Radiology Limb X Rays Flashcards

Questions and Answers

What is a wedge injury in a patient with osteoporosis?

Crush fracture of a vertebral body so bad, it looks like a wedge.

What is a biconcave injury in a patient with osteoporosis?

Compression fracture to both the superior and inferior parts of a vertebrae, making it biconcave, along with height loss.

How should you try to identify pelvic fractures?

Incomplete cortex.

What are the signs of pelvic diastasis (separation)?

Pubic symphysis and sacroiliac joints are widened. Signup and view all the answers

What is the most common site of pelvic avulsion injury?

ASIS - usually in young, athletic individuals. Signup and view all the answers

What is a sign of a sacral fracture?

Loss of arcuate lines. Signup and view all the answers

Clavicle fracture typically leads to what displacement?

Inferior displacement of distal component Signup and view all the answers

How are abnormalities of the acromioclavicular joint determined?

Malalignment of clavicle and acromion, inferior displacement of acromion Signup and view all the answers

What ligaments tend to tear in acromio-clavicular displacement?

Coracoclavicular ligaments Signup and view all the answers

How should a normal glenohumoral joint appear?

AP view (with the humeral head sitting neatly in the glenoid fossa) Signup and view all the answers

What two things will you look for on limb X ray in glenohumeral dislocation?

Glenoid and humeral head surfaces malaligned, humeral head not overlapping with coracoid process Signup and view all the answers

What will make you suspect a posterior humeral dislocation on X ray?

Widened glenohumeral joint, light bulb sign, no overlap with coracoid Signup and view all the answers

What is the most common site of humeral fracture?

Surgical neck Signup and view all the answers

When do shaft fractures of the humerus tend to occur?

In bone pathology (e.g. multiple myeloma, osteosarcoma) Signup and view all the answers

What is the order in which parts of the elbow ossify?

CRITOL (Capitulum, Radial head, Internal epicondyle, Trochlea, Olecranon, Lateral epicondyle) Signup and view all the answers

What are some features of a normal lateral elbow X ray in a 7 year old?

Anterior fat pad, anterior humerus line, radiocapitellar line Signup and view all the answers

What does the raised fat pad sign indicate?

Joint effusion, often due to hemiarthrosis from fracture Signup and view all the answers

What does the raised fat pad sign in the absence of trauma history indicate?

Possibly inflammatory condition Signup and view all the answers

What X ray features may indicate a supracondylar fracture?

Less than 1/3rd of capitulum lies behind the anterior humerus line Signup and view all the answers

How is radial head dislocation identified?

Radiocapitellar line does not pass through capitulum Signup and view all the answers

What forearm fractures might you be expecting in different age groups?

Elderly - Colle's type, Children - Greenstick Signup and view all the answers

What is a Colle's fracture?

Transverse fracture of distal radius leading to dorsal displacement and angulation of the wrist - dinner fork deformity Signup and view all the answers

What is a Reverse-Colle's fracture/Smith's fracture?

Transverse fracture of radius with palmar displacement and angulation of the wrist Signup and view all the answers

What might a comminuted fracture of the distal forearm appear like?

Lateral displacement of ulnar styloid process (AP), dorsal displacement of carpals and hand on lateral view Signup and view all the answers

Describe how an ulnar fracture leads to radial dislocation, and vice versa.

Both are bound together by an interosseous ligament. If one breaks, the ligament forces the other out of its socket at its weakest point (usually the elbow) Signup and view all the answers

Distinguish between a Torus injury and Greenstick fracture.

Torus injury has buckling without fracture; Greenstick has partial fracture, usually with buckling. Signup and view all the answers

Why is a lateral view essential in suspected wrist fractures?

To assess the radius, capitate and lunate line up together Signup and view all the answers

What is the most commonly fractured carpal, and when is X ray indicated to search for it?

Scaphoid, post-traumatic wrist pain with snuff box tenderness Signup and view all the answers

When do you treat scaphoid fracture?

