tuberosity

Rider's bone is an avulsion fracture at which region?

Costovertebral/transverse joints with OA implicated in pain production that stimulates upper GI dz.

Robert's Syndrome

How are AC joint separations graded?

Rockwood Classification System -3 major grades, Six total grades of injury, Types 4-6 are variations of Type 3 injury.

(AS) Erosion at anterior vertebral body margin in annulus insertion as a precursor to syndesmophyte formation

Romanus lesion

(AS) Undulating appearance of SI joint erosions

Rosary bead erosions

SI joint fusion

SI joint fusion

How is epiphyseal injury classified?

Salter and Harris classification system.

(CPPD) SLAC wrist.

Scapholunate Advanced collapse.

What is the name for a central disc lesion through the vertebral endplate?

Schmorl's Node

SLE has soft tissue atrophy, but no Ca+ which is a ddx for ________.

Scleroderma

Hyperuricemia as a result of another condition.

Secondary gout

Secondary Synovial Chondromatosis

Seen in joints with pre-existing degeneration.

What is the navicular fat stripe sign?

Seen in scaphoid fracture.

What is the empty vertebra sign?

Seen on AP views. Wide lucent gap between neural arch with horizontal fracture. Seen in chance fracture.

What is the naked facet sign?

Seen on CT axial images. There is an absence of one articular surface at a single facet joint via dislocation.

Gout has increased ______________ levels.

Serum uric acid

(AS) transient reactive sclerosis adjacent to romanus lesion as a precursor to syndesmophyte formation

Shiny Corner Sign

The GI tract can be effected by Scleroderma because with fibrosis there is _________, causing reflux which can cause _____________.

Shortening Barret's esophagus

Triangular fibrocartilage

Since there is not an ulnar and carpal articulation what is located in the space between?

(liver to just under rib 12, ascneding colon on right, transverse across, descending colon on left side down, kidneys are around L2, hepatic flexure on right, splenic flexure on left)

Soft tissue structures to note: Liver, spleen, kidneys, ureters, psoas, bladder, colon, haustras & areas of colon if visible

(RA) Fusiform PIP soft tissue swelling

Spindle digit

(RA) spotty carpal sign

Spotty appearance of carpals via numerous erosions.

(AS) Ossification of Superior SI ligaments creating triangular radiopacity

Star sign

What is a flake fracture (sliver sign)?

Steochondral fracture associated w/ patellar dislocations as medial facet impacts the lateral femoral condyle. -CT or sunrise view -Hallmark sign for recurring dislocation.

Seronegative Chronic Arthritis (Juvenile) AKA

Still's disease

__________ is the most common type of JCA and is most common in the ________.

Still's disease Knees

What is a march fracture?

Stress fracture of the metatarsals. In this pic, it is the 4th metatarsal shaft.

Lateral cervical labeled X-ray

Structures to know for C3-7: Body, pedicle, articular pillar, lamina, spinous, uncinate processes, semilunar facets, transverse process w/ foramina, spinolaminar junction

________ intracapsular hip fractures are frequently overlooked due to the common absence of ________.

Subcapital. Displacement.

(Neuropathic arthritis) Abrupt end to long bone some distance from its articulation with complete absence of the epiphysis & often the entire metaphysis d/t atrophic resorption.

Surgical amputation (usually @ shoulder)

Atrophic neuropathic arthritis is most common with _____(cause)___ at the __________ extremity.

Syringomyelia Upper

Connective tissue disorder that involves multiple organ systems, especially the kidneys

Systemic Lupus Erythematosus

Fracture dislocation is most common at ________ as the result of ________. Neurologic insult is ________.

T4-7. Severe auto accidents. Common.

What is te most common tarsal to dislocate?

Talus

What is commonly found in association with dislocation of the lumbar spine?

Teardrop fx.

HADD leads to Ca+ of...

Tendons, bursa, & other periarticular soft tissue.

Tarsal Coalition

The "C" sign and "anteater" sign are related to which congenital anomaly?

Lunate. Scaphoid.

The ________ is the most commonly dislocated bone in the wrist. ________ is second

Scaphoid. Triquetrum aka Fisher fracture.

The ________ is the most commonly fractured bone in the wrist. ________ is second (aka ________).

George's line AKA Posterior body line AKA posterior vertebral alignment line Seen on Lateral Cervical Draw line along posterior vertebral bodies Shows displacement of vertebrae: either anterolisthesis or retrolisthesis

The brown line represents what line, and what is its significance?

Young patients

The condition chondromalacia patella is most commonly seen in?

Os odontoideum vs fracture features.

The current theory is that os odontoideums are just non-union type 2 fractures that occur in kids.

False

The fibula bears weight, T or F

True

The periosteum is normally, radiographically invisible, T/F

Medial

The trochlea is at the ___________________ epicondyle.

What is the Denis classification of post-fracture spinal stability?

There are considered to be three spinal columns: -Anterior is ALL to mid-vertebral body. -Middle is mid-vertebral body to PLL. -Posterior is PLL to supraspinous ligament. +Fractures involving >1 column are unstable, neurological insult likely, and surgical intervention considered. Will always require a CT to look for retropulsion and MRI to evaluate soft tissues and cord.

True

There is no ulnar carpal articulation, T/F

How are vertical sacral fractures graded?

They are graded based on where the line is laterally/medially. Lateral has a lower neurologic impact. Medial fractures have a high neurologic impact.

M/c portion of the spine for DISH

Thoracics (Then cervical then lumbars)

Aggregation of sodium monourate crystals.

Tophi

Osteophytes that have a gap between the end-plate and the base of the osteophyte, tip does not protrude beyond the horizontal plane of the end-plate, stress response across disc & associated with DDD.

Traction osteophyte

20% of Down syndrome patients have ______ or ________.

Transverse ligament laxity or agenesis.

(Neuropathic arthritis) Multisegmental subluxated vertebral bodies.

Tumbling building-block spine

How are ankle fractures classified?

Two major fracture classification systems. -Dennis Weber (based on fibular fracture compared to the tibiotalar joint space). -Lauge-Hansen (based on MOI)

Most common causes of Enteropathic Arthritis

Ulcerative colitis Regional enteritis (Crohn's)

Inflammatory arthritis has ________ & ________ loss of joint space.

Uniform Symmetrical

What is Bohler's angle?

Used to assess calcaneal fracture.

What is the anterior humeral line?

Used to evaluate supracondylar humeral fractures.

Describe an anterior arch fracture.

Usually avulsions from hyperextension via the longus coli muscles.

Axillary view

View?

Baby arm

View?

Cross table lateral

View?

Sunrise or Tangetial view

View?

Tunnel or Intercondylar view

View?

Os Peroneum, located at the lateral, inferior aspect of the cuboid (within peroneus longus tendon)

What accessory sesamoid is shown? Describe its location.

medial collateral ligament

What anatomy structure is involved in Pellegrini Stieda disease?

Femoral/Mickulicz Angle -AP Pelvis -120-130 degrees

What angle is shown? What view is it best seen on? What is the normal range?-

Os Acromiale, an un-united secondary ossification center at the distal acromion May cause acromiohumeral impingement Axillary Shoulder View

What anomaly is shown? What is the significance? What is the best projection?

Rhomboid Fossa, an indentation at the proximal surface of the clavicle where the attachment of the costoclavicular AKA rhomboid ligament is located. Incidental finding AP Clavicle or AP shoulder

What anomaly is shown? What is the significance? What views is it best seen on?

Radioulnar synostosis, failure of segmentation of the proximal radial ulnar joint, and results in variable length of fusion Standard Elbow Views Limited supination/pronation

What anomaly is shown? What view is it best seen on? What is the significance?

Un-united 2nd degree ossification: failure of union of apophysis resulting in a small round ossicle near the TP

What anomaly is this an example of?

pars fracture isthmic, traumatic, degenerative (osteoarthritis), dysplastic due to congenital anomalies

What are causes of spondylolisthesis?

-Short and project posteriorly -Deep inferior vertebral notch -On AP film look round -On Lateral film look linear

What are characteristics of lumbar pedicles?

-Flat & spatulated -Project laterally & posterior -Iliolumbar ligament attaches at L5

What are characteristics of lumbar transverse processes?

-limp and non-specific groin pain which may radiate to ant/med knee -Hip pain upon motion, esp abduction and int rotation -Pn may be intermittent -Commonly, hx of previous hip trauma +ve ortho tests

What are clinical findings related to Legg-Calve Perthes Dx?

-anteromedial knee pain/tenderness, stiffness, swelling -movie sign -retropatella pain

What are clinical presentations of chondrmalacia patella?

Young child (11-14) has insidious onset of pain in hip & knee with limp due to micro or macro trauma

What are common factors related to Klein's line, such as age and cause?

-At dorsum of knee -Lined by synovium -Connected to joint via gastrocnemius-semimembranous bursa -Capsular swelling due to excess synovial

What are components related to bakers cyst?

Impaction, volvulus, space occupying lesion, intussusception, adhesions, strangulations, surgery or hernias

What are different causes for bowel obstruction?

Lordosis, kyphosis Osseous anatomy Congenital anomalies Normal variants

What are examples of what you look at in the A portion of film interpretation?

Density, contour, cortical margins, trabecular pattern, size, and shape

What are examples of what you look at in the B portion of film interpretation?

-Whitening of bone= sclerosis -Fragmentation/collapse/deformity

What are findings related to avascular necrosis or bone infarct?

-Shallow acetabulum (un developed ball & socket joint) -Femoral head or acetabular deformity -Wide range of severity -Leads to unstable hip -Found in children

What are findings related to developmental hip dysplasia AKA congenital hip dysplasia?

-X ray findings: Multiple block vertebrae -Scoliosis, anomalous rib development, Sprengle's deformity, omovertebral bone, platybasia

What are findings that would indicate Klippel feil?

Joint between the metatarsals and tarsals

What are lisfranc joints?

-IVD: disc narrowing & osteophytes (bone spurs) due to degenerative disc disease -Facet joints: joint space narrowing & osteophytes -Uncovertebral joints: joint space narrowing & osteophytes So spondylosis & osteochondrosis

What are signs of cervical osteoarthritis?

-Excessive translation of vertebra -C1-C2 instability: Transverse ligament rupture, congenital anomalies, trauma, inflammatory joint condition -Wide atlantodental interval

What are signs of upper cervical instability and causes?

-Female- gonadal shield used -Female pelvis more dome shaped, pubic margins more round & long -Male pelvis more triangular shaped, pubic margins more triangular

What are some differences to help differentiate the male vs. female pelvis?

Juvenile kyphosis or vertebral epiphysitis

What are the 2 AKA's for Scheurmanns Disease?

-PA Ulnar Deviation -PA Clenched Fist

What are the 2 accessory projections of the wrist?

-Jones AKA Tangential -Medial Oblique

What are the 2 accessory views of the elbow?

Individual digits & Ball Catchers view

What are the 2 accessory views of the hand?

1) Outer fibrous= vascular layer that supplies blood 2) Inner cambium= layer of osteoblastic/osteoclastic activity

What are the 2 layers of the periosteum?

