MSK On Call

Is this an adult or child? They Fell onto an outstretched hand do you see anything?

Answer

-Child! Those growth plates aint closed

-Uhm I think I want more than one view

You got another view

Answer

Minimally displaced fx

Wheres the fx?

Answer

PIP of the third finger, swollen

Whats this called?

Answer

Lipohemarthrosis from soft tissue swelling of the knee fat pad. Might've fx the patella.

This a child or adult? Are those bunions I circled?

Answer

-Child

-Sesamoid bones

-The one that is not at the joint is at the apophysis

-Normal variants since on both sides

Patient has snuff box tenderness...what are we telling this patient?

Answer

Well we can't be 100% sure its a fx so come back in 7-10 days for a follow up!

Three sites you don't want to miss a fx in that could result in AVN

1.Scaphoid

2.Femoral neck

3.Talar neck

What sign is this? And what does it indicate the patient might have?

Answer

Anterior sails sign with no posterior fat pad sign. Most likely radial head fx given its an adult.

Most common fx of the arm in a kid

supracondylar fx

This person fooshed

Inclination of the distal radius with volar tilt

Oh no what did this person do? He was mugged and fell while escaping the mugger.

Answer

Galeazzi fx!

-Mid-distal radial fx with DRUJ dislocation.

Follow up question: He said he fell recently...did he?

No. Hematoma formed its older.

This is a 12 y/o who twisted his ankle skate boarding

Answer

I think its a salter harris 2 fx? Someone correct me if im wrong

Whats a great mneumonic for a SALTER Harris fx?

SALTER:

-Straight across

-Above (metaphysis)

-Low or below (epiphyses)

-Two and through (both)

-Erasure of growth plate

-Ruh roh ruined

SO what type is this?

Answer

Salter Harris II

13 y/o with right hip pain. Can you see anything on this view alone?

Answer

No, lets get a frog leg view with the AP

Now what do you think happened?

Answer

Salter Harris fx of the right acetabulum.

This person had a tonic clonic seizure, which way did it dislocate?

Answer

Posteriorly

Two deformities seen in shoulder dislocations on scapular Y view

Bankart lesions and hills sach deformity

A child with multiple fx in varying stages of healing with knee pain.

What should you probably do?

Call CPS

Injuries that are sus for child abuse

-Long bone fx

-healing fx in different stages

-Injuries that don't fit their age

-Posterior rib fxs

Oof what did they do?

Answer

Jones fx:

-What we worry about is blood supply isn't great in that area

This person twisted their ankle and now they pain at the ankle and proximal leg. What injury is this?

Answer

Maissoneuve fx

Maissoneuve fx

combo of:

proximal fibula injury

lower disruption injury at syndesmosis

tears of interosseous membrane

DO NOT MISS FX

This is benign or aggressive?

Answer

Benign Non ossifying fibroma

Anterior or posterior shoulder dislocation

Answer

anterior shoulder dislocation.

-They move medially and inferiorly

What avulsion fx is this?

Answer

AIIS, rectus femoris originates here

Avulsion fractures

-ASIS (ANTERIOR SUPERIOR ILIAC SPINE)- SARTORIUS

-AIIS (ANTERIOR INFERIOR ILIAC SPINE) - RECTUS FEMORIS

-GREATER TROCHANTER - GLUTEUS MEDIUS AND MINIMUS

-LESSER TROCHANTER - ILIOPSOAS

Density wise is this man's bones more lucent or sclerotic?

Answer

More lucent

Well we got a CT...any more worried?

Answer

Oh no its lytic, might be a lesion

What type of fx is this? This individual is elderly, probs has osteoporosis

Answer

Sacral insufficiency fx

This person skis what type of injury is this?

Answer

Ulnar Collateral ligament tear or gamekeeper's thumb (Skier's thumb is another name bc no one knows of the art of gamekeeping anymore)

This is normal, but note where the medial and lat epicondyle is

This is a 20 y/o female who was playing soccer with her friends when she collided with the ball, turned, and felt a pop in her right knee before it gave out and she hit the ground.

Oh no what did she do?

Its a lateral epicondyle impactation fx. We see this with ACL injuries. Also she has an effusion

Segond fx

Avulsion of lateral tibial plateau- associated with ACL and IT band injury. Thought to represent detachment of the lateral capsular ligament.

This person was in a MVA and slammed their arm into the steering wheel.

Answer

Monteggia fx

Monteggia fx

Fracture of the ulnar shaft with radial head subluxation/dislocation

What fx?

Answer

Scaphoid

Bennett fx

Fx of the proximal end of the first metacarpal

Rolando fx

Comminuted fx of 1st MCP base

Bennett vs Rolando fx

bennett- fx thru base of 1st MCP

Rolando- comminuted Bennett fx

What salter harris fx type is this?

Answer

Salter Harris III

What type of fx is this?

Answer

Salter IV or to be fancy triplane fx

3 views for a triplane fx

sagittal, horizontal, vertical

This is a 20 month old with ankle pain

Answer

Healing toddler fx

Well we got a CT on the leftmost bc we were worried, what is this?

Answer

Thats track formation=infectious, osteomyelitis

What happened and what type?

Answer

AC joint injury type III (coracoclavicular ligament tear)

DO you tell this person they need ACL surgery or not?

Answer

Its mangled yes they do need ACL surgery (should be nice n smooth fibers)

Whats fx?

Answer

Hamate fx

What happened to cause this?

Answer

Patellar maltracking/sling shot patella, medial retinaculum tear, patella dislocates.

And you're done :)

My friend has patellar maltracking and she literally describes it as her patella acting like a sling shot going in and out of place with certain activities.