112 Questions
What is the most common cause of femur fracture in the general population?
Car accidents
In the elderly, what is the most common cause of femur fractures?
Falling
What is the consequence of a fracture to the femoral neck?
Avascular necrosis
Which scenario typically results in a fracture to the femoral neck or femoral head?
High-impact trauma
What is often obvious in the case of high-impact trauma causing a femoral shaft fracture?
Sudden, immediate pain
Which type of fracture involves a minor crack in the femoral neck?
Pipkin Classification type I fracture
What diagnostic imaging technique remains the gold standard for bone fracture detection?
Radiography
What is the most common type of hip fracture?
Intertrochanteric fracture
What is the Salter-Harris classification primarily used to classify?
Growth plate fractures
What type of force causes transverse fractures across the femoral shaft?
Force exerted perpendicular to the shaft
Which type of fracture involves a complete crack in the femoral neck but no bone displacement?
Garden Classification type 2 fracture
What is the pathology associated with open or compound fractures?
Exposure to the outside air
What imaging technique may be necessary to detect brain damage or subdural hemorrhage in cases of suspected abuse?
(CT) scans of the head
What is the pathology associated with open or compound fractures?
Exposure to the outside air
What is the most common type of hip fracture?
Intertrochanteric fracture
What imaging technique may be necessary to detect brain damage or subdural hemorrhage in cases of suspected abuse?
(CT) scans of the head
Which artery provides 90% of the blood circulation to the femoral head?
Lateral epiphyseal artery
What is the predominant branch that delivers blood to the femoral head?
Lateral epiphyseal artery
What is the primary cause of avascular necrosis in the femoral head?
Disruption of the vascular supply due to fractures in the femoral neck
What type of injury occurs in 2% of individuals with femur shaft fractures?
Injury to the femoral artery
What is a characteristic feature of stress fractures on radiographs?
Sclerotic band across the bone
Which type of fracture can occur during normal activity or from minimal trauma?
Pathologic fracture
What type of fracture occurs in abnormal bone from abnormal stress?
Fatigue fracture
What type of fractures occur spontaneously in abnormal bone, particularly in the presence of bone tumors?
Pathologic fractures
What is a common cause of compression fractures?
Excessive pressure or illness
Which type of fracture typically occurs at the growth plates due to force?
Salter-Harris fracture
What type of fractures are linked with abuse, particularly in children but also in the elderly?
Nonaccidental fractures
What type of injury often indicates potential abuse when seen on radiographs as small chips from the long bones?
Nonaccidental injury
What is the specificity of radiography with fat pad elevation greater than or equal to 1.5 mm as a diagnostic reference for femoral neck fractures?
0.857
In the study, what imaging modality remains the gold standard for diagnosing occult femoral neck fractures?
MR imaging
What is the most common reason for imaging in elderly patients according to the retrospective review of Duke University’s MR imaging database?
Fall
What was the average age among individuals imaged for lower-extremity injuries in the emergency setting based on the retrospective review of Duke University’s MR imaging database?
70.8 years
What did the retrospective review of Duke University’s MR imaging database find regarding patients imaged for lower-extremity injuries in the emergency setting?
Underwent x-ray examinations only
In the study, what did MR imaging reveal in 81 individuals (83%) based on a retrospective study conducted in London?
Both fractures and muscle injuries
What type of fractures did MR imaging detect in 43% of the individuals according to a retrospective study conducted in London?
Femur fractures
What did the retrospective study by Collin et al investigate?
Observer variation for radiography, CT, and MR imaging of non-displaced occult hip fractures
What role does MR imaging play in diagnosing femur fractures?
Visualizing soft tissue and bone marrow edema
What percentage of individuals imaged for lower-extremity injuries in the emergency setting underwent at least 2 x-ray examinations according to the retrospective review of Duke University’s MR imaging database?
77%
What was the sensitivity of radiography using positive lateral or posterior sign as diagnostic criteria according to the study?
0.857
What is the estimated cost of more than 250,000 sub-capital hip fractures below the femoral head reported annually in the United States?
$15 billion
Which group has a disproportionately high risk of femoral neck stress fractures?
Postmenopausal women
What percentage of femoral shaft fractures in adolescents and the general population are caused by motor vehicle accidents?
80% to 90%
What is the estimated percentage of white women suffering a hip fracture by the age of 80?