Metaphysis and diaphysis

What are the 2 parts of the long bone that are primary ossification centers that ossify before birth?

1) Curvature initiation 2) Subsequent progression

What are the 2 stages of functional scoliosis?

1) AP: unweighted or weighted 2) Axial

What are the 2 standard projections for the AC joint?

AP (unweighted and weighted) Axial

What are the 2 standard projections for the Acromioclavicular joint?

AP and Axial

What are the 2 standard projections for the clavicle?

-AP -Axial

What are the 2 standard projections of the clavicle?

-AP Hip -Frog Leg Hip (lateral)

What are the 2 standard projections of the hip?

AP Lumbar and Lateral lumbar

What are the 2 standard projections of the lumbar spine?

AP internal rotation of GH joint and AP external rotation of GH joint (internal rotation see greater tuberosity best and is medial, and external rotation both greater and lesser tuberosity seen)

What are the 2 standard projections of the shoulder for the GH joint?

AP and Lateral thoracic

What are the 2 standard projections of the thoracic spine?

AP internal rotation and AP external rotation

What are the 2 standard views of the GH shoulder joint?

Avulsion or compression

What are the 2 types of fractures related to the calcaneus?

Left anterior oblique (LAO) and right posterior oblique (RPO)

What are the 2 views you would be able to see left IVF's with?

Right anterior oblique (RAO), and left posterior oblique (LPO)

What are the 2 views you would be able to see right cervical IVF's with?

-Nasium (P-A where you can see nose & upper cervical complex) -Vertex (see atlas looking down on it) -Base Posterior (see atlas looking down on it)

What are the 3 accessory views of the Upper cervical spine?

-stated age -chronological age -skeletal age (Review Rad I Lab Intro Cervical Spine for skeletal maturation of hand and cervical spine)

What are the 3 ages related to skeletal maturation?

1) Acromioclavicular 2) Acromiohumeral 3) Glenohumeral

What are the 3 joints of the shoulder?

Diaphysis Metaphysis OR Physis (growth plate) Epiphysis

What are the 3 main portions of a long bone?

1) ASIS (sartorius) 2) AIIS (rectus fem) 3) Ischial tuberosity (hamstrings)

What are the 3 most common avulsion sites?

1) One in centrum= Vertebral body 2) One for each half of neural arch

What are the 3 primary ossification centers of the vertebrae?

APOM AP cervical Lateral cervical

What are the 3 standard projections of the Cervical spine?

-AP -Lateral -Lateral Oblique

What are the 3 standard projections of the elbow?

PA, Medial/Internal Oblique (teacup) & Lateral (straight or fan)

What are the 3 standard projections of the hand?

AP, Lateral, and Medial (internal) oblique

What are the 3 standard projections of the knee?

PA, Oblique and Lateral

What are the 3 standard projections of the wrist?

1) Lateral hemivertebra 2) Dorsal hemivertebra 3) Ventral hemivertebra

What are the 3 types of hemivertebra?

-Stress fracture -Elongated pars -Acute pars fracture

What are the 3 varieties of Type II or isthmic spondylolisthesis?

-Scapular Y view -Baby Arm -Axillary View -Swimmers Lateral

What are the 4 accessory projections for the shoulder?

1) Stress View= Flexion/Extension 2) Obliques 3) Pillar views 4) Swimmer's Lateral

What are the 4 accessory projections in the cervical spine?

-Oblique -Modified Ferguson -Lateral lumbosacral spot -Stress views: Flexion/Extension

What are the 4 accessory projections of the lumbar spine?

-Scapular Y-View -Baby Arm -Axillary View -Swimmer's Lateral

What are the 4 accessory view of the shoulder?

1) narrow joint space (chondral thinning)(superior joint 1st) 2) osteophytes 3) subchondral cysts AKA giodes 4) subchondral sclerosis AKA eburnation

What are the 4 major findings of osteoarthritis?

1)Avascular= distention of the capsule, increased jt space, Waldenstrom's sign, small epiphysis 2) Revascularization: flattened, fragmented, small epiphysis, homogenous sclerosis (snowcap sign: due to increased density from osteoid repair), subchondral fracture (crescent sign:indicates impending collapse) 3) Repair: gradual reconstitution of normal density, 4) Deformity: coxa vara, enlarged head (coxa magna), flattened head (mushroom deformity, coxa plana), large greater trochanter, sagging rope sign

What are the 4 phases of Legg-Calve perthes Dx?

Solid, Laminated, Spiculated, and Codman's triangle

What are the 4 types of periosteal reactions?

1) One at tip of spinous 2) One at each TP so 2 3) Ring epiphysis at upper & lower vertebral body= 2

What are the 5 secondary ossification centers of the vertebrae?

Type I= Dysplastic (congenital) Type II= Isthmic (stress fracture, elongated pars or acute pars fracture) Type III= Degenerative (arthrosis) Type IV= Traumatic (fracture of neural arch that is NOT pars) Type V= Pathologic (bone disease) Type VI= Iatrogenic (surgery) (DIDTPI)

What are the 6 different types of spondylolisthesis?

CRITOE 1) C= Capitulum (1 yr) 2) R= Radial head (5 yr) 3) I= Internal/Medial epicondyle (7 yr) 4) T= Trochlea (10) 5) O= Olecranon (10) 6) E= External/Lateral epicondyle (11)

What are the 6 secondary ossification centers of the elbow, from first to ossify to last?

-Adolescent coxa vara -Epiphyseal coxa vara -Epiphysiolisthesis

What are the AKA's for slipped capital femoral epiphysis (SCFE)?

-Edema at inferior pole of patella -Edema at proximal end of patellar tendon

What are the MRI findings related to Sinding Larsen Johansson disease?

Lateral (to see abnormal fluid), KUB (scout), IVP (Intravenous pyelogram), and Barium Study

What are the accessory projections of the abdomen?

-Lateral/external oblique -Sunrise/Tangential -Tunnel/intercondylar -Cross Table Lateral

What are the accessory projections of the knee?

P: pancreatitis, pregnancy. L: lupus (SLE) A: alcohol excess (chronic) S: steroids. T: trauma. I: idiopathic, infection. C: caisson disease, collagen vascular disease. R: radiation, rheumatoid arthritis. A= Amyloid arthropathy. G= Gaucher dx. S= sickle cell disease (PLASTIC RAGS)

What are the causes of avascular necrosis?

-MC fractured carpal -Occurs via FOOSH -Proximal pole predisposed to AVN when fx -Most common at scaphoid waist -Best seen on PA or PA Ulnar deviation Views -COmmonly Occult

What are the characteristics of scaphoid fractures?

-50% of patients are asymptomatic -No correlation between degree of slippage & severity of pain -Deep, dull aching type of pain

What are the clinical findings of spondylolysis?

-Male 13-17 years old -75% thoracic spine -Pain, fatigue, hyperkyphosis, posterior shift in weight bearing -Diminished ROM -Tender SP's

What are the common clinical presentations of Scheurmanns Disease?

-Early osteoarthritis -Deformed articular surface -Persistent pain

What are the complications/considerations of osteochondritis dessicans?

-May self resolve -Can rupture -Common treatment= drainage or steroid injections

What are the complications/considerations related to Baker's cyst?

-Self limiting with rest -May leave residual deformity

What are the considerations related to OsGood Schlatter Disease?

-Type II dens fracture: Narrow zone of separation, irregular margins, tilted orientation of dens, interrupted cervical line, normal anterior tubercle size, straight posterior shape of anterior tubercle -Os Odontoideum: wide zone of separation, round & smooth margins, vertical orientation of dens, interrupted cervical line, hyperplastic/hypertrophic (large) anterior tubercle, angular position of anterior tubercle

What are the differences between a Type II dens fracture and Os odontoideum?

-transverse -vertical -stellate/star-like

What are the different patella fracture patterns?

Idiopathic, congenital, developmental, tumor-associated, or neuromuscular

What are the different types of scoliosis based on etiology?

-waldenstrom's sign -wide irregular growth plate

What are the earliest X-ray findings for slipped epiphysis?

-Female 9 times more common than males -20-40 years old -Multiparous (multiple births)

What are the factors related to those with osteitis condensans ilii (OCI)?

Loss of vascularity to bone causing sclerotic & deformed bone Lunate= Kienbock Scaphoid= Preiser

What are the findings of AVN in the hand and what 2 are common?

-Small osseous fragments at sight of origin/insertion of large muscles or ligaments -Best seen on standard projections: AP Pelvis -May need surgical pinning

What are the findings of pelvic avulsion fractures, what view is best and what is the significance?

-Soft tissue swelling -Thickened patellar ligament -Blurred infrapatellar fat pad -Irregularity of anterior tibial tuberosity

What are the findings related to OsGood Schlatter Disease?

-Often causes pain -Foot deformity visible

What are the findings related to hallux valgus?

-Osteochondral fragment= contour deformity to articular surface -Chondral fragment: MRI needed to show this

What are the findings related to osteochondritis dessicans?

Disarticulation at 1 or more of the talar joints

What are the findings related to talus dislocation?

Measure thickness of heel pad from the inferior aspect of calcaneus to the margin of the heel soft tissue

What are the landmarks and methods for measuring heel pad thickness?

Draw line along the anterior cortex of the humerus Lateral Elbow Average= the line should bisect the humeral condyles, and for children under 2.5 should bisect middle third of capitellum, for children over 2.5 should intersect anterior third of capitellum Supercondylar humeral fracture (most common fx of peds patients) from FOOSH (fall on outstretched hand)

What are the landmarks and methods for the Anterior Humeral Line? What projection is it best seen on? What are the normal values? What is the significance?

-Line from distal clavicle undersurface and line at distal acromion undersurface -AP shoulder or AP AC joint

What are the landmarks and methods for the acromioclavicular alignment? What views is it best seen on?

-Distance from top of humeral head to acromion undersurface -AP Shoulder or AP AC joint

What are the landmarks and methods for the acromiohumeral distance? What view is it best seen on?

-Draw line thru ulnar shaft -Draw line thru humeral shaft -Measure acute angle in between (inferior angle) AP Elbow 5-15 Degrees If abnormal= Cubitus varus or valgus

What are the landmarks and methods for the carrying angle? What view is it best seen on? What are the normal values? What is the significance?

-Draw true vertical line from center of femoral head upward. Draw second line from center of femoral head to edge of acetabulum. Measure the angle. (forms an umbrella over the femoral head)

What are the landmarks and methods for the center edge angle?

-Measure in 3 places of joint from humeral head to glenoid: top, middle & bottom -AP External Rotation

What are the landmarks and methods for the glenohumeral joint space? What view is it best seen on?

1. Identify 3 highest points on calcaneus (tubercles) 2. Connect anterior to middle, and middle to posterior 3. Measure acute angle

What are the landmarks and methods of Boehlers Angle?

Measure in 2 places top & bottom of joint from clavicle to acromion AP Shoulder or AP AC joint

What are the landmarks and methods of the acromioclavicular joint space? What views are best?

Draw line through long axis of scaphoid, line through short axis of lunate, and measure the acute angle (superior angle) Lateral Wrist View 30-60 degrees Dorsal vs ventral intercalary instability

What are the landmarks for the scapholunate angle? What view is it best seen on? What are normal values? What is the significance?

