Radiology Test 2 Review

Most common area for a clavicular fracture?

-Middle 1/3rd

Proximal Clavicle Fracture

-Rare

-Most often due to direct trauma

-Nonunion is uncommon

-Difficult to visualize on radiograph due to overlapping structures

Middle Clavicle Fracture

-80% of clavicle fractures

-Caused by FOOSH or shoulder pointer

-Bayonet apposition is common

-May heal with exuberant callus (potential of TOS complication)

Surgical Treatment is needed in middle clavicle fracture if?

-Displaced >2cm or 10% of overlap

-Comminution

-Open fracture

-Concern for neurovascular compromise

-Concern for severe cosmetic deformity

Middle Clavicle Fracture on Xray

Distal Clavicle Fracture

-15% of clavicle fractures

-Weighted views may help identify

-May be intra-articular with associated AC joint injury

Distal Clavicle Fracture on Xray

Complications from Clavicle Fractures

-Post traumatic osteolysis

-AC & SC degeneration

-Neurovascular compromise

-Nonunion

-Malunion

Post Traumatic Osteolysis on Xray

Type 1 AC Injury

-AC ligament sprain

-Normal radiograph

-Treated conservatively

-Coracoclavicular ligaments are intact

Type 2 AC Injury

-AC ligament ruptured with widened AC joint

-Coracoclavicular ligament sprain

-Treat conservatively

In Type 1 AC injury Describe the ligamentous damage

-AC ligament is strained

-Coracoclavicular ligaments are intact

In Type 2 AC injury describe the ligamentous damage

-AC ligament is ruptured

-Coracoclavicular ligaments are sprained

Type 3 AC Injury

-AC ligament ruptured

-Coracoclavicular ligament ruptured

-Clavicle elevation >5mm from opposite side or 100% elevation

-May require surgery

Type 3 AC injury coracoclavicular space indication?

-Greater than 25mm

Type 4 AC injury

-AC ligament ruptured

-Coracoclavicular ligament ruptured

-Clavicle displaced posteriorly into trapezius

-Requires surgery

Type 5 AC Injury

-AC ligament ruptured

-Coracoclavicular ligament ruptured

-Clavicle >100% elevation

-Requires surgery

Type 6 AC injury

-AC ligament ruptured

-Coracoclavicular ligament ruptured

-Clavicle inferiorly displaced (Underneath the coracoid process)

-Required surgery

Type 2 AC Injury on Xray

Type 3 AC Injury on Xray

Type 4 AC Injury on Xray

Type 5 AC Joint Injury on Xray

Scapular Body and Neck Fractures

-Most common

-associated with severe trauma and often show rib and other fractures

Coracoid Fracture

-Direct trauma

-Fatigue fracture in trap shooting

-Avulsion

Scapular Fracture on Xray

Os Acromale on Xray

Bankart Lesion

-Avulsion of the anterior inferior glenoid labrum with anterior GH dislocation

-Seen as osseous fragment at anterior inferior glenoid rim

-Indicates previous dislocation

TUBS=

-Traumatic unilateral with Bankart

AMBRI=

-Atraumatic Multidirectional bilateral treated with rehab or inferior capsular shift surgery

Bankart Lesion on Xray

Most common direction of GH dislocation

-Anterior

Most common subtype of anterior dislocation

-Subcoracoid

Hill-Sachs Fracture

-AKA hatchet fracture

-Impaction fracture of the posterolateral humeral head on the anteroinferior glenoid

Hill-Sachs Fracture is best visualized on?

-Internal rotation

Flap Fracture

-Avulsion of greater tuberosity at insertion of the supraspinatus

Hill-sachs Deformity on Xray

Hill-Sachs + Bankarts on Xray

Posterior GH Dislocation is best seen on?

-Scapular Y or Axillary views

Mechanisms of Posterior GH Dislocation

-Electrocution

-Seizure

-FOOSH

If you have a posterior GH dislocation you are unable to?

-Unable to externally rotate

Associated Findings in Posterior GH Dislocation

-Reverse Hill-Sachs/trough line sign

-Lightbulb sign

-Rim Sign

-Reverse bankart

Trough Line on Xray

Light Bulb Sign on Xray (Posterior GH Dislocation)

What Nerve is damaged when distal humerus is fractured?

-Radial Nerve

If Proximal humerus is fracture what nerve is affected?

-Axillary Nerve

Narrowing of the subacromial space on radiograph suggest?