When you suspect it: 30% do not show up on X ray but can still have significant sequelae (e.g. AVN) Signup and view all the answers

Triquetrium fracture can only be seen on what view?

Lateral Signup and view all the answers

When might you order an oblique view hand X ray?

When nothing has come up on the usual (AP and lateral) views or you suspect Hamate fracture Signup and view all the answers

What radiographic signs indicate that the carpals may have a dislocation or fracture?

Non-uniform distance between all of them Signup and view all the answers

What is the most commonly damaged carpal ligament?

Scapholunate ligament - leads to widening (>2mm) of this joint on ulnar deviation view Signup and view all the answers

What bone do the most common wrist dislocations involve?

Lunate Signup and view all the answers

What are the features of a normal hip X-ray?

Unbroken Shenton's line, taken in AP or lateral positions, intact cortex of femur Signup and view all the answers

How are proximal femoral fractures classified?

Intracapsular - subcapital, transcervical, basicervical; Extracapsular - intertrochanteric, subtrochanteric Signup and view all the answers

What are the X ray features of a Subcapital Femoral Fracture?

Shenton's line is disrupted, increased opacity of femoral neck, lesser trochanter more prominent Signup and view all the answers

What is the Garden classification?

Assessing severity of femoral neck fractures Signup and view all the answers

What are the features of an intertrochanteric fracture?

Fracture runs between trochanters, often comminution with lesser trochanter, does not involve femoral neck Signup and view all the answers

What are the features of a subtrochanteric fracture on X ray?

Fracture is distal to the trochanters, femoral neck intact Signup and view all the answers

When is hip dislocation most common, and in what direction does it usually occur?

Post-total hip replacement, usually posterior Signup and view all the answers

What are the two main causes of femoral shaft fracture?

High impact collision (road accident), pathological fracture Signup and view all the answers

What are the normal findings on an AP knee X ray?

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What are the normal findings on a lateral knee X ray?

Widening of the fat pads superficial and deep to the suprapatellar pouch can be indicative of knee joint effusion Signup and view all the answers

When is a Skyline view of the knee indicated?

Assessing osteoarthritis of the patellofemoral compartment Signup and view all the answers

What are some signs of tibial plateau fracture on X ray?

Displacement of the plateau Signup and view all the answers

How might a patellar fracture appear on X ray?

Increased density surrounding the fat pads, indicating joint effusion due to blood leakage Signup and view all the answers

What are some normal variants of knee anatomy sometimes seen on X ray?

Fabella - normal sesamoid bone at lateral head of gastrocnemius tendon; bipartite patella area - patellar is in two pieces Signup and view all the answers

Most tibial fractures result from high force impact, but some may be more subtle. Which ones might be more subtle or might not show on X ray initially?

Stress fracture, toddler spiral fracture Signup and view all the answers

What will a tibial stress fracture look like?

Periosteal thickening, region of increased density Signup and view all the answers

What view should be done of suspected ankle fractures?

Ankle mortise Signup and view all the answers

What are the main bones and ligaments which may be injured during an ankle fracture?

Tibia, fibula and talus; distal tibiofibular syndesmosis; lateral and medial ligaments Signup and view all the answers

How are lateral (fibular) malleolar fractures classified?

Weber A - distal to ankle joint; Weber B - at level of ankle joint; Weber C - above ankle joint Signup and view all the answers

What are the features of a bimalleolar ankle fracture?

Transverse medial malleolus fracture, lateral malleolus fracture (usually Weber B), medial widening of the joint due to displacement of the talus Signup and view all the answers

What are the features of a trimalleolar fracture?

Medial malleolus fracture, lateral malleolus fracture (usually Weber C), posterior malleolus fracture Signup and view all the answers

What are the features of a Maisonneuvre fracture?

Disruption of medial ankle joint with small bone avulsion, disruption of the distal tibiofibular syndesmosis, proximal fibular fracture Signup and view all the answers

What fractures tend to be associated with falling from height?