Pseudo fracture of uncovertebral joints (A Mach effect seen in cervical osteoarthritis)

What are the light area lines through the vertebral body?

Even alignment of clavicle & acromion undersurfaces

What are the normal findings for the acromioclavicular alignment?

Line should be smooth- bilaterally symmetric

What are the normal findings for the iliofemoral line?

The line should cross through the lateral femoral head. Compare to opposite side, and should be same degree of overlap of femoral head.

What are the normal findings related to Kline's line?

2-4mm Should be symmetrical

What are the normal values fo the acromioclavicular joint space?

28-40 degrees

What are the normal values for Boehlers Angle?

Females: Less than 21mm Males: Less than 23mm

What are the normal values for males & females heel pad thickness?

7-11mm

What are the normal values for the acromiohumeral distance?

4-5mm

What are the normal values for the glenohumeral joint space?

Average= 9mm Range= 6mm-11mm

What are the normal values for the teardrop distance? (avg. and range)

-Primary only (No secondary) -3 total: One for anterior arch, 2 for posterior arch

What are the ossification centers of atlas?

-Same primary as normal vertebra & more: 1) One in centrum= Vertebral body 2) One for each half of neural arch, 3) and 2 more for the dens -Secondary ossification center: Tip of Dens

What are the ossification centers of axis?

-AP Lumbopelvic or AP Pelvis -Draw horizontal line at top of each crest, and measure the distance -Normal= even alignment bilaterally

What are the projection, landmarks, and normal values of pelvic leveling lines?

-AP lumbopelvic or AP Pelvis -Landmarks- Horizontal lines at the top each femoral head -Normal= alignment bilaterally

What are the projections, landmarks, and normal values of femoral head leveling?

-Kidney shaped -Largest bodies in spine -All surfaces are concave

What are the properties of the lumbar vertebral body?

-Hadleys S curve -AP lumbar and Oblique lumbar -Draw line along inferior margin of TP down along the inferior articular process, then go across the facet joint along the superior articular process of the vertebra below -Should have an 'S' Shape

What are the radiographs representing and what views are used? What are the landmarks and normal measurements?

Pain & crepitus Movie sign= pain exacerbated by prolonged sitting in confined space

What are the signs & symptoms of chondromalacia patella?

PA and Lateral (notice NOT AP like thoracic, and for lateral arms up)

What are the standard projections for the chest?

AP and Lateral Coccyx

What are the standard projections for the coccyx?

AP Hip and Frog leg (frog leg shown, other one would be without legs abducted)

What are the standard projections for the hip?

AP/PA and Lateral

What are the standard projections for the ribs?

AP and Lateral Sacrum

What are the standard projections for the sacrum?

AP, PA

What are the standard projections of the abdomen?

Basicervical, mid-cervical, transcervical or subcapital

What are the sublocations for femoral head dislocations?

-Spontaneous healing possible -If displaced +/- surgery

What are the treatments for osteochondritis dessicans?

-Coronal canal dimension -AP Lumbar (can do for cervical or thoracic) -Measure between pedicles (interpeduncular distance) -In lumbar: average of 25-30mm

What are these lines and what view is used? What are the landmarks and normal values?

Prevertebral soft tissues Seen on Lateral Cervical Landmarks: C1 anterior arch, C2-3 inferior corners, C4 superior corner, C5-7 inferior corners C2-3: Retropharyngeal space, less than 7mm C4-5: Retrolaryngeal space, less than 20mm C5-7: Retrotracheal space, less than 22mm (note how soft tissue is thinner at top and thickens at esophagus)(Remember rules of 6's and 2's, at C2: under 6mm, at C6 under 22mm) Soft tissues increase post trauma.

What are these spaces representing and what is the significance?

Phleboliths (vein stones)

What are these?

The patellar articular surface can have osteoporosis; decreased joint space; and patella alta

What are x-ray findings for chondrmalacia patella?

Intercondylar or intertrochanteric fossa

What area is best seen in a tunnel view?

Tibiofemoral articulation (patient toes in)

What articulation is best seen on a medial oblique view of the knee?

The medial & lateral components of the patello-femoral articulation

What articulation is best seen on a sunrise or tangential view?

Capitulum AVN AKA Panners Disease: avascular necrosis of lateral humeral condyle (osteochondritis dissecans) Common in children, especially throwers Abnormal density & contour of the lateral condyle Standard Elbow Views

What avascular necrosis is shown here? Who is this common in? What are findings? What view is it best seen on?

Protrusio acetabuli (protrusion of acetabuli into pelvic inlet)

What can acetabular fractures lead to?

pneumonia, surgery, tumors, chest trauma, cystic fibrosis

What can atelectasis be caused by?

-decrease ROM -tenderness/pain - + trendelenberg

What can be seen clinically in slipped epiphysis?

Trauma, surgery, or arthritis

What can cause patella alta or baja?

By traumatic disruption of scapholunate ligament, causing separation of scaphoid & lunate "Terry Thomas" Sign PA Wrist

What causes a scapholunate dissociation? What is the sign? What view is it best seen on?

Infection or malignant tumor

What causes endosteal destruction?

TOS (thoracic outlet syndrome)

What condition are cervical ribs associated with?

Klippel Feil

What condition could this X-ray be a sign of considering multiple blocked vertebra, scoliosis and a short webbed neck?

Pedicle agenesis

What condition is related to the winking owl sign?

rheumatoid arthritis

What condition is related to this necrosis?

-Limbus bone: herniation of nuclear material thru the corner of the vertebra that appears as a small osseous fragment at the corner of the body -Lateral view -Dorsal ones can cause symptoms

What condition is seen, what view is best, and what are the complications?

Osteitis Condensans Ilii

What condition is shown?

osteoarthritis of the hip

What condition is shown?

Scheurmanns Disease

What condition is this an example of?

Olecranon foramen, foramen connecting the olecranon & coronoid fossa due to failure of ossification centers AP Elbow Incidental finding

What congenital anomaly is shown in 2? What view is it best seen on? What is the significance?

Pedicle agenesis

What congenital anomaly is shown?

Symphalangism, ankylosis/fusion of interphalangeal joints

What congenital anomaly is shown?

Carpal Coalition, which is failure of segmentation of 2 or more carpals that can be bony or fibrous Continuous trabecular pattern across 2 carpals Usually always within the same horizontal carpal row (or can be acquired if not)

What congenital anomaly is shown? What are findings?

Polydactyly AKA Hyperdactyly AKA Supernumerary digits More than typical number of digits

What congenital anomaly is shown? What are the AKA? What are the findings?

Syndactyly, failure of separation of soft tissue between 2 or more digits Continuous soft tissue across 2 digits PA Hand

What congenital anomaly is shown? What are the findings? What view best shows this?

Madelung deformity, premature closure of medial radial growth plate, with ulnar deviation of the hand being a lot more posterior on the lateral view PA and Lateral Wrist Slanted radial articular surface, longer ulna, dorsal malposition of ulna on lateral view

What congenital anomaly is shown? What view is it best seen on? What are findings?

Supracondylar Process/Spur, slender bony spur extending from anteriomedial aspect of distal humerus Standard Elbow Views Typically incidental, may be complicated by an accessory ligament of Struthers attaching to medial epicondyle: may cause median nerve compression

What congenital anomaly is shown? What view is it best seen on? What is the significance?

Sinding Larsen Johansson Disease

What disease is known as jumpers knee?

Baastrups Disease related to interspinous space narrowing Lateral View Can be painful

What disease is related to interspinous osteoarthritis, what view is it best seen on and what are its complications?

Talonavicular dislocation

What dislocation is here?

Subtalar dislocation

What dislocation is seen here?

Tibiotalar dislocation

What dislocation is shown?

Normal= looks more sharp like batman ears Osteoarthritis: looks rounder like scooby doo ears (seen on pic)

What do the unicinate processes look like in a normal spine vs. cervical osteoarthritis?

-Sagittal canal dimension -Lateral Lumbar -Draw line connecting superior and inferior processes, then measure distance between the posterior body and the line drawn -Measurements need to be over 12mm

What do these lines represent and what view is used? What are the landmarks and normal values?

Osteochondroma points away from the joint. Supracondylar process points towards it.

What do you need to DDX from a supracondylar process of the humerus?

Spine inflammation

What does spondylitis mean?

Slippage

What does spondylolisthesis mean?

Pars stress fracture

What does spondylolysis mean?

Osseous spur in spine

What does spondylophyte mean?

Many spondylophytes

What does spondylosis mean?

1)= Trapezium 2)= Trapezoid 3)= Capitate 4 and 5)= Hamate

What does the 1st metacarpal articulate with, the 2nd, and the 3rd? What do the 4th and 5th metacarpal articulate with?

A= Alignment, anomalies, anatomy B= Bone C= Cartilage & joints S= Soft tissues

What does the ABC'S of film interpretation stand for?

ilium, ischium, and pubis at age 15-16

What does the os coxa consist of and when do they fuse?

Colle fracture

What fracture is shown?

Radial Head fracture (Chisel fracture) FOOSH= Fall on outstretched hand Cortical disruption along radial head or neck Standard Elbow views

What fracture is shown? What often causes it? What is the radiographic finding? What view is best seen?

Supracondylar fracture, most common pediatric elbow fracture FOOSH= fall on outstretched hand Abnormal anterior humeral line (AHL passes anterior to middle third of capitellum) Lateral Elbow View

What fracture is shown? What often causes it? What line of mensuration is best to measure? What view is best to see this?

Grade III spondylolisthesis

What grade spondylolisthesis is shown?

Decreased

What happens to Boehlers angle with a compression fracture of the calcaneus?

Occurs with additional carpal dislocation and ligamentous tear (scapholunate ligament) "Signet ring" Sign PA Wrist View

What happens with a scaphoid dislocation? What is the sign and what view is it best seen on?

Not seen on X-ray, so MRI needed

What imaging is best to evaluate a baker's cyst?

MRI is best, as X-ray is less sensitive

What imaging is best to evaluate osteochondritis dessicans?

Medial rim of acetabulum

What is Kohler's teardrop?

AVN of capitulum

What is Panner's Dx?

ossified post-traumatic lesions at the medial femoral collateral ligament adjacent to the margin of the medial femoral condyle.

What is Pellegrini-Stieda, seen here?

Anterior wedging of the vertebral bodies that results in hyperkyphosis

What is Scheurmann's Disease?

Slippage of the epiphysis at the growth plate

What is Slipped capital femoral epiphysis?

Choleliths

What is a "bag of diamonds" finding linked with?

Fx of Distal radius

What is a Colles fracture?

AC ligament sprained, coraclavicular ligament is normal= NO X-ray fings

What is a Grade I AC separation?

AC ligament torn, coraclavicular ligament is sprained, so slight upward deviation

What is a Grade II AC separation?

The AC & coraclavicular ligaments are torn with elevation

What is a Grade III AC joint separation?

Glenoid fx at posterior rim seen in Posterior Shoulder dislocations

What is a Reverse Bankart lesion?