-Compromise of supraspinatus

Fat Pad Sign

-Anterior normally visible but should be flat

-Posterior not normally visible

-Indicates joint effusion (intra-articular frature, Hemorrhage, Inflammation, Infection)

Anterior Fat Pad

-Distends first

-aka sail sign

-More sensitive

Posterior Fat Pad

-Distends with greater swelling

-More specific

-If visible = very likely there is pathology

Fat Pad Sign on Xray

Supracondylar Fracture

-Most common elbow fracture in children

-Transverse humeral fracture superior to condyles

-Distal fragment displaces posterorly

-Anterior Humeral line is abnormal

What line is abnormal in a supracondylar fracture

-Anterior Humeral line

Supracondylar Fracture on Xray

Medial Epicondyle Avulsion

-AKA Little Leaguer’s elbow

-Apophysitis or avulsion of the medial epicondyle

-Chronic or acute stress of the common flexor tendon

-Associated with lateral compression injury at the elbow

Medial Epicondyle Avulsion on Xray

Osteochondritis Dissecans of the Capitellum

-Seen in 12 to 16 year old throwing athletes

-DDX with AVN/osteochondrosis seen in younger patients (panner’s disease)

Osteochondritis Dissecans of the Capitellum

What is the most common adult elbow fracture?

-Radial Head/Neck Fracture

What is AVN in the Capitelum?

-Panner’s Disease

Common types of radial head/neck fracture?

-Vertical “chisel” fracture

-Impacted fracture of the neck

Radial head/neck fracture on xray

What is the most common pediatric dislocation?

-Radial head (AKA nursemaid’s elbow)

What is the most common associated injury with ulna dislocation?

-Fracture of the radial head (coronoid process fracture)

Terrible triad of Elbow?

-Elbow dislocation

-Radial head fracture

-Coronoid fracture

Ulna dislocation on Xray

Nightstick Fracture

-AKA parry fracture

-Single fracture of the ulna

-Due to direct strike

Nightstick Fracture on Xray

Both Bone Fracture

-Fracture of both forearm bones

-Due to FOOSH

Both Bone Fracture on xray

Monteggia Fracture/Dislocation

-Ulnar shaft fracture with dislocation of the radial head

Monteggia Fracture/Dislocation on Xray

MUGR =

-Monteggia -ulnar fracture

-Galleazzi-radial fracture

Galeazzi Fracture/Dislocation

-AKA Piedmont fracture

-Fracture of the distal radial shaft with dislocation of the distal radioulnar joint

Galeazzi Fracture/Dislocation on Xray

Essex-Lopresti Fracture/ Dislocation

-Radial head fracture with dislocation at the distal radioulnar joint

Essex-Lopresti Fracture/Dislocation on Xray

Colles Fracture

-Distal radius fracture with dorsal angulation of the distal fragment

-More common in female than males

-Dinner fork deformity-

What population often is more at risk for colles fracture?

-Osteoporotic women

Complications of Colles Fracture

-Most common show radiocarpal extension

-Ulnar styloid fracture

-CRPS

-Median neuropathy

Colles Fracture on Xray

Smith Fracture

-AKA reverse colles

-Distal radius fractures with volar angulation of the distal fragment

-Caused by fall on flexed wrist

-Seen in young males (Most common) and older females

Smith’s Fracture on Xray

Barton Fracture

-Fracture of the posterior rim of the distal radius

-AKA rim fracture

Barton Fracture on Xray

Reverse Barton on Xray

Hutchinson Fracture

-AKA Chauffeur Fracture, Backfire fracture

-Fracture of the radial styloid process

Hutchinson Fracture on Xray

Ulnar Styloid Process fracture

Uncommon in isolation (usually seen with other fractures)

-Caused by avulsion of ulnar collateral ligament

-Often heals non-union

Ulnar Styloid Process fracture on Xray

What is the most common carpal fracture?

-Scaphoid Fracture

Scaphoid Fracture

-most common occult fracture

-Caused by FOOSH

-Located in the waist (middle aspect)

-May appear on radiograph in 7-10 days

Complications in Scaphoid fracture

-Avascular necrosis (common in proximal pole)

-Nonunion (SNAC wrist)

-Carpal instability

-Degeneration

Scaphoid Fracture on Xray

Humpback Deformity

Scaphoid Non-union Advanced Collapse

Triquetrum Fracture

-Most common is Fischer fracture or avulsion at the dorsal surface with hyper-flexion

-2nd most common carpal fracture

-”pooping duck sign” on lateral radiograph

Pooping Duck Sign on Radiograph

Hamulus Fracture

-AKA hook of hamate fracture

-Seen in golf or racquet sports (may be fatigue or acute when striking the ground with racquet in anger)

Hamulus Fracture on Xray

Lunate Dislocation

-Most common carpal to dislocate

-Caused by Hyperextension

-Shows a “pie sign” on PA