Radiology 2B Week 2

What is the first step of bone repair post-injury?

Hematoma (blood clot) formation

How long is a hematoma present in the bone?

48 hours

What can break the hematoma?

Motion

What does the hematoma produce?

Chemotactic signals for fibroblasts

What replaces the hematoma?

Fibrocartilagenous matrix

What replaces the fibrocartilage matrix?

Soft callous

What replaces the soft callous?

Hard callous

How can can you tell if a fracture is acute on x-ray?

Sharp angle

possibly subluxation

What are the immediate complications of fracture?

Arterial injury

Compartment syndromes

Fat embolism

Thromboembolism

What are the intermediate complications of fracture?

Osteomyelitis

Hardware failure (rejection)

Reflex sympathetic dystrophy

Myositis ossificans

Synostosis

What are the delayed complications of fracture?

Osteonecrosis

Degenerative joint disease

Osteoporosis

Non-union

Malunion

What is the term for muscle turning into bone post-injury?

Myositis ossificans

What is the AKA of myositis ossificans?

Heterotopic ossification

What is the term for swelling and pain in a joint after a fracture?

Reflex sympathetic dystrophy

What is the term for clinical signs of fracture without radiographic signs?

Occult fracture

How long does an occult fracture take to reveal signs of healing on x-ray?

7-10 days

What is the most common location of occult fracture?

Scaphoid

What is the second most common location of occult fractures?

Ribs

What % of rib fractures can be seen on x-ray?

40%

What is the term for hemorrhage and bone marrow edema at trabecular micro fractures?

Bone bruise

What imaging modality is necessary to visualize bone bruise?

MRI (T2)

What are the AKAs of pseudofracture?

Looser's lines

Milkman's syndrome

Increment Fractures

Umbau zonen

What does a pseudo fracture represent?

Regions of unmineralized osteoid

What angle do pseudo fracture run relative to the cortex?

90 degrees (perpendicular

What conditions will present with a pseudo fracture?

Paget's disease

Rickets

Osteomalacia

Fibrous dysplasia

What is the most common location of an oblique fracture?

Diaphysis

What is the angle of an oblique fracture?

45 degrees

What type of forces create a spiral fracture?

Torsion

Axial compression

Angulation

(combined)

What are the margins of a spiral fracture like?

Sharp and pointy

What is the angle of a transverse fracture?

90 degrees

What does transverse fracture indicate?

Pathological bone

What is the term for the position of distal fragments in relation to proximal fragments in fractures?

Alignment/angulation

What is the term for no perceivable angulation on frontal and lateral views?

Good alignment

What is the term for the closeness of bony contact at fracture site?

Apposition

What is the term for partial bony contact at a fracture site?

Partial apposition

What is the term for twisting forces on long axis induced rotational deformity?

Rotation

What is used to describe rotational malpsoiton of fragments?

Rotation

What is the term for a partial loss of contact between articular components of joint?

Subluxation

What is the term for a complete loss of contact between articular components of joint?

Dislocation

What is the term for a dislocation with a fracture present?

Fracture dislocation

How is dislocation described in the extremities?

Position of distal bone in relationship to proximal

How is dislocation described in the spine?

Position of upper segment upon lower

What is the term for a displacement or frank separation of a syndesmosis?

Diastasis

What bones can be affected by diastases?

Pubic symphysis

Skull

Distal tibiofibular syndesmosis

What is the MOI of a posterior ulna dislocation?

FOOSH + hyperextended elbow

What is the classification system for growth plate injuries?

Salter Harris

What determines the classification type for a salter Harris fracture?

The components of bone involved

What is the acronym for the presentation of salter Harris fractures?

SALTR

I = Slip

II = Above

III = Lower

IV = Through

V = Rammed

What type of salter Harris fracture involves partial or complete separation of epiphysis from the shaft of the bone?

Salter Harris I

What type of forces cause a Salter Harris I?

Shearing/avulsive

What type of salter Harris fracture is a slipped capital femoral epiphysis?

Salter Harris I

What line is used to evaluate for SCFE?

Klein's line

What is a positive finding for Klein's line?

The line does not intersect the femoral head

What disorder does "epiphyseal beaking" refer to?

SCFE

What demographic is most affected by SCFE?

Obese boys, 11-15 yo

What is the most common type of salter Harris fracture?

Salter Harris II (75%)

What parts of the bone does a Salter Harris II fracture go through?

Growth plate

Metaphysis

What is the term for a metaphyseal fragment seen in Salter Harris II fractures?

Thurston Holland fragment

What type of Salter Harris fracture goes through the growth plate and epiphysis, but not the diaphysis?

Salter Harris III

Which Salter Harris Fracture requires immediate open reduction and realignment?

Salter Harris IV

Why does salter Harris IV fracture require immediate open reduction and realignment?

It can lead to closure of 1/2 of the growth plate and deformity

Which Salter Harris fracture is a crush injury of the growth plate?

Salter Harris V

What is the most common cause of premature closure of an entire growth plate?

Salter Harris V

What is the most common location of a Salter Harris II fracture?

Distal tibia

Distal Radius