Humeral head fracture seen in posterior shoulder dislocation

What is a Reverse HIll Sachs Lesion?

Herniation of nuclear material through the vertebral endplate, it is painful when acute

What is a Schmorl's node and why is it significant?

Garden

What is a commonly used classification system for femoral neck fractures?

Smooth line

What is a normal finding for Shenton's Line?

The acetabular floor should not cross the line (usually it is lateral)

What is a normal finding related to Kohler's line?

Spondylophytes

What is an alternate name for osteophytes in the spine?

A bone spur at the location of the attachment site for a ligament or tendon to bone, known as an enthesis

What is an enthesophyte?

Hemivertebra

What is anomaly is shown?

-Dens breaks thru plane of foramen magnum -McGregor's is best -Neurological complications -Best seen osseously in CT -Best see neural tissue in MRI -Relative contraindication depending on severity- could do low force

What is basilar impression?

Olecranon Fractures

What is best seen on Jones or Tangential View of the elbow?

When the scapholunate ligament tears and the scapholunate joint is widened

What is best seen on a PA Clenched fist view?

To stress scaphoid to see for a fracture (MC fx carpal) Colle fx= distal radius

What is best seen on a PA Ulnar deviation?

Lipohemearthrosis: collection of fluid in joint capsule

What is best seen on a cross table lateral view of the knee?

Humeral dislocations

What is best seen on a scapular Y view?

Useful for single digit swelling

What is best seen on an Individual Digit view?

Humeral dislocations

What is best seen on an axillary view of the shoulder?

Can see soft tissue swelling

What is best seen on an oblique hand view?

Distal pole of scaphoid and triquetrum

What is best seen on an oblique wrist view?

Ventral or palmar surface, thumb always flexed forward Can also see dorsal lunate dislocation

What is best seen on the Lateral Wrist view?

Proximal radial-ulnar joint

What is best seen on the Lateral oblique view of the elbow?

More than 2 spots on rib are broken creating a unique isolated segment, go against natural movements of ribs and is dangerous

What is flailed chest?

Tennis or golfer's elbow

What is known as lateral epicondylitis caused by overuse injury?

Little League Elbow

What is known as medial epicondylitis caused by overuse injury?

-Measures the superior, axial & medial joint space widths -AP Hip

What is measured with the hip joint space width and what view is it seen on?

-Children: Supracondylar humerus. -Adults: Radial head. -Elderly: Distal radius (aka Colle's fracture).

What is most common location for a FOOSH fracture in - children, adults, elderly.

A well defined triangular area of subchondral sclerosis in the ilium just lateral to the SI joint.

What is osteitis condensans ilii?

-Separation of an osteochondral fragment from the articular surface -Leads to "loose body" chondral or osteochondral fragment -Micro/macro traumatic origin vs. focal AVN

What is osteochondritis dessicans?

-Posterior indentation of sternum -Can have cardiac complications

What is pectus excavatum?

-Soft wide shoes -Often treated surgically

What is recommended for those with hallux valgus and how is it treated?

Osteoarthritis of the knee

What is seen here?

chondromalacia patellae (CMP) which is abnormal softening of the cartilage beneath the patella

What is seen in the photo and what is it?

Osgood-Schlatter, which is inflammation of where the patellar ligament attaches at the tibial tuberosity

What is seen in this radiograph?

Lipohemarthrosis

What is shown here?

Sacral agenesis or sacral dysgensis leads to caudal regression syndrome

What is shown here?

Sail Sign AKA "Fat Pad" sign AKA postive posterior fat pad sign Indicates capsular effusion (pushes fat pads away from humerus, lucency betwen bone & soft tissue) Elbow trauma: Sensitive finding to intracapsular joint problems, such as fracture, dislocation or chondral injury (often fractures)

What is shown here? What does it indicate? What is the significance?

Os fabella, which is a sesamoid bone found in tendon of lateral head of gastrocnemius

What is shown in the radiograph and where is it found?

Metacarpal fracture, specifically a Barroom fx (very common and can happen anywhere along the bone)

What is shown?

Sacral dysgenesis that causes caudal regression syndrome

What is shown?

bone island

What is shown?

HADD AKA Hydroxyapatite Deposition Disease AKA Calcific Tendinitis; calcification within (SITS) rotator cuff tendons, bursa, and periarticular soft tissue via hydroxy apatite crystals Globular calcification in periarticular soft tissue Standard views No complications, except sometimes pain & tendon tears (supraspinatus most common)

What is shown? What are the findings? What are the best views? What are the complications?

AVN of Humeral Head AKA Hass Disease (2nd most common after hip) Whitening AKA Sclerosis, fragmentation, collapse Standard Views Arthroplasty often necessary (joint replacement)

What is shown? What are the findings? What is the best view? What are the related complications?

AC Joint Separation, damage to acromioclavcular joint stabilizing ligaments Direct or indirect trauma Vary from noral to grossly misaligned Standard Views: weighted & unweighted No complications, except instability when extreme

What is shown? What causes this? What are the findings? What are the best views? What are the complications?

Anterior GH Dislocation Forceful abduction & external rotation Humeral head dislocates anterior to glenoid, and sits medial & inferior to glenoid Axillary or Standard Shoulder Views Humeral head fracture or Glenoid fracture at anterior rim

What is shown? What injuries can cause this? What are the findings? What is the best view? What are related complications?

Posterior GH dislocation Electrocution, epileptic convulsion, extreme trauma (Triple E's) Humeral head dislocates posterior and sits medial to glenoid Axillary or Standard Views Humeral Head Fx= Reverse Hill Sachs Lesion AKA Trough Sign Glenoid fx at Posterior Rim= Reverse Bankart Lesion

What is shown? What mode of injury causes this? What are the findings? What is the best view? What are the related complications?

-Vertebral slippage: either anterolisthesis or posterolisthesis -Abnormal George's line -Lateral views -May cause pain or dysfunction

What is spondylolisthesis, what are the findings, what view is it best evaluated on, and what are the associated complications?

Failure of segmentation of 2 or more tarsals, so will have a lack of joint between tarsals

What is tarsal coalition?

Hallux Valgus

What is the AKA for a bunion?

Chisel fracture

What is the AKA for a radial head fx?

Nursemaids Elbow Occurs via a pulled arm Coud be recurrent & often transient

What is the AKA for a radial head subluxation, what can cause it and what are characteristics?

heel spurs

What is the AKA for calcaneal enthesophytes?

-Physis -Cartilage so is radiolucent on X-ray -Responsible for longitudinal growth of bone during skeletal immaturity (skeleton Not ossified til age 25)

What is the AKA for the growth plate or epiphyseal plate? What is it made out of?

The abducted view of the arm is best to see an axial perspective of the GH and AC joints

What is the Baby arm shoulder view best for?

-Curvature produces asymmetrical forces on the vertebral endplates of the growing spine -Growth retardation on compressed side -Growth acceleration on tension side (only true in skeletal immaturity, opposite Wolf's Law, as more pressure decreases growth)

What is the Hueter-Volkmann law?

To better see kidney filtration, to look for obstruction (done when kidney stones are present)

What is the IVP view used for?

Kidney, ureter and bladder (KUB)

What is the KUB view used to see?

An optical illusion, perceived lucency that can look like a fracture Base of dens, to look like a type 2 fracture Also can happen with ribs

What is the Mach effect and where can it happen?

Better see L5

What is the Modified Fergusson view used for?

Axial calcaneus

What is the accessory projection for the ankle?

Apical lordotic (to see lung apex)

What is the accessory projection for the chest and what is it used for?

Obliques

What is the accessory projection for the ribs?

Swimmer's Lateral

What is the accessory projection of the thoracic spine?

Kohler's line

What is the aka for measurement of protrusio acetabuli?

epitransverse process= superior extending osseous structure originating from C1 TP. May or may not connect.

What is the arrow pointing to?

-Male avg.= 3mm (1-5mm) -Female avg.= 7mm (2-20mm)

What is the average for males and females for the presacral/retrorectal soft tissue space?

1) Avg. Superior= 4mm 2) Avg. Axial= 4mm 3) Avg. medial= 8-9mm

What is the average for the superior, axial and medial hip joint space width?

Colon, to see if there are any obstructions or lesions 1) Single contrast infused barium, 2) double contrast infuse barium & air (only used when concerned)

What is the barium view used to see? What are the 2 types?

McGreggor's line

What is the best line of mensuration to use related to occipitalization?

single violent injury or repetitive knee flexion/extension

What is the cause of osgood?

Hormonal influences which permit relaxation of the joint ligaments, increasing joint mobility during pregnancy

What is the cause of osteitis condensans ilii (OCI)

-Failure of growth center to develop -Common dural pouch w/ 2 nerve roots -Most common at C6 -Hypertrophy of contralateral pedicle

What is the cause of pedicle agenesis and what are common characteristics?

1. Short webbed neck 2. decreased cervical ROM 3. Low posterior hairline

What is the classic triad of Klippel Feil?

Inferior & medial

What is the common displacement for an Anterior hip dislocation?

goes inferior & medial

What is the common displacement for an anterior hip dislocation?

Superior & lateral displacement of the femoral head

What is the common displacement for posterior hip dislocations?

Joint arthroplasty

What is the complication of osteoarthritis if severe?

Joint arthroplasty

What is the complication related to protrusio acetabuli?

May be painful

What is the complication with Pellegrini Stiedas Disease?

pleural effusion blunting of costophrenic angles (always most inferior area due to gravity keeping fluid down, so if standing will be inferior if laying on side will be lateral) hemothorax and chylothorax

What is the condition for excess collection of fluid between the visceral and parietal pleura? What is the sign on X-ray? What are the 2 types?

AVN of Femoral Head: primary blood supply to the femoral head in child through the isolated epiphyseal vessels that are vulnerable to disruption, this leads to avascular necrosis of the femoral head

What is the definition of Legg-Calve Perthes Disease?

Bayonette deformity

What is the deformity related to the Madelung Dx?

Cortex or Compact bone, that is made by dense collagen fibers, is the thickest midshaft, and is radiopaque on X-ray.

What is the dense outer layer of bone called, and what are some characteristics of it?

Riedels lobe is thin and mainly project inferiorly and never cross the midline, hepatomegaly expands in all areas and will cross the midline Riedels is an incidiental finding, hepatomegaly is very dangerous

What is the difference between Riedels lobe and hepatomegaly?

-Anterior obliques in cervical show ipsilateral IVF's -Anterior obliques in lumbar show contralateral pars interarticularis (so opposite for posterior obliques also)

What is the difference between cervical vs. lumbar oblique views?

-Sensitivity= ability to determine abnormal vs. normal -Specificity= ability to test exactly what the problem is

What is the difference between sensitivity and specificity?

Tube pointed upwards at 20 degrees

What is the difference between the AP and Axial view for the clavicle?

Popliteal artery anuerysm

What is the differential diagnosis for baker's cyst?

4-7 y/o, more in males

What is the epidemiology of Legg-Calve-perthe?

Adolescents 11-15 in more males

What is the epidemiology of Osgood Schlatter's?

more in females, multiparous (multiple births), 20-40 years

What is the epidemiology of osteitis condensans ilii?

