rad IIB (post midterm material)

what are the types of intracapsular femoral fractures

subcapital

midcervical

basocervical

what are the types of extracapsular femoral fractures

intertrochanteric

trochanteric

substrochanteric

which types of femoral fracture is a red flag for drug induced fractures

subtrochanteric

what do intracapsular fractures have a higher risk of

non union

avascular necrosis

who is more at risk for proximal femoral fractures

geriatric patients

older females (post menopausal)

what are predisposing pathologies for proximal femoral fractures

paget's disease

fibrous dysplasia

benign/malignant bone tumors

osteoporosis

osteomalacia

radiation induced osteonecrosis

many elderly who fracture proximal femur ______

die within 6 months from secondary pulmonary and cardiac complications

what imaging modalities are useful for proximal femur fractures

CT, MRI, isotopic bone

which type of intracapsular hip fractures are uncommon

basocervical

midcervical

what does a basocervical fracture suggest

malignancy --> METS, multiple myeloma

-the area is rich in marrow and usually has a lot of strength

what is the most common proximal location for intracapsular fracture

subcapital

what is the classification system for subcapital fractures

Garden

according to Garden classification system, incidence of complications and severity of AVN ______ with each stage

increases

what does an isolated avulsion fracture of the lesser trochanter suggest

underlying bone pathology

what orientation is a intertrochanteric femur fracture usually

oblique

what drug is usually associated with subtrochanteric fractures

bisphosphonate use (Fosamax)

what other conditions can cause subtrochanteric fractures

paget's

mets

mid diaphyseal fracture of femur is ______

uncommon

most hip dislocations go _____

posterior

what are most hip dislocations associated with

acetabulum fracture

what is the MOI of posterior hip dislocation

hip in flexion and adduction of thigh followed by direct blow to knee

what associated fracture is found in up to 90% of posterior hip dislocations

posterior lip of acetabulum fracture

where does the femur lie in posterior hip dislocations

cephalad and lateral to acetabulum

what are contraindications for posterior hip dislocations

adjusting in side posture on either side

what is the MOI for anterior hip dislocation

hip in forced abduction and extension

getting hit from behind

where does the femoral head lie in anterior hip dislocation

caudal and medial to acetabulum and near the obturator foramen

what are hip dislocaiton complications

nerve injury

sciatic nerve paralysis from posterior

myositis ossificans and AVN of femoral head

degenerative arthritis

aka for SCFE

adolescent coxa vara

epiphyseal coxa vara

epiphysiolisthesis

SUFE

what salter harris classification is SCFE

type 1

what are the findings of SCFE

upward displacement, external rotation, and adduction of neck on head

-varus deformity, adduction, and external rotation of femur

when does SCFE occur

during rapid growth

what is the single most important factor for etiology of SCFE

elevated body weight

what side is most common for SCFE

left hip

what is hte most common disorder of adolescent hip

SCFE

what age groups are affected by SCFE

10-15 years

what age groups are affected by legg calve perthes

5-7 years

what age groups are affected by congenital hip dysplasia

infants

what is the classic presentation of SCFE

limp with hip pain referred to knee in an obese adolescent --> frohlich's body type

