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

Fractures of the lower leg are most common in which locations

Middle or distal thirds

Tibial fractures heal in about how long in adults

16 weeks (heal very slowly)

Delayed or nonion after fractures of the lower leg are more common where

In the distal 1/3

What type of fracture in the lower leg are common in the proximal third of the tibia

Stress fractures

Segonds fracture

Segonds fracture is associated with

ACL tear

Appropriate follow up after finding a Segonds fracture

MRI and orthopedic consult

Another example of a Segonds fracture

Fabella

Vertical fracturing of the lateral tibial condyle and an FBI sign to go with it

Spiral fracture of the tibia

Toddlers fracture

Tibial fracture with an FBI sign on the lateral view

Non-union tibial and fibular fracture

Stress fracture in the tibia

Stress fracture of the proximal tibia

Stress fracture of the distal tibia

Growth Arrest/Recovery lines

Oblique fracture of the proximal fibula

What occurs when a child (1-3 yrs) twists and falls

Toddlers fracture

What are the routine radiographs of the ankle

AP

Lateral

Oblique

Toddlers fracture

Another toddlers fracture

You always need to have what piece of anatomy in the lateral ankle X ray

Tuberosity of the base of the 5th metatarsal

Examples of the routine radiographs of the ankle

Swelling on the lateral side of the ankle is from

Inversion injury

Fracture on the distal tibia

What makes a bad lateral X ray

Fibula needs to be off the posterior malleolus

Tensile force in the ankle causes what type of fracture

Avulsion fractures

Angular force in the ankle causes what type of fracture

Oblique fracture

Rotatory force in the ankle causes what type of fracture

Spiral fracture

The inversion injury of the ankle has what type of force laterally? Meaning what type of fracture laterally? What about medially?

Tensile force means avulsion laterally

Angular force means oblique medially

-and then it's opposite of reversion injuries

The ankle joint is a ring made up of the

Tibia, fibula and talus and their ligamentous attachments

What's the idea of the ankle joint being a ring called

Neer`s ring analogy

A single break of the ring in the ankle is

Stable

A brake in two positions of the rink in the ankle is

Unstable

What is the most common combination of fractures of the ring in the ankle? Therefore?

Bi-malleolar fracture

-therefore most ankle fractures are unstable

An Avulsion fracture of the medial malleous is from what type of injury

Version injury

Avulsion fracture at the lateral malleolus of the ankle is from what type of injury

Inversions

Avulsion fracture of the medial malleolus

Transverse fracture of the medial malleolus and widening of the tibiofibular syndesmosis and an oblique fracture of the proximal fibula is called

Maisonneuve fracture

Avlusion fracture of the lateral malleolus

Fracture of the distal tibia and avulsion fracture of the medial malleolus is from what type of injury

Eversion injury

Inversion vs eversion injury of the ankle slide

Salter type III of the distal tibia, medial malleolus

Salter type IV fracture of the distal tibia, medial malleolus

Salter type II of the distal tibia

If you have soft tissue swelling over the lateral malleolus than what is the mechanism of injury

Inversions injury

Maisonneuve fracture is from what type of sever injury

Eversion injury

Maisonneuve fracture

Indications of stress views

Instability and no radiographic evidence of fracture

Another Maisonneuve fracture

Fracture through the talar neck and complete transverse fracture of the medial malleolus

Oblique fracture of the distal fibula

Transverse lateral malleolar fracture has what type of mechanism of injury

Inversion injury

Nondisplaced oblqiue fracture of the distal fibula

Oblique fracture in the distal 1/3 of the fibula could be from what type of injury

Eversion

One more Maisonneuve fracture

Fracture of the distal fibula and posterior malleolus

Fracture of the medial malleolus and the posterior malleolus

For something to be unstable there needs to be _________ degrees of talar dome angulation

>16 degrees

For something to be unstable there needs to be ________ anterior translation on the anterior draw stress

>3mm

What things need to be present for something to be considered unstable in the lower leg

>16 degrees talar dome angulation

Asymmetrical lateral mortise spacing

>3mm anterior translation on anterior draw stress

What is the most common fractured tarsal bone

Calcaneus

Example of >16 degrees talar dome angulation

Stress fracture of the distal fibula

Calcaneal fractures occur from

Compressive force from falls

What do you use to help find a calcaneal fracture

Boehler`s angle

What is the angle that goes from one super positioned margin of the calcaneal tuberosity to the superior tip of the positioned face and then a line that goes from the superior margin of the anterior process to the superior tip of the posterior facet and measure the angle between those lines

Boehler`s angle

Boehler`s angle should be

Not less than 28 degrees

When you see a calcaneal fracture where else should you look

Evaluate thoracolumbar spine to look for compression fractures

Boehlers angle

Communities calcaneal fracture with decreased bohlers angle

Fat pad at the back of the ankle

Kagers fat pad

Another calcaneal fracture with decreased bohlers angle

What is the second most common tarsal fractured

Talus

Calcaneal stress fracture

Accessory ossicle adjacent to the navicular

Os tibial externum

Vertical fracture through neck of the talus

Fracture of the lateral process of talus

Another vertical fracture through the neck of the talus

Talar dome avulsion

Avascular necrosis of the talus

Os trigonum

The medial cuneiform articulates with

First metatarsal

Os tibial externum

In the blue

The intermediate cuneiform articulates with

2nd metatarsal

The lateral cuneiform articulates with

3rd metatarsal

The cuboid articulates with

4th and 5th metatarsals

Accessory ossicle off the cuboid

Os peroneum

Image of the cuneiforms and the cuboid articulating with the tarsals

Bipartite medial sigmoid of the first metatarsal

In the orange on the left

A transverse fracture at the base of the 5th metatarsal

Dancers (jones) fracture

Os peroneum

Ruptured Achilles tendons

Fat pad behind the ankle and in front of the Achilles

Kagers fat pad

Dancer (jones) fracture results from

Plantar flexion and inversion of the foot

Common to have pain where with a dancers (jones) fracture

Ankle pain

What fracture could you miss if you don't include the base of the tuberosity of the 5th metatarsal on the lateral foot X ray

Dancers (jones) fracture

Normal apophysis vs a dancers fracture in the foot

Dancers (jones) fracture