20%
What condition can increase the risk of femur and hip fractures in the elderly population?
Low bone mineral density
Where is the femoral head located?
At the top of the femur at the junction of the femoral neck and the upper femoral body
What forms an angle opening medialward with the femoral body?
The femoral neck
What is the reason for requiring at least 2 projections in the case of bone trauma?
To ensure that all fractures or dislocations are visible on at least one radiograph.
What is the recommended position for the patient during an anteroposterior (AP) projection for femur imaging?
Supine position with the femur centered over the image receptor.
In areas of more complex bony anatomy, such as the joints, why might more than 2 projections be needed to assess trauma adequately?
To provide additional images to assist with a more accurate diagnosis.
What may be a distinguishing factor between a growth plate and an impacted fracture when viewed on radiographs?
The growth plate margin appears as a white boundary, making it easily confused with an impacted fracture in which trabeculae have become enmeshed.
What type of stress image is taken to show that a joint is unstable, as in the case of a dislocation?
Stress images taken with a joint under stress
What imaging technique may be preferred when a fracture is not evident on radiographs, but clinical suspicion of a fracture is high?
Magnetic resonance imaging (MRI)
Why might radiographs of the unaffected leg be helpful for diagnosis in certain cases?
To compare with affected leg for symmetry and detect any abnormalities
What is the most common cause of femur fractures in the pediatric population?
Child abuse
Which group is at the highest risk of femur fractures resulting from falling?
Elderly (age >65)
What complication may result from a fracture to the femoral neck?
Avascular necrosis
Which type of trauma typically results in a fracture to the femoral neck or femoral head?
High-impact trauma
What is the most common cause of femur fractures in the general population?
Car accidents
What is the significance of a femur fracture in the pediatric population?
Sign of child abuse
What is a common cause of femoral neck stress fractures?
Excessive physical activity
What is the estimated percentage of white women suffering a hip fracture by the age of 80?
20%
What percentage of femoral shaft fractures in adolescents and the general population are caused by motor vehicle accidents?
80-90%
What is the primary cause of avascular necrosis in the femoral head?
Femoral neck fracture
What type of force causes transverse fractures across the femoral shaft?
Torsion
Where is the femoral head located?
In the hip socket
What is the sensitivity of radiography using the lateral or posterior sign as diagnostic criteria for femoral neck fractures?
0.875
What did MR imaging reveal in 83% of individuals based on a retrospective study conducted in London?
Occult hip fractures
What was the specificity of radiography with fat pad elevation greater than or equal to 1.5 mm as a diagnostic reference for femoral neck fractures?
0.857
What is the predominant cause of avascular necrosis in the femoral head?
Prolonged immobilization
What was the average age among individuals imaged for lower-extremity injuries in the emergency setting based on the retrospective review of Duke University’s MR imaging database?
70.8 years
What type of fractures did MR imaging detect in 43% of the individuals according to a retrospective study conducted in London?
Proximal femur fractures
What did the retrospective study by Collin et al investigate?
Observer variation for radiography, CT, and MR imaging of non-displaced occult hip fractures
What role does MR imaging play in diagnosing femur fractures?
Assessing soft-tissue damage resulting from femur fracture
Where is the femoral head located?
In the hip joint
What percentage of white women suffer a hip fracture by the age of 80?
20%
What is the primary cause of avascular necrosis in the femoral head?
Fracture of the femoral neck
What is the most common site of avascular necrosis?
Femoral neck
What type of fracture involves a complete crack in the femoral neck but no bone displacement?
Compression fracture
What may be a distinguishing factor between a growth plate and an impacted fracture when viewed on radiographs?
Visible periosteal reaction
Which artery provides 90% of the blood circulation to the femoral head?
Lateral epiphyseal artery
What type of stress fractures appear as areas of increased uptake before any changes are visible on radiographs?
Stress fractures
What type of fractures are linked with abuse, particularly in children but also in the elderly?
Nonaccidental fractures
What is often evident on radiographs in cases of stress fractures?
Sclerotic band across the bone
What type of fracture involves a minor crack in the femoral neck?
Fatigue fracture
What is a characteristic feature of stress fractures on radiographs?
Areas of increased uptake
What is the estimated cost of more than 250,000 sub-capital hip fractures below the femoral head reported annually in the United States?
$20 billion
What was the average age among individuals imaged for lower-extremity injuries in the emergency setting based on the retrospective review of Duke University’s MR imaging database?
