Red Dot OSCE Flashcards

What is an avulsion fracture?

Small chunk of bone attached to tendon/ligament gets pulled away from main part of bone

What is a multi fragmentary fracture?

Bone that is broken in at least 2 places

What is a impacted fracture?

Broken ends of the bone are jammed together by force of injury

What is a transverse fracture?

Bone is broken perpendicular to length

What is a greenstick fracture?

Paediatric fracture
Bone bends and cracks instead of completely breaking

What is a pathological fracture?

Fracture caused by underlying disease

What is a spiral fracture?

Fracture that occurs due to a rotational/twisting force

What is a buckle/torus fracture?

Paediatric fracture
Incomplete fracture with a bulging cortex

What is a displaced fracture?

When broken bone fragments move out of alignment

What is a non-displaced fracture?

When broken bone stays in the original position

What are the 3 criteria for describing a fracture?

1. Fracture type

2. Fracture location

3. Fracture displacement

When are k-wires used as treatment for fractures?

Common for wrist, hand and supracondylar fractures in the elbow

When are IM nails used as treatment for fractures?

For long bone fractures e.g. femur, tibia and humerus.

When is ORIF used for treatment for fractures?

If the fracture is displaced or unstable
If there are multiple breaks
If the fracture involves a joint

When is POP/cast used as treatment for fractures?

For fresh fractures
Post operation or post reduction

Direct impact of the hand can cause what type of fractures?

Multi fragmentary, impacted fractures

Punch injuries of the hand can fracture which 2 bones?

4th/5th metacarpal

Hyperextension injury of the hand can cause what dislocation?

PIPJ dislocation

Abduction and adduction injuries of the hand can cause which type of fracture?

Avulsion

Rotational forces of the hand can cause what type of fractures?

Spiral fractures

What is a Bennett’s fracture?

Fracture-dislocation of the base of the first MC

What is an intra-articular fracture?

Fracture which involves joint surface

What is an extra-articular fracture?

Fracture which does not involve joint space

What is a Rolando’s fracture?

Fracture-dislocation of 1st MC which is multi fragmentary

What is a Boxer’s fracture?

Transverse fracture of the 5th metacarpal

Where are avulsion fractures in the hand commonly found?

Base of phalanges/metacarpals

What dislocation is common of the hand?

IPJ dislocations

What is a Skier’s thumb fracture?

Ligamentous injury at base of proximal phalanx, causing an avulsion fracture

What does OA appear like (4 signs)?

Uniform joint space narrowing
Subchondral cyst formation
Subchondral sclerosis
Osteophyte formation

What does RA look like (5 signs)?

Peri-articular osteopenia
Joint space narrowing
Erosive changes
Subchondral cysts
Soft tissue swelling

What does psoriatic arthritis appear like (5 signs)?

Swelling around joint
Abnormal calcifications
Narrowing of joint spaces
Marginal erosions
Periosteal reaction

What does gout look like (3 signs)?

Swollen joints
Soft tissue nodules adjacent to joint which may contain calcifications
Peri-articular erosions with sclerotic base

What does enchondroma appear like in the hands radiographically?

Seen in phalanges
Endosteal scalloping and narrow zone of transition

What is osteomyelitis?

Bone infection

What does osteomyelitis appear like radiographically?

Obliteration of soft tissue fat planes
Intramedullary destruction
Cortical destruction

Explain the steps for assessing a hand radiograph

Soft tissue
Metacarpals
Phalanges
Alignment
Joint spaces

What are the 3 arcs along the carpal bones that should be smooth and unbroken?

Along proximal row proximally
Along proximal row distally
Along capitate and hamate

FOOSH of the wrist usually fractures what 2 carpal bones?

Scaphoid
Triquetrum

High impact injuries to the wrist can cause which fracture and dislocations?

Perilunate or lunate dislocations
Barton fracture

A direct blow to the wrist can fracture which 2 bones?

Hamate or ulna

Scaphoid fractures have a high chance of…

AVN

What is a perilunate dislocation?

Capitate dislocates and moves posteriorly
Everything distal to lunate moves posteriorly
Lunate still articulates with radius but not capitate

What is a lunate dislocation?

Lunate fully dislocates and moves anteriorly
Does not articulate with radius or capitate

What is seen in subluxation of the scaphoid?

Joint space widening between scaphoid and lunate

Hyperextension injury of the wrist can cause which fracture?

Colles fracture

Hyperflexion injury of the wrist can cause what fracture?

Smiths fracture

What is a Colle’s Fracture?

Extra-articular fracture of the radius with posterior displacement of fragment

What is a Smith’s Fracture?

Distal radius fracture with anterior displacement of fragment

What is a Hutchinson Fracture?

Fracture of the radial styloid

What is a Barton’s Fracture?

Intra-articular oblique fracture of the distal radius with posterior displacement of fragment
Often has associated dorsal subluxation of radiocarpal joint.

What is a Reverse Barton’s Fracture?

Intra-articular oblique fracture of the distal radius with anterior displacement of fragment
Often has associated volar subluxation of radiocarpal joint.

