FUND IMAGING: EXAM #2 (SKEL III W/PICS)

Female pelvis X-ray

(Female pelvis has a rounded (ovoid) shape)

What sex is this patient? How do you know?

Male pelvic x-ray

(Male pelvis has a triangular (android) shape)

What sex is this patient? How do you know?

Pelvic trauma

____________ – AP view is usually sufficient CT scan is second line study

> 1 cm

Widening of the symphysis pubis ________ is abnormal = considered a fracture/pelvic instability

(**Observe for SI joint widening also!)

Widened symphysis pubis and SI joint

What's going on here?

Left inferior pubic rami fx

What's going on here?

Avulsion fracture of anterior superior iliac crest

What's going on here?

Pelvic fx with posterior dislocation of hip

What's going on here?

Severely fractured pelvis with ruptured bladder

What's going on here?

Fx superior pubic rami

Flamingo view

Other Pelvic Views: ______________

o Look for instability of the pelvic ring

Judet View

Other Pelvic Views: ______________

o Evaluate posterior wall of acetabulum

Paget's disease

______________ – benign lesion of the pelvis

o Increased sclerosis and enlargement of the left hemi-pelvis and right hip

chondrosarcomas

Malignant tumors

Adult – ________________

- Metastases are also common

Ewing's sarcoma

Malignant tumors

Child – _______________

- Metastases are also common

frog leg view

Plain films include an AP view and _______________ (abducted)

MVC's

Hip dislocations – usually the result of _________

Posterior

______________ dislocation is the most common hip dislocation

- Displaced superiorly and laterally on film

Anterior

__________ dislocation can also occur

- Displaced inferiorly and medially

Left Posterior Dislocation

Trauma pt comes in s/p MVC. VSS. Pt CC is hip pain. nSuperior and lateral to the acetabulum. What's going on?

Anterior Dislocation

Anterior dislocation- Right
Inferior and medial to acetabulum

femoral neck

M/C hip fractures are

Fx’s of the _____________ (90%)

- Often due to osteoporosis

- Stress fx’s of the femoral neck may appear sclerotic

intertrochanteric region

Fx’s of the __________________

- Often due to trauma

***Shortened leg with internal rotation

CT scan

Nondisplaced hip fractures are best evaluated by ____

Femoral neck fracture

Fracture of the neck of the femur

Intertrochanteric fracture

fracture that occurs between the greater and lesser trochanters of the hip

Osteoarthritis

_____________ is the most common cause of chronic hip pain

- Patient presents with pain and loss of mobility, starting with internal rotation.

- 90% of patients over 40 have some DJD of the hips

- DJD changes include joint space narrowing, subchondral cysts, and osteophyt

Avascular necrosis

_______________ of the hip

- Femoral head is flattened, irregular and sclerotic

- Crescent sign may be seen

Best study is an MRI

(**Steroid use, EtOH abuse...)

crescent sign

Your pt is a chronic alcohol abuser with hip pain. What sign might you see if they have avascular necrosis?

(Radiologist says: "Subarticular lucency of the femoral head")

Benign

The femur is prone to tumors – benign and malignant

__________ – fibrous cortical defects, fibrous dysplasia, non-ossifying fibroma

Malignant

The femur is prone to tumors – benign and malignant

___________ – chondrosarcoma, metastases

AP view

Lower Extremity Knee Plain films include:

_________ – joint space narrowing or calcification of the cartilage

lateral view with partial flexion

Lower Extremity Knee Plain films include:

_________________ – patella and joint effusions

Sunrise or Merchant view

Lower Extremity Knee Plain films include:

__________________ – relationship of patella to the anterior femur

Tunnel view

Lower Extremity Knee Plain films include:

____________ – tibial spines and femoral condyles

MRI

_______ is the best study for ligaments, cartilage and tendons (of the knee)

Joint effusion

_____________ is best seen on a lateral view superior to the patella and anterior to the femur

Knee DJD

What's goin on here?

Total knee replacement

What procedure was done to this pt?

Loose bodies (NOT a Fx)

Is this a fracture?

Chondrocalcinosis

Calcification of the articular cartilage

AP view

Tibial plateau fractures can be difficult to see

- Best seen on ___________

o If films are negative and still suspect fractures-MRI or CT is indicated

Bipartite patella

______________ is a normal variant that may appear to be a fracture

Patellar fracture

MOI: direct fall, direct hit, forceful extension
Surgery is typical

Tibial plateau fracture

valgus and compressive forces to knee with knee in flexion. often in conjunction with MCL injury.

Supracondylar fracture of femur

Occur after Severe Impaction Injury to the Femur
May be associated with Hip Fracture/Dislocation
Transverse or Oblique Orientation

Dislocated patella

athlete may have tight lateral tissue, weak VMO, or forced to outside by contact with another object

Giant cell tumor

_____________ is a benign tumor that commonly occurs in the knee – often in the proximal tibia

Spiral fractures

_____________ are common to the tibia – often has an associated fibula fracture

Tibia Fracture

1. Mechanism: direct force to fibula or indirect -- tibial torsion (skiing)
2. Symptoms: sudden pain and loss of function
3. Signs: a) possible deformity and crepitus, b) rapid swelling, c) delayed ecchymosis, d) possible false joint motion, e) painful weight bearing

Fibula Fracture

- caused by a direct blow to the outside of the leg

ankle effusion

An __________ appears as an anterior fat line in front of the joint space on the lateral view

lateral malleolus fracture

1. MC distal fibula fx
2. oblique or spiral fx m/c
3. result of outward or external rotation of foot

medial malleolus fracture

Bimalleolar fracture

Fractures of both the medial and the lateral malleolus.

Growth arrest lines

_____________:

oOccur in the distal tibia

oDue to a period of arrested growth – perhaps sickness

Bone islands

___________ – benign finding

Calcaneal view

Plain films include an AP view, lateral view and oblique view

- ______________ is needed for suspected calcaneal fracture

Talar fracture

____________ – always involves the neck of the talus

Calcaneal fracture

- AKA "lover's fracture"; usually the result of a fall from height.

Calcaneal spur

"heel spur"

Jones fracture

______________ – base of 5th metatarsal

Lisfranc fracture

_____________ – fx of 2nd, 3rd, 4th and 5th MT with lateral dislocation

o MOI – foot caught in stirrup

March fracture

______________ – stress fracture of 2nd, 3rd, or 4th MT

Seen in new recruits, athletes and dancers

Gout

_________ – involves the 1st MCP joint

Osteomyelitis

infection of the bone

Bunions

__________ – Hallux Valgus