Bone Radiology 2 (DM)

What are the standard views for throacic spine

AP and Lateral

What do we evaluate on thoracic spine XR

Transverse processes, pedicles and spinous processes

Vertebral bodies for height and symmetry

Anterior vertebral line

Posterior vertebral line

What are the standard views for lumbosacral spine

AP

Lateral

Right and Left Lateral Oblique

Sacral

Indications for Lumbosacral Spine XR

Age Extremes

Significant trauma

At risk for pathologic fracuture

What are we evaluting for on lumbosacral XR

Transverse process, pedicles, and spinous process

Vertebral bodies for height and symmertry

Anterior vertebral line

Posterior vertebral line

Left transverse process fracture (L2 and L3)

Compression Fracture

Scotty dog

A method to assess for fracture for spondylosis (pars interarticular fracutre)

Spondylolysis

Spondylolysis

Spondylolisthesis

anterior slipping of the vertebral body

Spondylolisthesis

Most Common Site of Spondylolisthesis

L5-S1

Spondylolisthesis L4-L5

Spondylosis

Spondylosis

Ankylosing spondylitis

Bamboo spine

diffuse bony fusion due to Ankylosing spondylitis

Scoliosis

curvature in the sagittal plane

Scoliosis

Sacral fracture

Right superior & inferior pubic rami fractures** (& left total hip replacement)

Open book pelvis fracture

Acetabular fracture right hip

How does fracture hip pain preseny

isolated groin pain

How does dislocation hip pain present

high energy injury\

history of hip replacement

How does trochanter bursitis hip pain present

presents with pain over the lateral aspect of the hip

How does OA hip pain present

Decreased rom on exam

X-ray shows joint space narrowing & spur formation

What are the standard XR views of the hip

AP pelvis

AP hip

Lateral hip

How will the leg look with a hip fracture

Flexed + Abducted + external rotation

Fracture left femoral neck

Right femoral neck fracture

Right intertrochanteric hip fracture

Intertrochanteric fracture

If an eldery patients presents with hip/groin/buttocks pain with instability with gait but has normal XR, what always should be done

MRI

Right subtrochanteric femur fracture

Osteoarthritis

Avascular necrosis left femoral head / Legg-Calve-Perthes Disease

Slipped capital femoral epiphysis right hip

Comminuted fracture at the junction of the middle & distal third of the right femur

A femur fracture in a child who shouldn’t be able to walk is a red flag for

Child abuse

Most Common Site of Knee Fracture

Tibial plateau

What is the standard views of the knee XR

AP

Lateral

Ottawa Knee Rule

Indications for Knee XR for pain

• Age > 55

• Tenderness at fibular head / patella

• Inability to flex to 90 degrees

• Inability to bear weight for 4 steps at onset and now

Lateral tibial plateau fracture

Lateral tibial plateau fracture

Comminuted medial & lateral tibial plateau fractures

comminuted proximal fibular fracture

What XR findings can indicate a subtle tibial plateau fracture

1- Depressed lateral articular surface

2- Fracture line

3 –Sclerotic band of bone indicating compression fracture

Subtle lateral tibial plateau fracture

Posterior dislocation right knee 

Knee dislocation are usually caused by

Significant MOI (i.e. MVC)

Knee dislocations are high risk for

Popliteal artery injury

Peroneal nerve injury

Compartment Syndrome

DVT

Patellar subluxation L knee

What direction does the patella typically subluxate

Lateral

Patellar fracture

What is distrupted with patella fracture

disruption of both the quadriceps & patellar tendon mechanisms

Inability to extend the lower extremity at the knee

DJD

DJD left knee

Ottawa Anke Rule

Indications for Ankle XR

• Pain in either malleolar zone

• Bony tenderness posterior edge or tip of lateral malleolus

• Bony tenderness posterior edge or tip of medial malleolus

• Inability to bear weight both immediately & in the ED (4 steps)

What is the standard views for ankle XR

AP

Lateral

Mortis

Mortise

The bracket shaped joint surface between talus and tibia

Maisonneuve fracture

Promixal fibula fracture with widening of medial ankle mortise ± medial malleolus fracture

What fracture typically occurs with ankle inversions

5th Metatarsal

What structures should be assessed on all ankle injury

Promixal fibula

Base of 5th Metatarsal

Normal mortise view

Lateral soft tissue swelling, no fracture

Most Common Ankle Fracture

Lateral Malleous

Lateral malleolar fracture w/ accessory ossicle

Bimalleolar fracture

Trimalleolar fracture

A fracture of the medial malleolus, lateral malleolus, and posterior malleolus

Trimalleolar fracture

Maisonneuve fracture

Ottawa Foot Rule

Indications for foot XR

• Pain in midfoot (cuboid, navicular, or cuneiforms)

• Bony tenderness at the navicular bone or at the base of the 5th metatarsal

• An inability to bear weight both immediately & in the ED for 4 steps

Most Common Stress Fracture

Metatarsals

Normal apophysis right foot

Severe arthritis

What is a standard foot series

AP

Oblique

Lateral

Bohler’s angle

The angle between the talus and calcaneus

What is a normal Bohler’s angle

20-40 degrees

When is Bohler’s angle helpful for XR

If < 20 degrees, indicates calcaneal fracture

calcaneal fracture

Lisfranc Joint

The joint made of the lining up of 2nd metatarsal and 2nd cuneiform mediallly

Lisfranc fracture

Treatment for Lisfrance Fracture

Surgery

Most Common Toe Fracture

5th

Most Common MOI for Toe Fracture

Blunt Trauma

Displaced Salter-Harris I fracture base proximal phalanx right 4th toe