Calcaneal fractures, axial loading fractures of the spine Signup and view all the answers

What are the standard views for a calcaneal fracture?

Lateral and axial Signup and view all the answers

What is Boher's angle?

28-40 degrees Signup and view all the answers

What are the X ray signs of calcaneal fracture?

Flattening of Boher's angle, non-intact cortex of calcaneus/loss of smooth cortical edge, depression of the articular surface Signup and view all the answers

What fracture is identified at the mandible that needs further checking?

Dislocation or fracture at the temporomandibular joint Signup and view all the answers

What is the normal X ray view for examining the mandible?

Orthopantomogram Signup and view all the answers

What sign might be present in mandibular fracture?

Loss of smoothness in the cortical edge of the mandible Signup and view all the answers

What view may help if you are unsure if there is a fracture near the temporomandibular joint?

Mandibular view Signup and view all the answers

What are the three views used for C spine injuries?

Lateral, AP, Odontoid Peg View (Open mouth) Signup and view all the answers

What is the Open mouth view done for?

To view the odontoid peg Signup and view all the answers

When is CT or MRI indicated in the context of C spine injury?

High-risk injury, neurological deficit, limited clinical examination, unclear X ray findings Signup and view all the answers

What is the systematic approach to assessing C Spine injury?

CABSSE - Coverage, Alignment, Bones, Spacing, Soft tissue, Edge of image Signup and view all the answers

What are the soft tissue findings you expect in a normal C spine X ray?

Narrow to C4, then widens Signup and view all the answers

Where do you expect to see a corticated ring on spinal X ray?

C2 Signup and view all the answers

What X ray features will likely occur in a fracture of C1?

Loss of integrity of its ring structure, unequal distances of lateral masses of C1 to the Odontoid Peg Signup and view all the answers

What X ray features can occur in a fracture of C2?

C2 bone ring becomes incomplete, odontoid peg is displaced Signup and view all the answers

What is a hangman fracture?

High force hyperextension injury leading to fracture of C2 Signup and view all the answers

Aside from hangman injury, what fracture can occur as a result of extension of the neck?

Extension teardrop fracture Signup and view all the answers

At what vertebral levels do flexion teardrop fractures usually occur?

C3-7 Signup and view all the answers

What might you see in bilateral perched facets, and what is the cause?

Loss of alignment, AP view shows larger space between spinous processes, no fracture seen Signup and view all the answers

What would soft tissue in front of C3, 50% the size of the vertebral body maybe indicate, assuming everything else is normal?

Fracture. Should be around 30%. Do CT Signup and view all the answers

How will a 'clay-shoveler's' fracture show?

Broken spinous process Signup and view all the answers

What view is required in sternal fracture?

Lateral Signup and view all the answers

How do you identify a sternal fracture?

Look for discontinuity of the cortex Signup and view all the answers

When is a CXR indicated in the context of rib fracture?

If there are suspected complications - hemorrhage or pneumothorax Signup and view all the answers

What might the CXR of a patient who has sustained rib fracture appear like if complications develop?

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What is the best systematic approach to assessing thoracic and lumbar spine X rays?

CABSSE - Coverage, Alignment, Bones, Spacing, Soft-tissues, Edge of image Signup and view all the answers

What is the three column model of spinal fractures?

If it affects only one column, it is probably stable; if it affects more than one column, it is probably unstable Signup and view all the answers

Why must you always assess for other fractures if you find one?

In spinal injuries - 1 column fracture has 15% chance of another fracture being found somewhere; 2 column fracture has 40% chance Signup and view all the answers

What features will you expect on compression fracture of the spine?

Loss of body height Signup and view all the answers

What features might you expect on a burst fracture?

Anterior and middle column disruption, vertebral body fragmentation, widening of pedicles on AP Signup and view all the answers

Where are flexion-distraction injuries most common?

Thoracolumbar junction Signup and view all the answers

What X ray features are seen in flexion-distraction injuries?