What is a Monteggia Fracture?

Ulnar fracture with dislocation of radial head

What is a Galleazzi Fracture?

Radial fracture with dislocation of ulnar head

What is the difference radiographically between avulsion fractures and accessory ossicles?

Ossicles have smooth and rounded edges with cortical margins

What is a joint that is important to look at when assessing wrist radiographs?

Radioulnar joint

What is a Salter-Harris Fracture?

Fractures involving the growth plate

Explain abbreviation for Salter-Harris fractures?

SALTR
(I) Straight = Through physis only
(II) Above = Above physis through metaphysis
(III) Lower = Below physis through epiphysis
(IV) Through = Through metaphysis, physis and epiphysis
(V) Rammed = Crush injury to physis

What are the steps when assessing a wrist radiograph?

Soft tissue
Bone cortex
Bony alignment
Carpal arcs
Carpal alignment
Radius and ulna
Metacarpals

What is an Essex-Lopresti Fracture?

Fracture of radial head with associated longitudinal disruption of interosseous membrane and distal radioulnar joint

A fall onto a flexed arm can cause which fracture?

Monteggia fracture

A direct blow to the forearm can cause what type of fracture and to which bone?

Isolated minimally displaced fractures to radius or ulna

A direct blow to the elbow can cause what type of fracture and to which area?

Intra articular multi fragmentary fracture of the olecranon

FOOSH can cause what fracture of the elbow?

Radial neck and head

What is a key thing to assess on an AP elbow view?

Radio capitellar and coronoid-trochlear joint spaces should be equal and parallel

Where is the radiocapitellar line for elbow xrs?

Passes through proximal humerus to capitellum

Disruption of the radiocapitellar line suggests…

Dislocation of radial head or displacement of capitellum

What is important to assess on the lateral elbow XR view?

Capitellum and trochlea should be superimposed
Radiocapitellar line should be uninterrupted

Where is the anterior humeral line on elbow xrs?

Anterior surface of humerus should intersect with mid 1/3 of capitellum

Disruption of the anterior humeral line can suggest…

Supracondylar fracture

What are the 2 fat pads present on an elbow XR?

Anterior and posterior fat pad

When should the fat pads be present on an elbow XR?

Anterior is normal unless raised to sail sign
Posterior is always abnormal

What does olecranon bursitis appear like radiographically?

Extensive soft tissue swelling around olecranon

Elbow dislocations are most likely to be what direction?

Posterolateral

Explain the steps for interpreting an elbow xray

Alignment (anterior humeral line and radiocapitellar line)
Check for raised fat pads
Check bony cortexes

What are 2 common fractures of the radius at the elbow joint?

Radial head and neck fractures

A direct fall to the shoulder can fracture which bone?

Clavicle

FOOSH can cause a fracture in which bone of the shoulder?

Humerus

A direct blow to the shoulder can fracture which bone?

Scapula

Which GHJ dislocation is more common?

Anterior

What are the causes of posterior GHJ dislocation?

Seizures
Electric shocks

What sign is commonly seen with a posterior GHJ dislocation?

Lightbulb

What is a Hill Sachs lesion?

Compression fracture of humeral head

What is a Bankhart lesion?

Fracture of glenoid

What is a supracondylar fracture?

Extra-articular fracture of the distal humerus

What can you see radiographically if an anterior GHJ dislocation is present?

Humerus head is underneath coracoid process

What are the steps when assessing AP shoulder xrs?

Assess ACJ for widening
Assess full clavicle
Assess CCJ for widening
Check GHJ
Check ribs and scapula
Check humerus

What are the steps when assessing Y view shoulder xrs?

Check humeral head is sitting in middle of Y
Check coracoid process pointing anteriorly
Check acromion is posterior
Check scapula
Check ribs

What are the steps when assessing axial shoulder xrs?

Check coracoid and acromion process forming a C shape
Check coracoid process is medial and acromion process is lateral
Check humeral head is sitting centrally on glenoid fossa

What acronym is used for reading chest x rays?

Airway
Bones
Cardiac silhouette
Diaphragm
Edge of heart
Fields of lung
Gastric bubble
Hila
Instruments

Blunt chest wall injuries usually fractures…

Ribs

What is pneumonia?

Acute infection of lung

What does pneumonia appear like radiographically?

Consolidation

What is a pneumothorax?

Collection of air inside the pleural cavity

What does a pneumothorax appear like radiographically?

Visible rim of air between lung margin and chest wall
No visible lung markings

What is a tension pneumothorax?

Air enters pleural space and is unable to leave

What does a tension pneumothorax appear like radiographically?

Depression of the hemidiaphragm
Absent lung markings
Mediastinal shift to the right

What does heart failure appear like radiographically?

Cardiomegaly
Effusions
Dilated upper lobe vessels

What is pulmonary oedema?

Accumulation of fluid in the parenchyma and air spaces of lungs

What does pulmonary oedema appear like radiographically?

Bilateral peri-hilar shadowing
Blunting of the costophrenic angles

What is a pleural effusion?

Accumulation of fluid in the pleural space