Diagnostic Imaging 2- Exam 2- Extremity Trauma #1 start to elbow notes

When looking at a trauma there is a minimum of how many views that need to be taken

2 at right angles

Most common location for a fracture that you can't see on X ray at first

Scaphoid

Tension results in what type of fracture

Transverse fracture

Compression results in what type of fracture

Oblique

Rotation results in what type of fracture

Spiral

Angulation results in what type of fracture

Transverse

Angulation and compression result in what type of fracture

Transverse and oblique fracture

What type of fractures run at right angles to the long axis and result from direct blows or tensile forces?

Transverse fractures

What type of fractures are common in pathological bone conditions

Transverse fractures

Example of a transverse fracture

What type of rapture runs about 45 degrees to the long axis of the bone and is from Angulation or angulation and compression type of injury

Oblique fractures

Oblique fractures sometimes have a small _________ component

Transverse

Example of a transverse fracture

Fracture that encircles the shape and is longer than an oblique fracture that results form torque and axial compression? The ends are pointed like a pen

Spiral fracture

What describes the closeness of the bony contact at the fracture site

Apposition

When takin about apposition of a fracture, how do you describe it?

Describe the offset of the distal in relation to the proximal

What are some ways that you can describe apposition

Overriding, distraction, no apposition

Example of displaced vs non-displaced fractures

Examples of fractures loosing apposition

What describes the position of the distal fragment in relation to the proximal in the longitudinal axis

Alignment

Alignment deals primarily with

The direction and degree of Angulation

Alignment describes the Angulation of the

Distal fragment

Example of a loss of alignment posteriorly

What is described by being produced by a twisting force along the longitudinal axis

Rotation

Rotation is more easily determined one

Clinical evaluation

When assessing rotation it ideally should include

Joints above and below the fracture

In males the highest rate of fractures is when? When will it decrease and then increase again?

2nd and 3rd decades

Decreases 45 yrs and then raises after 65

In females the highest rate of fractures is when? When will it decrease and then increase again

Up to 20 years

Decreases at 45 then steadily increases after that

Between 10-16 yers of age___________ are the most common as this is the weakest area of teh bone

Epiphsyeal

Common sites of fractures in the elderly

Thoracolumbar pain

Proximal femur

Distal radius

Proximal humerus

Indirect signs as a diagnostic clue of a fracture

Joint effusions

Double cortical line

Cortex buckling

Displacement or obliteration of fat stripe

Rates of fracture repairs in infants

4-6 weeks

Rates of fracture repair in adolescents

6-8 weeks

Rates of fracture repair in adults

10-12 weeks

Sometimes 16-20 weeks

What is it when the callus is sufficiently developed to allow weight bearing or similar stress

Clinical union

Factors influencing the rate of repair

Decree of trauma

Age

Vascularity of fragments

Separation

Inadequate immobilization

Presence of pathologies

Complications of fracture

Non-union

Delayed union

Arrest/stimulation of growth

Malunion or angular deformities

Avascular necrosis

DJD

fractures that are healed but with malunion

Fractures that are healed with non-union

What are injures involving the active physics

Salter Harris fractures

Salter Harris fracture that is a complete shear injury of the physis

Salter Harris type I

Salter Harris fracture that is through the physis and metaphysis

Salter Harris type II

Salter Harris fracture that is through the physis and epiphysis

Salter Harris type III

Salter Harris fracture that is through the physis, metaphysis and epiphysis

Salter Harris Type IV

Salter Harris fracture that is compression fracture of the physis

Salter Harris type V

What is the most common type of salter Harris fracture

Type II

What salter Harris fracture are intra articulator

Type III and Type IV

Salter Harris fracture types diagram

Salter type I fracture example

What does a salter Harris type I fracture look like

Wide growth plate and soft tissue swelling

Another salter type I fracture example

Salter type I fracture in the shoulder example

Salter type I fracture in the hip example

This example also shows a SCFE- slipped capitus femoral epiphysis (from resistive soft tissue trauma)

What line can be used in the pelvis to find a SCFE in the hip

Klein`s line

What sign can be seen with a Salter type II fracture

Thurston-Holland sign

What is the thurston-holland sign

Metaphyseal fragment

Salter type II in the thumb

Another example of a salter Harris type II fracture

Don't forget the thurstand holland sign

Osteopetrosis and salter type II in the hip

Another example of salter Harris type II fracture in the lower leg

Don't forget about the thurstand Holland sign

Salter Type III is what kind of fracture

Intra-articular fracture

Salter type III in the ankle

Another example of salter type III fracture

Salter Harris fracture that includes the eipiphysis, physis and metaphysis

Salter type IV

Example of salter Type IV fracture

Another example of salter type IV fracture

What is the least common type of Salter Harris fracture as well as the hardest to see

Salter type V

Example of Salter type V

Routine vies of the shoulder

AP internal

AP external

Y view

How do you get acromio-clavicular joint injuries

Fall on shoulder or outstretched hand (FOOSH)

Mild sprain of the AC joint is what type

Type I

Moderate sprain of the AC joint is what type

Type II

Severe sprain of the AC joint is what type

Type III

When evaluating AC sprains, what do you look at

Look at bottom of clavicle to see if its elevated as a well as the distance between coracoid and clavicle

Also look at both AC joints

When you have elevation of the clavicle it is at least what grade with an AC separation

At least grade 2

Normal AC width is

Less than 5mm

You're allowed how much bilateral difference in the AC width

Less then 2-3 mm

Normal distance between the coracoid and clavicle is

11-13mm

You're allowed how much bilateral difference between the distances of the clavicle and coracoid

Less than 5mm

What grade AC separation is typically radiographically normal

Grade I

With a grade 2 AC separation the _______ ligament is torn white the __________________ ligaments remain intact

Acromioclavicular ligament torn

Coracoclavicular ligament remain intact

What ligaments are torn in a grade 3 AC seperation

Acromioclavicular and coracoclavicular

Grade 1 AC separation

Grade 2 AC separation

Grade 3 AC separation

If there is elevation of the clavicle between 11-13 mm on an AC separation than it is what grade? What if it is greater than 13?

Between 11-13 than Grade 2

Greater than 13 than Grade 3

AC joint separation leading to a distance greater than 5 mm without elevation of the clavicle is what grade

Grade 1

What is the most common fracture to occur during birth

Clavicle fracture

Most common location of a clavicle fracture

Middle third

Complications of a clavicle fracture

Malunion

Non-union

Neuromuscular injury

DJD

Post traumatic osteolysis

What is post traumatic osteolysis that can occur with a clavicle fracture

Reabsorption of distal end after many micro traumas

Transverse midclavicular fracture example

In a clavicle fracture the proximal fragment is elevated by the _____________ and the distal fragment is depressed by______

Elevated= SCM

Depressed= by weight of the shoulder

Another example of a transverse mid clavicle fracture

Undisplaced midhsaft clavicular fracture example

Routine radiographs of the clavicle

Frontal and AP axial

Oblique mid clavicle fracture example

Old transverse mid clavicle fracture with non union example

Old transverse mid clavicle fracture with malunion example

Complications of clavicle fractures

Extra callus may cause neurovascular compromise

Laceration of subclavian artery or brachial plexus