Diagnostic Imaging 2- Exam 2- Lower Extremity Trauma Notes- part 1

Hip routine radiographs for the AP and frog leg

AP and frog leg

How do you get a true AP on the hip

Internally rotate 15 degrees

Riginomentrics of the hip joint

Gluteal fat pad and iliospoas fat pad

3 things that can cause decreased join space

Joint disease (inflammatory, degenerative)

Developmentally smaller

Infection

When an inflammatory joint disease causes decreased joint space what happens

It's more actors the whole joint space

When a degenerative joint disease causes decreased joint space what happens

It's more in the weight bearing part of the joint

What is the most common dislocation of the hip

Posterior

What are the different dislocations of the hip

Posterior

Anterior

Central

When there is a dislocation of the hip, what follow up is needed

CT to check for fracture of acetabulum

Posterior hip dislocation commonly occurs when the hip is in

Flexion

What fracture is frequent with a posterior hip discoloration

Positive or acetabular rim fix

What is the position of the leg after a posterior hip dislocation

Leg is superior to acetabulum, internally roaster and adducted

On X ray when the femur is superior to the acetabulum it is what type of hip dislocation

Posterior hip dislocation

Example of posterior hip disc location

Another example of a posterior hip dislocation

What can you look for to tell if it is a congenial hip dislocation

Putti`s Triad

What is Putti`s triad

Smaller or absent femoral capital epiphysis

Increased acetabular angle

Lateral displacement

Anterior hip dislocations are the result of

Abduction and external rotation of the leg

Often times with an anterior hip dislocation the femur head goes

Inferior

What does the leg look like with an anterior hip dislocation

Externally rotated, abducted and flexed

What fracture my be seen with an anterior hip dislocation

Associated femoral head fracture

Anterior hip dislocation

Posterior hip dislocation vs an anterior hip dislocation

Example of a congenital hip dislocation

Fracture of the proximal femur most commonly occurs in

Elderly, especially women

Fracture of the proximal femur can be divided into

Intracapsular and extracapsular

Avascular necrosis is a big concern with what style of fracture of the proximal femur

Intracapsular

What are the different Intracapsular fracture of the proximal femur

Subcaptial

Trans cervical

Basicervical

What are the types of extracapsular fractures of the proximal femur

Intertrochanteric

Subtochanteric

What is the most common location for a proximal femur fracture

Subcaptial

Subcaptial femoral neck fracture

Another Subcaptial femoral neck fracture

One more example of a subcaptical femoral neck fracture

Very subtle Subcaptial femoral neck fracture

One more subtle Subcaptial femoral neck fracture

Basicervical femoral neck fracture

Another Basicervical femoral neck fracture

One more Basicervical femoral neck fracture

Intertrochanteric femoral neck fracture

Two types of stress fractures can be recognized, what are they

Fatigue fracture

Insufficiency fracture

What does a fatigue fracture result from

Application of abnormal stress or torque to a bone with normal elastic resistance t

What does an insufficiency fracture result from

Normal stress placed on a bone with deficient electric resistance

When is there pain or pain relieve with fatigue fracture

Pain with pain relieve at rest or reduced physical activity

Basicervical stress fracture

Displaced Basicervical fracture of the right femoral neck

Another Basicervical stress fractures

Slipped capital femoral epiphysis (SCFE)

What line can help you find a SCFE

Klein line

What are the types of extracapsular hip fractures

Intertrochanteric

Trochanteric

Subtrochanteric

Comminuted Intertrochanteric fracture

Another Intertrochanteric fracture

Salter Harris type II fracture in the hip

Femoral shaft fractures are usually the result of?

Severe violence

Under age 5 is suspicious for abuse

Most common form of femoral shaft fractures

Transverse fracture of the mid shaft

Transverse fracture of the proximal 1/3 of the femur

What type of therapy given for osteoporosis can cause demineralization in the bone and therefore a stress fracture in the mid shaft of the femur

Bisphosphonate

Stress fracture in the mid shaft of the femur

Salter Harris type II at the distal end of the femur

What are the routine radiographs of the knee

AP

Open joint

Lateral

The 3 different views for imaging of the knee examples

In the knee intra-articulated fractures will cause leakage of blood and marrow into the joint which will distend the bursa to form a lipohaemarthrosis, fat lies on top of the blood. What is this called?

FBI sign

The fat pad posterior to the quadriceps tendon is divided into anterior and posterior compartments by?

The suprapatellar bursa

What exactly is the FBI sign

Fat floating on blood

What is the fat bad above the patella that can been on a lateral knee view

Hoffa`s fat pad

Example of FBI sign in the knee

The suprapatellar bursa should be how thick

5mm or less

FBI sign means

Lipohemarthrosis

Another example of an FBI sign

Avulsion of the anterior tibial spine is more common in who

Children

How do you get an avulsion of the anterior tibial spine

Hyper extension of the knee with internal rotation of the tibia

How do half of the avulsion fractions of the anterior tibial spine occur

Fall of bicycle

What soft tissue damage do you see in adults with avulsion of the anterior tibial spine

ACL tears

Avulsion fractures in the knee area occur most commonly at the insertion of what ligament

Anterior cruciate ligament (ACL)

Avulsion of the anterior tibial spine

What is the most common fracture of the patella

Transverse

What are the different types of fractures of the patella

Transverse

Comminuted or Stella the

Vertical/longitudinal

Avulsion

Osteochondral

Transverse fracture of the mid portion of the patella

Another example of a transfer fracture of the mid portion of the patella

Bipartite patella is not a fracture because

It's an ununified growth plate

Example of bipartite patella

Another example of bipartite patella

Tripartite patella example

Lateral dislocation of the patella

A complete tear of a cruciate ligament looks like what on imaging

Discrete complete disruption of all visible fibers (WHITE ON T2 MRI)

Partial/intrasubstance tear of a cruciate ligament looks like what on imagine

Abnormal signal intensity within substance of the ligament (will be more grey, a little bit lighter)

ACL ligament

PCL ligament

ACL tear

Another ACL tear

What can happen to the PCL with an ACL tear

It can looked bowed out

What is O`Donoghue`s triad (aka unhappy triad)

ACL tear

MCL tear

Medial meniscal tear

PCL tear

Meniscal tear looks like

Defect extending to the articular surfaces

Describe a meniscal tears

Popping sound at injury

Tightness

Swelling in knee

Locking up, catching or giving way

Tenderness in joint

Tear in the posterior horn of the meniscus

Another tear of the posterior horn of the meniscus

One more tear of the posterior horn of the meniscus

Tear in the lateral collateral ligament

MCL tear