10-15 year olds in more males

What is the epidemiology of slipped epiphysis?

Sever's

What is the eponym associated with avascular necrosis of the calcaneus?

legg-calve-perthes=kids chandlers=adult

What is the eponym for AVN of the femoral head in adults vs. children?

Blount disease

What is the eponym for AVN of the tibial plateau?

Repetitive microtrauma to attachment of patellar tendon to patella creating traction tendon tendonitis (similar to OsGood Schlatter)

What is the etiology of Sinding Larsen Johansson Disease?

unknown, thought to be hormonal and an increase in the mobility of SI. The increased stress on the subchondral bone and results on whitening/subchondral sclerosis

What is the etiology of osteitis condensans ilii?

Enthesis= attachment site for muscle or ligament

What is the general site for where avulsion fractures take place?

-Rockwood classification system Grade 1-6 -Grade 1 NO film findings, all ligaments are intact but the AC ligament is sprained -Grade 2: Acromioclavicular ligament tears, the Coraclavicular are sprained. Mild elevation of clavicle, better seen w/ weighted views -Grade 3- both ligaments are torn (AC and both medial & lateral CC ligaments)- The clavicle rises up (greater than 5mm) -Grade 4-6: just more severe forms of type 3. Same ligaments are torn

What is the grading system used for AC joint separation, and explain the significance of each grade?

Apophysis, which is a secondary growth center at the end of bones used for attachment of ligaments or tendons

What is the greater trochanter an example of?

Chandler's Dx

What is the idiopathic AVN of the femoral head in adults called?

synovial

What is the inferior 2/3 of the SI joint consist of?

Better see the L4/L5/S1 complex

What is the lateral lumbosacral spot used for?

-McNabbs Line -Lateral Lumbar -Draw line along inferior endplate of lumbar vertebrae -The line shouldn't intersect the superior articular process

What is the line shown and what view is used? What are the landmarks and normal values?

FOOSH (fall on outstretched hand)

What is the most common MOI for elbow fractures?

Lumbo sacral junction, either sacralization of L5 or lumbarization of S1

What is the most common area for transitional segments to occur?

Lunate-triquetrum

What is the most common carpal coalition?

Osteoarthritis

What is the most common cause of IVF or canal stenosis?

Ventral dislocation FOOSH Lateral Wrist View "Pie" or "piece of pie" sign on PA Views (and from a lateral view looks like a slipped out C)

What is the most common dislocation of the lunate? What causes this? What view is it best seen on? What is the Radiographic sign?

Colles Fracture FOOSH Transverse radial fracture with dorsal displacement of fracture fragment that produces a "dinner fork" deformity

What is the most common distal radius fracture? What causes it? What are the characteristics?

Radial head or neck

What is the most common fracture in adults?

Fall from height onto feet resulting in compression fx

What is the most common mode of injury for calcaneal fractures?

Supracondylar ridge

What is the most common place for a child fracture?

degenerative spondylolisthesis

What is the most common type of spondylolisthesis?

Lunate

What is the most commonly dislocated carpal?

Talus

What is the most commonly dislocated tarsal?

Scaphoid (scaphoid waist specifically)

What is the most commonly fractured carpal?

Calcaneus

What is the most commonly fractured tarsal?

Priesser dx

What is the name for AVN of the scaphoid?

Bakers cyst

What is the name for a popliteal cyst?

Choleliths

What is the name for gall stones?

Radiolucent

What is the name for something that is black on X-ray, like air or fat?

Radiopaque

What is the name for something white on X-ray that indicates it is very dense?

Omovertebral bone (Bone connecting scapula to cervical spine)

What is the name for the Bony bridge between C5/6 and the superior angle of the scapula present in the Klippel Fiel condition?

Osgood Schlatter Disease

What is the name for the disease caused by partial disruption of the intrapatellar ligament resulting in pain, and the quadriceps pulling on immature bone/cartilage at the tibial tuberosity?

Smith fracture (reverse Colles)

What is the name for the fracture of distal radius with ventral discplacement of distal portion, occur with falls onto a flexed wirst or with direct trauma to the dosral aspect of the wirst?

Periosteum, which is highly innervated and elicits pain, is responsible for appositional growth, repair & nutrition.

What is the name for the outer membrane that covers the entire surface of bone, except the articular surfaces? Include some characteristics of it.

synovial herniation pits

What is the name for the round cortical irregularities on the femoral neck that can be associated with acetabular impingement & os acetabuli?

Uncovertebral Joints AKA Joints of Luschka created by uncinate process articulation in cervical spine

What is the name for these joints?

Os trigonum, located posterior to the talus

What is the name for this accessory sesamoid? Describe its location.

Boehlers Angle Lateral Ankle

What is the name for this angle and what view is it seen on?

Kohler's line AKA Ilioischial Line AKA Measurement for Protrusio Acetabuli

What is the name for this measurement (include all 3)?

Joint Mice AKA Synoviochondrometaplasia: bony depris that causes a lot of crepitus

What is the name for this?

Kienbock's disease

What is the name of AVN for the lunate?

Butterfly vertebra

What is the name of this anomaly?

The trochanteric line should pass through or below the fovea capitis

What is the normal finding for Skinner's line

1:1 Ratio of patellar lenght to patellar tendon length (20% variation ok)

What is the normal value for the Insall-Salvatti index?

Os Terminale of Bergmann

What is the only non-worrisome dens anomaly?

Solid Periosteal reaction

What is the only periosteal reaction that you do not have to worry about at all?

-Posterior fossa= olecranon fossa -Anterior fossa= coronoid fossa

What is the posterior vs. anterior fossa of the elbow?

Idiopathic (80%)

What is the primary type of scoliosis based on etiology?

Self-resolving, will go through stages on its own

What is the prognosis of Legg-Calve perthes Dx?

Weighted views can increase sensitivity to detect AC joint injury

What is the purpose of the weighted AP view for the AC joint?

Round density within cortical bone

What is the radiographic finding of bone islands AKA enostoma?

Calcification along MCL AP Knee

What is the radiographic finding related to Pellegrini Stiedas disease? What view is it best seen on?

Abnormal Klein's line

What is the radiographic finding related to SCFE?

Calcification at inferior pole of patella

What is the radiographic finding related to Sinding Larsen Johansson disease?

-hyaline -thin fibrocartilage

What is the sacrum of the SI joint lined with and what is the Ilium of the SI joint lined with?

Congenital (10%)

What is the second most common type of scoliosis based on etiology?

Scaphoid (signet ring sign)

What is the second most commonly dislocated carpal?

Triquetrum (from FOOSH)

What is the second most commonly fractured carpal?

Hatchet shaped

What is the shape of lumbar SP's?

Otto's pelvis sign

What is the sign for bilateral protrusio acetabuli?

Compression fracture of the calcaneus when is is less than 28 degrees

What is the significance of Boehler's angle?

Calcaneal compression fracture or abnormal calcaneal development

What is the significance of Boehlers angle?

-If the femoral head is medial to Klein's line or asymmetry is noted from side to side, then *slipped femoral capital epiphysis* is suspected= SFCE. -Only for the skeletally immature, and related to growth plate injury

What is the significance of Kline's line and who can it be done on?

if there is crossing, then this indicates Protrusio acetabuli from Rheumatoid arthritis or Paget's

What is the significance of Kohler's line?

An intersection may indicate facet imbrication

What is the significance of McNabbs line?

SFCE (slipped femoral capital epiphysis), Hip dislocation, femoral neck fracture

What is the significance of Shenton's line?

Joint abnormality or fracture can be found. Most common= fractures leading to superior displacement or coxa vara

What is the significance of Skinner's line?

IF L5 body crosses the line there is anterolisthesis

What is the significance of Ullman's line?

-Usually an incidental finding -May be pain producing

What is the significance of accessory sesamoid bones in the foot?

-Incidental finding -Don't confuse with fracture

What is the significance of bipartite hallux sesamoid?

Incidental finding

What is the significance of bones islands AKA enostomas?

-Symmetrical so does not usually affect curvature -Clinically insignificant if isolated

What is the significance of butterfly vertebra?

-Degenerative finding at the enthesis -May be painful

What is the significance of calcaneal enthesophytes?

-Useful for evaluating stenosis, congenital malformation, intraspinal neoplasms. -If increased could indicate spinal cord tumor -Should be combined with other methods

What is the significance of coronal canal dimensions?

Acromegaly, peripheral edema, callus formation

What is the significance of heel pad thickness?

They cause structural scoliosis

What is the significance of hemivertebra?

Incidental

What is the significance of nuclear impression?

-May cause femoracetabular impingement in abduction -Could be old AIIS Avulsion

What is the significance of os acetabuli?

-May cause femoroacetabular impingement -DDX= old AIIS avulsion

What is the significance of os acetabuli?

Benign & self limiting

What is the significance of osteitis condensans ilii (OCI)?

If hypertrophy of the contralateral pedicle is absent, then it is a sign of lytic metastasis

What is the significance of pedicle agenesis?

Pelvic distortion, subluxation, leg length, inequality

What is the significance of pelvic and femoral head leveling?

Soft tissue mass, fracture or edema

What is the significance of presacral/retrorectal soft tissue space?

No joint movement

What is the significance of sacroiliac ankylosis?

May lead to joint ankylosis

What is the significance of sacroilitis?

A below normal measurement, below 12mm, indicates canal stenosis

What is the significance of sagittal canal dimension?

-Avascular necrosis -Talus fracture

What is the significance of talus dislocation?

An interruption indicates facet imbrication. A wide facet joint is linked to disc problems.

What is the significance of the Hadleys S curve?

Patella alta (up) or Patella baja (down)

What is the significance of the Insall-Salvati ratio?

Assess degree of spondylolisthesis according to number. Express in terms of grades. When L5 is anterior to the sacrum this is known as "spondyloptosis" (grade V)..

What is the significance of the Meyerding's Method?

It is used to grade skeletal maturity based on level of ossification and fusion of iliac crest apophyses; can tell you whether or not scoliosis will advance or not Graded from 0-5

What is the significance of the Risser sign?

-Widening= AC joint separation, post traumatic osteolysis of clavicle -Narrowing= Osteoarthritis

What is the significance of the acromioclavicular alignment?

-Widening= AC joint separation, post traumatic osteolysis of clavicle -Narrowing= Osteoarthritis

What is the significance of the acromioclavicular joint space?

-Widening= glenohumeral dislocation, humeral fracture -Narrowing= acromiohumeral impingement, indirect sign of rotator cuff tear

What is the significance of the acromiohumeral distance?

Congenital dysplasia and femoracetabular impingement

What is the significance of the center edge angle?

Less than 120 degrees= coxa vara Over 130 degrees= coxa valga

What is the significance of the femoral/mickulicz's angle?

-Widening= effusion or dislocation -Narrowing= osteoarthritis

What is the significance of the glenohumeral joint space?

1) Superior narrowing= DJD 2) Axial narrowing= inflammatory arthritides 3) Medial widening= effusion, and by both DJD & inflammatory arthritides

What is the significance of the hip joint space width?

