Week 4 - Recognizing Traumatic Skeletal Abnormalities & Arthritis

Fractures appears as a ___________________ at the highly reflective bone-soft tissue interface

Discontinuity

What is a complete fracture?

broken all the way through

What is an incomplete fracture?

Part of the cortex is fractured

What are the two types of incomplete fractures?

- Greenstick Fracture

- Buckle Fracture

What is a greenstick fracture?

An incomplete fracture where only one part of the cortex is fractured that is MC in children

What is a buckle fracture?

Compression of the cortex leading to the bulging of the cortex

What is dislocation?

Bones are no longer in apposition

What is Subluxation?

partial dislocation

An 80 year old woman arrives at the ER w/ severe right shoulder pain and immobility. On P/E, he right arm is abducted and external rotated. Most likely Dx?

Shoulder dislocation

What is the cause of shoulder dislocation?

Fall on an outstretched arm

What is the different between Anterior vs. Posterior Shoulder dislocation?

Anterior - Presents w/ abducted and external rotated arm and "squaring off" of shoulder (90% of Shoulder dislocations

Posterior - Common w/ seizures and arm present as adducted and internally rotated

What is Hill-Sachs deformity?

A dent in the humeral head common in Anterior shoulder dislocation

What is a Bankart lesion?

Fracture of anterior inferior glenoid common in Anterior shoulder dislocation

What is the lightbulb sign?

Loss of normal half-moon overlapping present in posterior shoulder dislocation

What is rim sign?

Increase space b/w humeral head and anterior glenoid rim present in posterior shoulder dislocation

What is congenital/development dysplasia?

Abnormal positioning of the femoral head in the acetabulum presenting with asymmetric skin folds and limited hip abduction with + Barlow's/ortolani maneuver

What is posterior hip dislocation?

- An injury that occurs when force is applied to a flexed, adducted hip

- Account for 90% of sports-related hip dislocation

What is anterior hip dislocation?

Presents as a reported force/blow to an extended, externally rotated leg

What are avulsion fractures?

a piece of your bone is pulled off by a tendon or ligament

What are the common sites of avulsion fractures?

- ASIS - from sartorius

- AIIS - from rectus femoris

- Ischial tuberosity - from hamstring

- Lesser trochanter - from ilopsoas

35 y.o. Triathletes presents with pain that improves at rest. On P/E, there is pain upon palpation o the second and third metatarsal bone of the right foot - most likely dx?

Stress Fracture

What are the causes of stress fractures?

- Fracture of 3rd metatarsal common in military

- Fracture of shaft of 2nd and 3rd metatarsal also called March fracture

How is stress fracture evaluated?

- Bone scan/MRI (if needed)

What is the cause of a Nightstick fracture?

Isolated fracture of the ulna (transverse and mid-diaphysis, usually from direct blow)

Signs and symptoms:

laceration of the volar forearm,

decreased active and passive ROM

30 year old man sustained a left forearm injury as a result of falling from a 15-foot ladder. lacteration over the volar forearm. pain and swelling of affectd arm with decreased active and passive ROM Most likely dx?

Nightstick fracture

What is a Monteggia fracture?

Fracture caused by Fall on an Outstretched Hand (FOOSH) or a direct blow to the ulna presenting with proximal ulnar shaft fracture and radial head dislocation

due to direct blow to the ulna ir FOOSH

includes both proximal ulnar shaft and the radial head dislocaiton

can include the radial nerve

10 year old presents with a blunt injury to his right arm that is swollen and tender around his elbow on PE. Most likely Dx?

Monteggia Fracture (Proximal ulnar shaft Fracture)

What is a Galeazzi fracture?

Distal radial shaft fracture with dislocation of the ulnar-radial joint caused by FOOSH/falling on a pronated forearm

23 y.o. Male landed on his pronated outstretched left arm and presents with tenderness to palpation with a notable deformity characterized by radial wrist angulation. Distal ulna is palpable. Most likely dx?