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Study Notes

Clavicle and Acromioclavicular Anatomy

Clavicle fractures typically lead to inferior displacement of the distal component.
Abnormalities in the acromioclavicular joint are assessed by malalignment between clavicle and acromion, and inferior displacement of the acromion.
Coracoclavicular ligaments tend to tear in cases of acromioclavicular displacement.

Glenohumeral Joint Assessment

Normal glenohumeral joint appearance includes proper alignment in AP view, with the humeral head seated neatly in the glenoid fossa.
Signs of glenohumeral dislocation include malalignment of glenoid and humeral head surfaces and the humeral head sitting below the coracoid process.
Posterior humeral dislocation is suspected if there is a widened glenohumeral joint, a light bulb sign, and lack of overlap with the coracoid.

Humeral and Elbow Fractures

The most common site of humeral fracture is at the surgical neck, typically presenting as a transverse fracture with separation of the greater tubercle from the head.
Shaft fractures of the humerus often occur in conditions like multiple myeloma or osteosarcoma, visible as lytic lesions.
The order of ossification in the elbow is CRITOL, occurring between ages 6-12 and fusing in early adulthood.

Joint Effusion and Fracture Indicators

Anterior fat pad and radiocapitellar line should be present in a normal lateral elbow X-ray of a 7-year-old.
A raised fat pad sign indicates joint effusion, often from fractures, particularly radial head fracture or supracondylar fracture in children.
Fracture features include less than one-third of the capitulum lying behind the anterior humerus line indicating a supracondylar fracture.

Wrist and Forearm Fractures

Radial head dislocation can be identified if the radiocapitellar line does not pass through the capitulum.
Colle's fracture is characterized by a transverse distal radius fracture with dorsal angulation, while Reverse-Colle's (Smith's) fracture involves palmar displacement.
Ulnar fractures can lead to radial dislocation due to interosseous ligament connections, often evident by the loss of radiocapitellar line.

Pediatric Fractures and X-ray Views

Torus injuries present with buckling of bones without complete fractures, while greenstick fractures show partial fractures with buckling.
Lateral views are vital in suspected wrist fractures to ensure proper alignment of the radius, capitate, and lunate.
Scaphoid fractures should be suspected with post-traumatic wrist pain, particularly with snuff box tenderness.

Ankle and Foot Injuries

Ankle fractures are assessed using the ankle mortise view; commonly injured structures include tibia, fibula, and talus.
Weber classification categorizes lateral malleolar fractures relative to the syndesmosis: A (distal), B (at level), C (above).
Bimalleolar fractures feature transverse medial and lateral malleolus fractures with joint widening from talus displacement.

Pelvic and Spinal Fractures

Assess pelvic fractures by looking for incomplete cortex and signs of diastasis between the pubic symphysis and sacroiliac joints.
Signs of sacral fractures include loss of arcuate lines on X-ray.
C-spine injuries should be evaluated with a systematic approach (CABSSE) and include lateral, AP, and odontoid views.

Miscellaneous Fractures

Hangman fractures result from high force extension injuries leading to C2 fractures.
Flexion-distraction injuries disrupt all three spinal columns and often occur in thoracolumbar junctions.
Osteoporotic fractures can appear as wedge injuries or biconcave injuries due to vertebral body compression.

General Considerations

Rib fractures warrant Chest X-ray if complications like hemothorax or pneumothorax are suspected.
Always check for additional fractures after identifying one in spinal injuries due to high co-morbidity rates.
Mandibular fractures require checking for possible dislocations or fractures at the temporomandibular joint.

X-ray Techniques

For sternal fractures, lateral views are required to inspect for cortical discontinuity.
Normal hip X-rays show Shenton's line uninterrupted and proper alignment in both AP and lateral views.

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Enhance your understanding of limb X-ray interpretations with these flashcards. Each card focuses on key concepts such as clavicle fractures, acromioclavicular joint abnormalities, and ligament tears. Perfect for students and professionals in the field of radiology.