Shows joint abnormality

What is the significance of the iliofemoral line?

Pain with lumbar extension

What is the significance of the knife clasp deformity?

If abnormal values it is related to abnormal posture, antalgia, muscular imbalance, and acute disc injuries

What is the significance of the lumbar disc angle?

-Anterior to S1= shearing stresses on the lumbosacral joints -Posterior to S1= increase stress on the pars and the lumbosacral joints

What is the significance of the lumbar gravity line?

-Increase in angle is related to movement of the nucleus anteriorly

What is the significance of the lumbar lordosis?

An increased angle may put more stress on the lumbosacral posterior joints

What is the significance of the sacral base angle?

If the distance is more than 11mm or discrepancy greater than 2mm between both hips, then hip disease is present. Signs for: -Hip Joint effusion -Legg-calve-Perthes -Septic or Inflammatory arthritis

What is the significance of the tear drop distance?

Nephroliths

What is the staghorn calculus related to radiographically?

AP Pelvis

What is the standard projection for the pelvis?

To look for stability in flexion & extension

What is the stress view for lumbars used for?

Fibrous tissue

What is the superior 1/3 of the SI joint consist of?

Kummell dx or Schuermanns Disease

What is the term for AVN of the vertebral bodies?

Nursemaid's elbow

What is the term for a radial head dislocation?

Hill Sachs lesion

What is the term for an impact fracture of the humeral head?

Severs Disease

What is the term for avascular necrosis at the calcaneus?

Freibergs Disease

What is the term for avascular necrosis at the metatarsal head?

Kohler's Disease

What is the term for avascular necrosis at the navicular?

Diaz Disease

What is the term for avascular necrosis at the talus?

Hemothorax

What is the term for blood in the pleural space?

Ulnar Variance Best seen on PA wrist Ulnar articular surface proximal or distal to radial articular surface Ulnar impingment - and ulnar impaction +

What is the term for congenital anomaly of the ulna being longer or shorter than the radius? What view is best seen on? What are findings?

Intervertebral chondritis

What is the term for disc narrowing due to osteoarthritis?

Polydactyly or hyperdactyly

What is the term for extra digits also known as supernumerary digits?

Lipohemarthrosis

What is the term for intra-articular fractures creating a fat-fluid level secondary to a bloody effusion from marrow leaking into joint?

Chylothorax

What is the term for lymph in the pleural space?

Spondylophytes

What is the term for osteophytes in the spine?

Nephroliths 85-95%

What is the term for renal stones? How often do they calcify?

Phleboliths

What is the term for small venous calcifications?

Rolando & Bennett Fx

What is the term for the 1st MC fracture?

Bipartite hallux sesamoid (normal amount of big toe sesamoids= 2) AP Foot

What is the term for the accessory secondary ossification center of normal sesamoid bone fails to fuse to parent bone in the big toe? What view best shows it?

Symphalangism Lack of joint space

What is the term for the ankylosis of interphalangeal joints? What is the radiographic finding?

Calcaneal enthesophyte

What is the term for the bony spurs at either the Achilles tendon or plantar fascia?

Eagle's syndrome

What is the term for the combination of stylohyoid ligament calcification & dysphagia?

Bipartite patella

What is the term for the congenital anomaly where the patella develops into two separate portions?

Epiphysis: it is a secondary growth center, it is composed of spongy bone surrounded by thin cortical bone, it is the articulating portion of the bone and is intracapsular

What is the term for the end of the long bone and what are some characteristics of it?

Boxer Fx

What is the term for the fracture of the 2nd/3rd metacarpal?

Barroom Fx

What is the term for the fracture of the 4th & 5th metacarpals?

Flap fracture

What is the term for the fracture of the greater tuberosity that may or may not happen with shoulder dislocation?

Avascular necrosis

What is the term for the loss of blood supply at the articular surface?

Bone infarct

What is the term for the loss of blood supply at the shaft of the long bone?

Os acetabuli Epiphysis or apophysis

What is the term for the un-united secondary ossification centers of the acetabulum? What are secondary ossification centers?

2= bipartite 3= tripartite Multiple= multipartiate

What is the term for un-united secondary ossification centers of the patella, when it is in 2, 3, and multiple parts?

Cortical island

What is the term for when a build up of cortical bone is found where trabecular bone should be?

Bone islands AKA Enostoma

What is the term for when an island of cortical bone is found in a trabecular pattern?

Enostosis AKA osteopoikilosis

What is the term for when there are a bunch of bone islands AKA enostomas?

Chondromalacia patella

What is the term related to the softening & degeneration of the patellar cartilage?

Transitional vertebra

What is the term used to describe a vertebra that has characteristics of 2 different spinal segments?

12 mm

What is the threshold for canal stenosis?

+ (impaction) or -(impingement) of 2mm

What is the threshold of ulnar variance?

When the acetabulum is not yet fused

What is the triradiate cartilage?

Femorotibial articulation

What is the true knee articulation?

Sprengle's deformity= failure of descent of scapula Can occur independently or w/ Klippel Fiel Related to reduced ROM of arm, scoliosis, spina bifida occulta, cervical ribs, omovertebral bone Treated surgically around age 4-7

What is the white arrow an example of?

Os Odontoideum Dens not united to body Smooth lucency seperates the base of the dens from the C2 body On lateral view: dramatic misalignment of spinolaminar junction between C1 and 2

What is this an example of (is not a Mach effect)?

Cervical rib- separate & distinct piece of bone that articulates w/ cervical TP Most comman at C7, then C6 & C5, can be bilateral or unilateral It is not an elongated C7 TP and that would have an articular space To find: Look at TP orientation as thoracic is more upward than cervical, and will help to determine between T1 and C7

What is this an example of ?

Surgical arthrodesis= surgical joint fusion Complications= hardware integrity and instability

What is this an example of and what are some characteristics?

-Osteoarthritis AKA DJD AKA joint arthrosis -Joint space narrowing, osseous spurs, subchondral sclerosis (whitening), and can lead to spinal stenosis -Can happen anywhere

What is this an example of and what are the characteristics?

Congenital spondylolisthesis Due to bilateral pedicle agenesis or malformed articular processes In cervical, most common at C6

What is this an example of and what causes it?

Inverted Napoleon hat sign: indicates Grade 3-5 spondylolisthesis of L5 as the L5 body sits in front of the sacrum on an A-P View

What is this an example of and what is its significance?

-Knife clasp deformity -AP Lumbar (or AP Pelvis) -Spina bifida occulta at the S1 tubercle and elongated L5 spinous

What is this an example of and what view is it seen on?

Nuclear impression Lateral or AP lumbar

What is this an example of and what views can it be seen on?

-Os Acetabuli= un-united secondary ossification center of acetabulum, resulting in small ossicle near acetabular rim -AP Lumbopelvic, AP Pelvis, Hip

What is this an example of and what views is it best seen on?

-Paraglenoid Sulci= Bony indentations at medial inferior margin of the ilium -AP LumboPelvic or AP Pelvis -No significance

What is this an example of, what are the best projections and what is its significance?

Caudal regression syndrome= sacral agenesis or sacral hypoplasia, a rare birth defect AP Lumbopelvic or AP Pelvis Neurogenic bladder, anorectal malformation, sensorimotor paresis, associated w/ maternal diabetes

What is this an example of, what are the best projections, and what is the significance?

-Rib fracture: seen by cortical & trabecular discontinuity (can cause pneumothorax)(may be occult- so re-Xray in a week)(usually fracture at rib angle)

What is this an example of?

Acquired Block Vertebra -if no wasp waist deformity, and especially if there is some kind of hard wiring present and no disc present at all

What is this an example of?

Atelectasis= loss of volume in lungs, increase in density (lung collapse) Found by focal or diffuse increase in density of the lung (more radiopaque)

What is this an example of?

Azygous fissure, when the azygous vein runs within the parietal & visceral pleura (surrounded by 2 layers of parietal and 2 of visceral) A non-worrisome anomaly

What is this an example of?

Bone island AKA Enostoma

What is this an example of?

Caudal regression syndrome, specifically sacral agenesis

What is this an example of?

Cervical osteoarthritis, as the IVF's have decreased severely, and there is bone spurring present

What is this an example of?

Complete Posterior arch agenesis Enlarged C2 SP Predisposition to Upper cervical instability

What is this an example of?

Dens Agenesis= Absent dens Upper cervical instability

What is this an example of?

Dens Hypoplasia= Small dens Suspect upper cervical instability

What is this an example of?

Eventration of Diaphragm= congenital weakness of diaphragm ( a non-worrisome anomaly)

What is this an example of?

Hemivertebra

What is this an example of?

Hemivertebra One half of the vertebra's primary ossification center fails to form, resulting in a triangular shaped vertebral body Always creates a congenital or structural cause of scoliosis

What is this an example of?

Nuchal bones= calcification of nuchal ligament, found floating in cervical soft tissue posteriorly It is an incidental finding No contraindication Fairly common

What is this an example of?

Occipitalization AKA Assimilation of Atlas= failure of separation of C0 & C1 Reduces ROM Predisposition to basilar impression and/or upper cervical instability

What is this an example of?

Os Terminale of Bergmann Den's tip separated Small round ossicle at superior tip of dens

What is this an example of?

Osteitis Condensans Ilii (OCI): triangular area of subchondral sclerosis on ilium aspect of SI joint

What is this an example of?

Pancoast AKA Superior sulcus tumor= apical lung tumor that is associated with Horner's syndrome Seen by increased density at the lung apex

What is this an example of?

Partial Posterior arch agenesis Enlarged C2 SP Predisposition to cervical instability

What is this an example of?

Pelvic avulsion fracture of AIIS (where rectus femoris attaches)

What is this an example of?

Pelvic avulsion fracture of the ischial tuberosity (hamstrings attach here)

What is this an example of?

Pelvic avulsion fracutre of AIIS

What is this an example of?

Pneumothorax= air in pleural space, seen as hyperlucent lung (more radiolucency)(can lead to lung collapse)(can be large or small, this is a large pneumothorax)

What is this an example of?

Posterior Ponticle= calcification of the atlanto-occiptal ligament between posterior lateral mass & posterior arch of atlas, that is seen on a lateral Cervical view. -Ossificaiton of arcuate foramen: where vertebral A and suboccipital N pass thru *Not a contraindication to adjust

What is this an example of?

Rib synostosis

What is this an example of?

Rib synostosis, a congenital fusion of the ribs

What is this an example of?

Rider's bone: an unexplained over growth of avulsed ischial tuberosity fragment

What is this an example of?

Riedel's lobe: accessory lobe of liver as a caudal elongation (described as tongue like projection, and does not cross the midline)

What is this an example of?

Riedels Lobe

What is this an example of?

Risser-Fergusson Angle; seen on an AP thoracic view, and uses 3 landmarks Choose the 2 end vertbrae at the extremes of the scoliosis, then choose the apical vertebra. Draw 2 diagonals that cross each other at the center of the vertebrae. Connect lines going thru the centers of the vertebrae & measure the angle at the apex.

What is this an example of?