Galeazzi Fracture

What is a Colles fracture?

fracture of the distal radius with dorsal displacement caused by FOOSH and presents with "dinner fork" deformity

73 y.o. Female tripped and experienced immediate pain and swelling over the right wrist and presents with dinner fork deformity of the wrist. Most likely dx?

Colles Fracture

What is a Smith's fracture?

fracture of the distal radius with volar displacement (aka reverse Colles fracture)

What is Boxer's Fracture?

Fracture at the neck of the 5th +/- 4th metacarpal

What is a Jones' Fracture?

Transverse fracture of 5th metatarsal caused by planar flexion of foot and inversion of ankle

What is Jefferson Fracture?

Fracture of C1 involving both anterior and posterior arches

How does Jefferson fracture present on X-Ray?

Bi-lateral, lateral offset of lateral masses of C1-C2 on AP open mouth view

How is Jefferson Fracture confirmed?

CT

What is Hangman's Fracture?

Fracture of posterior elements of C2 that is best seen on lateral X-Ray view

What is Burst Fractures?

Comminuted compression fracture of vertebral body associated with neurologic deficit

Are rib fractures detectable on initial exam?

No; it's not uncommon for them to be undetected

2 fractures in each or 3 or more contiguous ribs results in _________

Flair chest

What is the Salter-Harrison Classification?

Type I - Epiphyseal plate fracture

Type II - Epiphyseal plate and metaphysis (**corner sign)

Type III - Epiphyseal plate and epiphysis fracture

Type IV - Epipheseal plate, epiphysis and metaphysis fracture

Type V - Crush injury of Epiphyseal plate

What are the main sites of pathological fractures?

- Ribs

- Spine

- Proximal appendicular skeleton

What causes pathological fracture?

Metastatis

Osteoporosis

How long does the bone remodeling process take after a fracture?

8-12 weeks

What is seen on the xray with Internal endosteal healing

Indistinctness of fracture line (black)

What is External Periosteal Healing?

External Callus formation leading to bridging of fracture site (white)

What is the imaging of choice for arthritis?

X-Rays

Hypertrophic Arthritis (A)

Erosive/Inflammatory Arthritis (B)

Infectious arthritis (C)

What are the various AKA's for primary Osteoarthritis?

- DJD

- Spondylosis

What is Charcot arthropathy?

Develops from a disturbance in sensation that leads to multiple micro fractures, bone resorption, and bone fragmentation

X-Ray findings of Charcot Arthropathy?

- Fragmentation

- Bone resorption

What is CPPD?

- calcium pyrophosphate deposition disease (AKA pyrophosphate arthropathy) that commonly presents in the triangular fibrocartilage of wrist and meniscus

X-Ray findings of CPPD (4 potential findings)

-Chondrocalcinosis

- Hook shaped bone excrescences

- Calcificiation of triangular fibrocartilage

- Scapholunate dissociation

What is Erosive Arthritis?

A type of primary OA that presents with erosive joint changes, typically at the sites of PIP, DIP and/or 1st carpal-metacarpal

X-Ray findings of Erosive Osteoarthritis (1 finding)

Gull-wing deformity

What is Rhematoid Arthritis?

Inflammatory joint disease and pannus formation presenting at MCP, PIP and carpals

Common X-Ray findings of RA (4 findings)

- Ulnar deviation

- Subluxation MCP

- Increased atlantodental interval (ADI)

- Fusion of C/S facet joints

What is Gout?

Inflammatory arthritis with deposition of uric acid

X-Ray findings of Gout

- Rat bites deformities

- Olecranon bursitis

What is psoriatic arthritis?

joint pain and stiffness associated with psoriasis that presents at DIP joints

X-Ray findings of psoriatic arthritis

- Pencil-in-cup deformity

-Juxta-articulate erosion in DIP

What is infectious arthritis?

- AKA septic arthritis

- Usually monoarticular w/ soft-tissue swelling and osteopenia caused by Staph, Gonococcal and Mycobacterium

X-Ray findings of Infectious Arthritis

- Destruction of articular cartilage

- Rapid Destruction