45 years old
What type of fracture is caused by a force exerted perpendicular to the femoral shaft?
Transverse fracture
Which classification system includes 5 types and is particularly important because of its predictive value for femoral growth plate fractures?
Salter-Harris classification
What is the most common type of hip fracture?
Intertrochanteric fracture
What type of fracture disrupts the blood supply to the femoral head and can result in hip displacement as well as necrosis of the femoral head?
Type 4 femoral neck fracture
Which imaging technique remains the gold standard for diagnosing bone fractures?
Radiography
What artery provides 90% of the blood circulation to the femoral head?
Medial circumflex femoral artery
What type of fracture occurs spontaneously in abnormal bone, particularly in the presence of bone tumors?
Pathological fracture
What is often obvious in cases of high-impact trauma causing a femoral shaft fracture?
Displacement of the bone fragments
What type of force causes oblique fractures across the femoral shaft?
$45^\circ$ force to the shaft
What pathology is associated with open or compound fractures?
"Exposure to the outside air and often involve more injury to the surrounding muscles, tendons, and ligaments"
What condition can increase the risk of femur and hip fractures in the elderly population?
Osteoporosis
What type of injury often indicates potential abuse when seen on radiographs as small chips from the long bones?
Rib fractures
Why are at least 2 projections required in the case of bone trauma?
To assess the position of a fracture with more than 1 image
What imaging technique may be preferred when a fracture is not evident on radiographs, but clinical suspicion of a fracture is high?
MR imaging
What is the recommended position for the patient during an anteroposterior (AP) projection for femur imaging?
Supine position
What is the most common reason for imaging in elderly patients according to the retrospective review of Duke University’s MR imaging database?
Femoral neck fractures
What may be a distinguishing factor between a growth plate and an impacted fracture when viewed on radiographs?
The smooth and curved growth plate margin
What type of force causes transverse fractures across the femoral shaft?
Torsional force
Where is the femoral head located?
At the proximal end of the femur
What percentage of femoral shaft fractures in adolescents and the general population are caused by motor vehicle accidents?
50%
What diagnostic imaging technique remains the gold standard for bone fracture detection?
Radiography
What is often obvious in the case of high-impact trauma causing a femoral shaft fracture?
A large dome-like lump on the thigh
Study Notes
Femur Fractures
- The most common cause of femur fractures in the general population is motor vehicle accidents.
- In the elderly, the most common cause of femur fractures is falling.
Femoral Neck Fractures
- A fracture to the femoral neck can lead to avascular necrosis of the femoral head.
- A scenario that typically results in a fracture to the femoral neck or femoral head is high-impact trauma, such as a motor vehicle accident.
- Stress fractures involving a minor crack in the femoral neck can occur from normal activity or minimal trauma.
- A fracture involving a complete crack in the femoral neck but no bone displacement is known as a non-displaced fracture.
Imaging and Diagnosis
- The gold standard for diagnosing bone fractures is radiography.
- MRI imaging is often necessary to detect brain damage or subdural hemorrhage in cases of suspected abuse.
- Radiography with fat pad elevation greater than or equal to 1.5 mm has a specificity of 95% as a diagnostic reference for femoral neck fractures.
- MR imaging is useful in diagnosing femur fractures, particularly in cases where radiographs are negative but clinical suspicion is high.
Hip Fractures
- The most common type of hip fracture is sub-capital hip fractures below the femoral head.
- The estimated cost of more than 250,000 sub-capital hip fractures reported annually in the United States is significant.
- The femoral head is located at the proximal end of the femur and forms an angle opening medialward with the femoral body.
Other
- The primary cause of avascular necrosis in the femoral head is disruption of the blood supply to the femoral head.
- The artery that provides 90% of the blood circulation to the femoral head is the medial circumflex femoral artery.
- The Salter-Harris classification is primarily used to classify femoral growth plate fractures.
- Stress fractures often appear as areas of increased uptake before any changes are visible on radiographs.
- Femoral shaft fractures are often caused by transverse or oblique forces, such as those experienced in a motor vehicle accident.
- Open or compound fractures are associated with a high risk of infection and other complications.
Learn about the indicators of child abuse such as periosteal reaction and rib fractures, as well as the classification of fractures. Understand the importance of skeletal surveys and imaging techniques in diagnosing child abuse.
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