Sacroiliac ankylosis= fusion of SI joint, with continuous trabecular pattern Best seen on standard projections

What is this an example of?

Sacroilitis= inflammation of SI joint from trauma, disease or infection Seen as serrated contour of articular surfaces Best seen on standard projection

What is this an example of?

Schmorl's Node

What is this an example of?

Spina bifida occulta= failure of neural tube to close so neural arch is split Less severe than vera, so not found til later in imaging Lack or break in spinolaminar junction

What is this an example of?

Spina bifida vera, which is an extreme version of spina bifida apparent at birth, and that requires surgery. Meningocele= Meninges protrude thru cleft Meningomyocele= meninge & spinal cord protrusion

What is this an example of?

Spondyloschesis= spina bifida occulta at C1 (no spinolaminar junction on lateral view, and a gap of the posterior arch on AP view)

What is this an example of?

Stylohyoid ligament calcification

What is this an example of?

Traumatic spondylolisthesis of C2 AKA Hangman's fracture

What is this an example of?

congenital block vertebra failure of 2 or more vertebra to separate results in "wasp-waist" deformity and rudimentary IVD neural arch fusion in 50% of cases

What is this an example of?

Endosteal scalloping due to a benign tumor

What is this an example of? and what is the cause?

Nash and Moe Vertebral Rotation: the apex vertebra of scoliosis is divided in half on the AP View. Pedicle position on convex side is evaluated. The greater the convexity the greater the rotation.: Grade 0= No rotation Grade 1= Mild rotation toward line Grade 2= Pedicle approximates line Grade 3= Pedicle centered over line Grade 4= Pedicle crosses over line

What is this depicting and describe the different grades:

Risser Sign, it is looking at spinal maturation, and is important in looking at those with scoliosis because after the point of spinal maturation scoliosis will not progress. Grades 0-4 0= No ossification 1= Ossification of outermost quadrant 2= half 3= 3/4 4= Full fusion

What is this image looking at and what is its significance?

Third Condyle= small bony osseous structure at anterior margin of foramen magnum (usually always anterior)

What is this image showing?

Mcgreggor's Line- seen on Lateral cervical spine -Line from posterior hard palate to most inferior surface of the occiput -Best line to determine basilar impression= Dens too superior

What is this line and what is it's significance?

Cervical gravity line -Line thru apex of dens down -Should pass thru C7 body -Assesses the location of gravitational stress on the CT junction

What is this line and what is its significance?

Chamberlain's Line: Seen on Lateral Skull or Lateral cervical View Line from posterior hard palate to posterior margin of foramen magnum Used to see basilar impression

What is this line and what is its significance?

Ruth Jackson's line AKA Stress lines Seen on Lateral neutral, flexion & extension Cervical Views Draw line on posterior body of C2, and C7. Measure angles in flexion & extension. In neutral should cross at C5. Should intersect at C5/6 disc in flexion. And C4/5 disc in neutral & extension

What is this line and what is its significance?

-Ullmans Line -Lateral Lumbar -Line on S1 superior endplate, and line perpendicular to anterior margin of sacral base -L5 body should lie posterior or at the perpendicular line

What is this line and what view is used for this? What are the landmarks and normal measurements?

Cervical Lordosis AKA Cobb Method -2 lines, one thru atlas plane line, and 1 thru C7 inferior endplate, draw 2 perpendiculars & measure angle -Normal Value= 35 to 45 degrees -Correlation between a decrease in lordosis & trauma, muscle spasms & degeneration

What is this looking at and what is the significance?

Hip joint space width -Superior joint space= most superior point of convex articular surface of femur & adjacent cortex -Axial joint= between femoral head & acetabulum (middle) -Medial joint= teardrop distance (most inferior)

What is this measurement called? And describe the 3 components.

-Sacral Base Angle -Lateral Lumbar -Draw line along S1 superior endplate, and intersect it with a true horizontal line -Normal value-26-57 degrees with average of 41 degrees

What is this measuring and what is the view used? What are the landmarks and normal values?

-Lumbar Disc angle -Lateral Lumbar -Draw lines along all the endplates -8-14 degrees

What is this measuring and what is the view? What are the landmarks and normal values?

Lumbar Lordosis Lateral Lumbar Line along L1 superior endplate, line along S1 superior endplate, measure angle between 50-60 degrees

What is this measuring and what is the view? What are the landmarks and normal values?

Heel pad thickness Lateral Ankle

What is this measuring and what view is it seen on?

-Lumbar gravity line -Lateral lumbar -Vertical line drawn thru the center of the L3 body -Vertical line should intersect at S1

What is this measuring and what view is used? What are the landmarks and normal findings?

Lumbosacral disc angle

What is this measuring?

Sagittal Dimension of Canal AKA Eisenstein's Method Measure from posterior body to spinolaminar junction line C1: 22 mm C2: 20 mm C3: 18mm C4: 7-17mm (note how its larger at top and then decreases) Narrowing from degeneration or congenital issues Can use ratio to indicate stenosis called canal to body ratio (Pavlov's ratio)= 0.82

What is this showing and what is its significance?

Teardrop distance Medial joint space of hip

What is this showing and what is the AKA?

Gamekeeper's Thumb (Skier's Thumb)

What is this showing?

paracondylar process= inferior extending structure originating next to the occipital condyle. May or may not connect.

What is this showing?

Atlantodental interval AKA Atlas-odontoid space AKA Predental space AKA Atlas-dens interval Seen on Lateral Neutral, flexion and extension Cervical Views Value: Minimum of 1mm, maximum of 5mm in children and 3mm in adults -Decrease due to degeneration, increase due to trauma or other issues

What is this space and what is its significance?

Bone scan, beneficial for polyostotic involvement of abnormalities, it is sensitive to metabolic alterations but is non-specific.

What is this type of imaging and when is it beneficial?

Avascular necrosis with snow cap sign

What issue is shown?

slipped capital femoral epiphysis or SCFE

What issue is shown?

Disarticulation of radial head from capitulum Common in children Abnormal radiocapitellar line Standard Elbow Views

What joint is disrupted by a radial head dislocation? Who does this commonly happen to? What line of mensuration will be abnormal? What view is it best seen on?

Costotransverse joint

What joint is made by the articulation of #2 and #13?

Radio-capitellar Joint

What joint is shown?

Ulno-trochlear joint

What joint is shown?

CT scan (Similar to radiography, but mainly only see bone, good for acute trauma)

What kind of imaging is shown?

Iliofemoral line

What line is shown in A?

Klein's line AP or Frog leg Hip

What line is shown? What view is it best seen on?

Radiocapitellar Line Lateral, AP or Oblique Elbow Draw line through radial shaft Line should bisect the capitulum Radial head dislocation (nursemaid's elbow)

What line is shown? What view is it best seen on? What are the landmarks & methods? What are the normal values? What is the significance?

Insall-Salvatti ratio

What line of mensuration evalulates the patellar position?

Anterior humeral line

What line of mensuration is best to use if you suspect an elbow fracture?

Boehlers angle

What line of mensuration is used to evaulate the calcaneous for fx?

Klein's line

What line of mensuration of the hip is only related to pediatric patients?

Radius to scaphoid & lunate

What makes up the radiocarpal joint?

-Endosteum -No

What membrane lines the inner cortex and covers all the trabeculae, and involves osteoblastic/osteoclastic activity? Is it visible on X-ray?

-Meyerding's Method of Grading Spondylolisthesis -Lateral Lumbar -Line along superior endplate of S1, divided into 4 equal divisions -The posterior body of L5 should be aligned with the posterior S1

What method is this representing and what view is used? What are the landmarks and normal measurements?

Waldenstrom's sign

What name sign is seen on the avasacular phase of AVN?

crescent- subchondral fracture, and snowcap-whitening

What name signs are seen in revascularization phase of AVN?

Sagging rope sign and mushroom sign (flattening)

What name signs are seen in the deformity phase of AVN?

Anterior= 15% Posterior= 85%

What percentage of hip locations are anterior vs. posterior?

medial: posterior lateral: anterior

What portion of the SI joint is more medial and which is more lateral?

Lateral Wrist View

What radiographic view is shown on the right?

Herbert Screw Fixation

What screw is used for a scaphoid fracture

3-5mm

What should the SI joint space be?

Bayonette

What sign is asasociated with Madelung's Deformity?

Pie Sign

What sign is associated with lunate dislocation on the AP view?

FBI sign= fat, blood interface Bone marrow extrudes into the joint fluid causing fat to float on superior surface

What sign is related to lipohemarthrosis and what is it?

-Waldenstrom's sign -Hip joint effusion or lateral shift of the femur

What sign is related to the hip joint space width, and is seen as the widening of the medial compartment? What does it indicate?

AVN crescent sign

What sign is this showing?

Grade 1 Spondylolisthesis

What spondylolisthesis grade is this?

pars interarticularis

What structure is best seen on the lumbar oblique view?

pars interarticularis (portion of lumbar lamina)

What structure is shown?

Rotator Cuff so SITS- 1) supraspinatus, 2) infraspinatus, 3) teres minor, 4) subscapularis

What tendons are HADD associated with and put them in order from most common to least common:

Spongy bone AKA Trabecular AKA Cancellous bone, that is formed from haphazard formation of collagen, it has high water density so appears gray on X-ray, houses bone marrow, and is located mainly within the medullary cavity and the epiphyses.

What type of bone forms the inner network within the bone structure, and what are some characteristics of it?

MRI image (note how you can see soft tissue as white, this is important for disc or neural tissue evaluation)

What type of imaging is this?

Hyperextension

What type of injury commonly causes a dens fracture?

Salter Harris Type 1 growth plate injury

What type of injury is SFCE?

Flexion/Extension Lateral Cervical

What view is best to determine occipitalization?

Lateral Knee

What view is best to see Osgood Schlatter Disease?

Cross table lateral of the knee is necessary to demonstrate the fat-fluid accumulation in the suprapatellar bursa

What view is needed for lipohemarthrosis?

Lateral Elbow View (flexed at 90 degrees)

What view is shown

AP elbow view

What view is shown?

Axillary view of shoulder

What view is shown?

Baby Arm Shoulder

What view is shown?

Ball Catcher View AKA Norgards Projection

What view is shown?

Internal rotation of Shoulder

What view is shown?

Jones AKA Tangential Elbow View

What view is shown?

Lateral Hand View (can also have a fan lateral)

What view is shown?

Medial Oblique View of Elbow (see overlap of radial & ulnar bones, as the arm is internally rotated)

What view is shown?

Oblique Hand View

What view is shown?

Oblique Wrist View

What view is shown?

PA Hand View

What view is shown?

PA Ulnar Deviation View

What view is shown?

PA Wrist View

What view is shown?

Scapular Y View

What view is shown?

Swimmer's lateral View

What view is shown?

-Oblique Lumbar -Appears as a collar on the Scotty dog -Must be done bilaterally -Can do Stress views of flexion/extension to see instability

What view is the best to see a spondylolysis?

Cervical Oblique X-ray To see the Cervical IVF's, especially for radiculopathy

What view is this of the cervical spine, and when do you use this?

Scapular Y view (structures to know: acromion, clavicle, coracoid process, scapular neck, glenoid, scapular body)

What view is this?