what might be the initial presentation of SCFE

pain at thigh and/or knee

what test is positive with severe slippage of SCFE

trendelenburg test

what does bilateral severe slippage with SCFE cause

waddling gait

what conditions can SCFE be associated with

renal osteodystrophy

hypothyroidism

rickets

radiotherapy

what are the x-ray findings of SCFE

post medial slippage of epiphysis

widening of growth plate

reduced epiphyseal height

medial epiphyseal beaking

widened teardrop distance

abnormal Klein's line

medial femoral neck periosteal buttressing --> pistrol grip deformity

what are complications of SCFE

permanent coxa vara deformity

femral neck broadening and shortening

AVN of femoral head

acute cartilage necrosis

osteoarthritis

what does pistol grip deformity lead to

femoral acetabular impingement

aka for tibial plateau fracture

bumper/fender fracture

what side is involved in 80% of tibial plateau fractures

lateral plateau

what is the MOI of tibial plataeu fracture

impact of femoral condyles into weaker tibial plateau

axial load

who is most commonly affected by tibial plateau fractures

patients older than 50

osteoporotic

what imaging view is necessary to visualize tibial plateau fracture

obliques

T/F: 90% of fibular head fractures have something else associated with it

true

what is an anterior tibial spine fracture

avulsion fracture at origin of ACL --> tibial eminence

what is the MOI of anterior tibial spine fracture

hyperextension of knee with internal rotation of tibia

who is most often affected by anterior tibial spine fracture

children falling of bike

T/F: severity of ACL avulsion fractures increases from Type 1 to 4

true

what age group is affected by trampoline fracture

children 2-10 years old

what is the MOI of trampoline fracture

impaction between the descending child's leg and upward moving mat

what is the location of trampoline fracture

proximal tibial metaphysis fracture

who is most affected by tibial tuberosity avulsion fractures

adolescent boys who partake in athletic activities --> strong quads

what can predispose someone to tibial tuberosity avulsion fracture

presence of osgood schlatters

what is segond's fracture

avulsion fracture of bony insertion of TFL at margin of lateral tibial condyle

what is MOI of segond's fracture

forced internal rotation of tibia with varus stress (skiing, basketball, baseball)

what is associated with segond's fracture in 75-100% of cases

ACL tear --> need MRI

what is often associated with proximal fibula fractures

PCL tear

what causes FBI sign

intraarticular fracture leading to bone marrow extruding into joint fulid and creating a fat blood interface

what view is the only view to see FBI sign

cross table lateral

what is the most common fracture orientation for patella

transverse at midpoint of patella

what are the differential diagnoses for patella fracture

bipartite and tripartite patella

how do you differentiate between patellar fracture and bipartite/tripartite paetlla

-take x-ray of other knee because bipartite/tripartite patella is usually bilaterla

-bipartitie/tripartitie patella is usually in superolateral corner

what is a sellate patellar fracture

comminuted

what causes widening of the space between fragments with transverse patellar fracture

contraction of quads

what is the most common direction for patellar dislocation

lateral

what is sliver sign

flake fracture or osteochondral fracture

-associated with patellar dislocation as medial facet impacts the lateral femoral condyle

what is the hallmark sign for recurring patellar dislocation

flake fracture

what is a fracture through both tibia and fibula near midshaft (distal 1/3 of diaphysis)

boot top fracture

what is the most common location for ankle fracture

lateral malleolus

what view is needed to best see lateral malleolus fracture

medial oblique

what are the two main ankle fracture classifications

dennis weber (fibular fracture compared to tibiotalar joint space)

lauge hansen (MOI)

what is weber A fracture

transverse fracture through lateral malleolus

what is weber B fracture

oblique lateral malleolus fracture

tib fib syndesmosis should be ok but can be widened

medial malleolus fracture or deltoid ligament disruption

what is weber C fracture

widening of distal tibiofibular aritculat and torn syndesmosis

medial malleolus fracture or deltoid ligament disruption

-risk on non union

what is thumb sign

swelling near lateral malleolus that points to a higher concern for fracture

what is the medial clear space

space between the talus and medial malleolus

should be 4 mm

what does a widened medial clear space indicate

damage to stabilizing ligaments

what is the lateral clear space

tib fib distance

should be no more than 5 mm

what does a widened lateral clear space indicate

separated syndesmosis between tib and fib

what is the overlap between lateral tibia and fibula

should be at least 1 cm of overlap

what does a decreased tib fib overlap indicate

syndesmosis widening

what is the MOI Of medial malleolus fracture

hypersupination

what is the MOI of lateral malleolus fracture

hyperpronation

outward or external rotation of foot

what is a bimalleolar fracture

fracture of medial and lateral malleoli

-transverse on one side because of tensile forces and oblique or spiral on the opposite side

what is a cotton fracture

posterior lip of tibia (third malleolus)

what is cotton fracture associated with

tibiotalar dislocations

external rotation of foot

what is a trimalleolar fracture

fracture of medial, lateral and posterior malleoli

what view is used to visualize third malleolus fracture

lateral

what is a proximal fibular shaft fracture with rupture of the distal tib-fib syndemosis and has pain at ankle

maisonneuve fracture

what is MOI of maisonneuve fracture

forceful inversion and external rotation of the ankle

what is a toddler's fracture

-undisplaced spiral fracture of tibia in children 9 months to 3 years

-fall or child gets foot caught between slats of crib

what in the ankle is non union a likely complication

medial malleolus

what is the most commonly fractured tarsal

calcaneus