External rotation of Shoulder

What view of the shoulder is shown?

AP and Lateral Foot

What views are accessory sesamoid bones best seen for the foot?

APLP AP Pelvic

What views is Os acetabuli seen on?

-AP and Lateral Knee view -Incidental finding

What views is os fabella best seen on and is it a worrisome or incidental finding?

YY or Tri cartilage= ilium, ischium and pubis not fused

What will a pediatric pelvis look like?

Cobb's angle seen on AP thoracic View, and uses 2 landmarks. Draw lines along the superior & inferior endplates of the 2 vertebrae's that are at the extremes of the scoliosis. Draw 2 perpendiculars and measure angle in between. Preferred method for scoliosis angle.

What would this be an example of and what is its significance?

Willhelm R. in 1895

When and by whom was X-rays discovered?

C1 anterior tubercle hypertrophy= enlargement

When determining a trauma vs. congenital cause in the upper cervical complex what is something helpful to look at?

Fillings, metallic surgical pins, or structures exogenous to body

When do you see metal in an X-ray?

During rapid growth, so 10-15 yrs old with a peak of 13 for males and 12 for females

When does SCFE occur?

23

When does the sacrum fuse by?

12mm or less

When is canal narrowing considered canal stenosis?

To see rheumatoid arthritis (RA), metacarpal heads are most common area for this to happen

When is the ball catcher view useful?

Over 5 cm

When is the large bowel/intestine considered distended?

greater than 3 cm

When is the small bowel/intestine considered distended?

joint spaces, articular surfaces, subchondral bone plate

When looking at the C portion of film interpretation, what are examples of what you are looking at?

Viscera, airspaces, gas

When looking at the S portion of film interpretation, what are examples of what you are looking at?

Reverse Colles

When the fracture fragment goes anterior compared to shaft of radius & ulna it is known as a?

When there is suspected trauma to sacrum or SI joint

When would a gonadal shield not be used on a female?

Ultrasound imaging is beneficial for visceral evaluation, superficial soft tissue lesions like gallstones or kidney stones, or rotator cuff issues.

When would this technique of imaging be beneficial for traumas?

A DEXA scan is used for bone mass quantification, and is the gold standard for bone density so is beneficial for osteoporosis or osteomalacia.

When would this type of imaging be benefical, and what is it?

What is an occult fracture?

When you have clinical signs of fracture, but no radiographic evidence. -Follow-up x-rays at 7-10 days reveals signs of healing. -Most common at scaphoid, then ribs.

Inferior rim of glenoid

Where are Bankart lesions located?

Medial hallux sesamoid

Where are bipartite hallux sesamoids most common?

Superolateral corner of patella

Where are bipartite/tripartite/multipartite patellas always located?

Femoral head & calcaneus

Where are bone islands most common?

-Found in Right upper quadrant of abdomen (more anterior to spine compared to renal stones) -Only 15% calcify and can be seen on X-ray -Can see best on lateral view

Where are choleliths located and how often do they calcify?

-Most common at L1 -Asymptomatic and an incidental finding

Where are lumbar ribs most common, and what are the characteristics?

Left or right upper quadrant (seen on spine in lateral view, compared to gall stones that are more anterior)

Where are nephroliths found in X-rays?

Pelvis area (but can be found in other areas less commonly)

Where are phelobliths found?

Ribs 4-10

Where are rib fractures most common?

Radial head/neck

Where do adults most commonly have a fracture?

Compact bone, teeth, blastic tumors

Where do you see bone/calcium on X-ray?

Posterior patella (patella fossa)

Where does an os fabella occur generally speaking?

Subcutaneous fat or fat planes between muscles

Where is it normal to see oil/fat on X-ray?

Trachea, lungs

Where is it normal to see radiolucency as air and gas?

Soft tissues like muscle, organs, and medullary spaces

Where is it normal to see water on X-ray?

-Sesamoid bone located in lateral head of gastrocnemius -Incidental

Where is os fabella located and is it incidental or worrisome?

Digit 5

Where is symphalangism most common?

-Talocalcaneal= "C" sign -Calcaneonavicular= "Anteater" sign

Where is tarsal coalition most common, and include the signs (2 places)?

Anterior superior corner of vertebral body

Where is the most common location for a limbus bone?

Measures the soft tissue space between the anterior sacrum & posterior rectum -LS, LLS

Where is the presacral/retrorectal soft tissue space measured and what view is it seen on?-

1 sesamoid bone at 1st MCP joint

Where is the sesamoid bone in the hand?

-Humeral Head fracture= Hill Sachs Lesion AKA Hatchet deformity -Glenoid fracture at anterior rim= Bankart lesion

Which 2 areas can fracture as a result from an Anterior GH dislocation and what are the AKA's?

Epiphysis and apophysis

Which 2 parts of the long bone are secondary growth centers, that ossify after birth?

Os tibiale externum AKA Accessory Navicular; located at the inner side of arch near navicular (within posterior tibial tendon)

Which accessory sesamoid is shown? Describe its location.

Sprengel's Deformity, a failrue of descent of the scapula May occur independent or in conjunction with Klippel Feil AP Shoulder, or Frontal View of Thorax

Which anomaly is shown? What is its significance? What are the best projections?

Glenoid Hypoplasia, underdevelopment of glenoid via failed ossification center (resulting in a hypermobile & unstable GH joint) May cause GH instability, early osteoarthritis & pain Axillary View of Shoulder

Which anomaly is shown? What is the significance? What is the best projection to view it?

Medial condyle

Which condyle is bigger and more prominent in the femur?

Type II

Which dens fracture is most common?

Type 2= unstable Type 1 & 3= Stable

Which dens fractures are stable vs. unstable?

Bankart lesion AKA Glenoid fracture at anterior rim

Which fracture is shown?

Hill-Sachs lesion AKA Hatchet deformity AKA Humeral Head fx

Which fracture is shown?

Medial Epicondyle

Which humeral epicondyle is much larger, seen in blue?

Radio-capitular joint (radial head to capitulum)

Which joint is at the lateral portion of the elbow?

Olecranon trochlear joint

Which joint is at the medial portion of the elbow?

McGreggor's line

Which line of mensuration is most reliable in detecting basilar impression?

Acromioclavicular Alignment AP Shoulder or AC Joint Line at distal clavicle undersurface and line at distal acromion undersurface Lines should align Widening= AC joint separation, post traumatic osteolysis Narrowing= osteoarthritis

Which line of mensuration is show? What view is used? What are the landmarks & methods? What are the normal values? What is the significance?

Arcs of carpal alignment PA Wrist Draw line along proximal carpal row, draw line along distal aspect of carpal row, and draw a line along proximal aspect of the distal carpal row Each line should be smooth & arcing with no step off Misaligned carpals, instability, dislocation or fracture

Which line of mensuration is shown? What view is it best seen on? What are the landmarks & methods? What are the normal values? What is the significance?

Metacarpal Line/Sign PA Hand Draw line connecting distal most aspect of metacarpals 4 & 5, observe position of 3rd metacarpal head Line should be distal to or barely intersecting 3rd metacarpal Brachymetacarpia (short MC)

Which line of mensuration is shown? What view is it seen on? What are the landmarks and methods? What are normal values? What is the significance?

Acromiohumeral Distance AP Shoulder or AP AC joint Distance from top of humeral head to acromion 7-11mm Widening= GH dislocation or humeral fx Narrowing= AH impingement, indirect sign of rotator cuff tear

Which line of mensuration is shown? What view is used? What are the landmarks & methods? What are the normal values? What is the significance?

Glenohumeral Joint Space AP external rotation Measure in 3 places: top, middle & bottom 4-5mm Widening= Effusion or dislocation Narrowing= osteoarthritis

Which line of mensuration is shown? Which view is used? What are the landmark & methods? What are the normal values? What is the significance?

Acromioclavicular Joint Space AP Shoulder or AP AC Joint Measure superior & inferior portion of clavicle to acromion 2-4mm and should be symmetrical Widening= AC joint separation, post traumatic osteolysis of clavicle Narrowing= Osteoarthritis

Which line of mensuration is shown? Which view is used? What are the landmarks and methods? What are the normal values? What is the signigicance?

Ilioischial AKA Kohler's line

Which line will be abnormal with protrusio acetabuli?

L3

Which lumbar vertebra has the largest TP's?

Cuboid

Which metatarsal articulates with the 4th and 5th metatarsals?

Metaphysis

Which part of a long bone is the most metabolically active during growth, and calcifies the cartilage from the growth plate?

Diaphysis, the strongest component of a long bone

Which part of the long bone forms the shaft and contains bone marrow?

Waldenstrom's sign

Which sign is related to a discrepancy from one side to the other for the teardrop distance of 2mm or more?

Presacral/retrorectal soft tissue space

Which space is shown?

Dysplastic Spondylolisthesis

Which spondylolisthesis is due to spina bifida occulta?

Type II (the one with the accessory joint)

Which type of lumbosacral transitional segment is most symptomatic and causes pain?

Solid periosteal reaction- a single and continuous layer, hallmark of a benign process

Which type of periosteal reaction is shown, and what are some characteristics of it?

Laminated AKA Lamellated AKA Onion skin; is seen with alternating lines of density & lucency, seen in both benign & malignant processes

Which type of periosteal reaction is this and what are some characteristics of it?

Spiculated periosteal reaction AKA sunburst; seen as rapid, disorganized response that is a hallmark of aggressive, malignant lesions

Which type of periosteal reaction is this, and what are some characteristics of it?

Codman's triangle; triangle of new bone on either side of lesion, may be benign or malignant

Which type of periosteal reaction is this, and what are some characteristics?

Swimmer's Lateral X-ray used to see the CT junction

Which type of view is this and when is it used?

Cervical oblique

Which view allows you to see the cervical IVF's?

Lateral Wrist

Which view is best to visualize the lunate?

-10-15 year olds -Repetitive lumbar hyperextension, as in diving or gymnastics

Who commonly gets pars stress fractures?

Females

Who has a wider carrying angle, male or female?

Young females

Who more commonly gets chondromalacia patella young males or females?

Suspicion of Scaphoid fracture

Why would you take an ulnar deviation PA view?

Waldenstrom's Sign Hip joint effusion (non-specific)

Widening of the medial hip joint space or teardrop distance is known as which sign? What is this a sign of?

Joint arthroplasty

________________ is the process of joint replacement.

Skinner's line

line?

Phleboliths

phleboliths

sacral fracture (can see in sacral foramina: line at top out of alignment)

sacral fracture (can see in sacral foramina: line at top out of alignment)

What is the AKA for Joints of Luschka?

uncovertebral joints

-AP -Lateral -Medial Oblique

what are the 3 standard projections for the ankle/foot?

20-40 degrees

what are the normal values for the center edge angle?

Spinolaminar junction line AKA Arch-body line Seen on Lateral Cervical Draw lines of spinolaminar junction, and compare levels A discontinous line indicates displacement: either anterolisthesis or retrolisthesis

what is this line showing and what is its significance?

lateral and sunrise

what views can chondrmalacia patella be seen on?