Med Imaging E2: skeletal pt 2

when ordering extremity imaging

when ordering extremity imaging

order multiple views

joint above and below

follow entire perimeter to ensure you see all fractures

what is scapular Y-view (PA)?

plain film w/ pt rotated to look for suspected shoulder dislocations or fractures of scapula

what is axillary view?

plain film w/ arm abducted and beam is focused through axilla w/ film cartridge on superior aspect of shoulder

what is the best study for soft tissues?

MRI

what is visible in scapular Y-view (PA)?

coracoid, spine of scapula, body of scapula

humeral head should be in center of the “Y”

what is the best true lateral view of the shoulder?

axillary view

What does axillary view evaluate?

glenoid and humeral head for fractures and dislocations

What does scapular Y-view (PA) evaluate?

fractures of scapula or shoulder dislocations

what is this?

clavicular fracture (usually occurs in mid portion or distal 1/3)

what is this?

humeral head fracture w/ suspected dislocation

what is this?

humeral head fracture w/o dislocation

what is this?

glenoid fracture

what is this?

scapular fracture

what is acromioclavicular separation?

the ligament of the AC joint is disrupted, resulting in 5 degrees of AC separation

What are 95% of shoulder dislocations?

humeral head dislocated anteriorly from glenoid (medial aspect of humeral head is inferior and medial to the gelnoid)

what is this?

anterior humeral head dislocation (humeral head is moved inferiorly and medially)

what is the best view to see posterior dislocations?

Y- view

what is this?

posterior humeral head dislocation

what is this?

hill-sachs deformity (caused by repeat dislocations)

what is this?

DJD and calcific tendonitis

what is the 3rd most common site for osteogenic sarcoma?

humerus

Where is osteogenic sarcoma most common?

long bone in lower extremity around knee

what is the best view for the elbow?

lateral view w/ elbow flexed at 90 degrees

what indicates pathology on a lateral view w/ elbow flexed at 90 degrees?

posterior fat pad

what should be seen and adjacent to the bone in a lateral view w/ elbow flexed at 90 degrees?

anterior fat pad

How are normal apophyses (growth plates) distinguished from pathology?

by having well defined margins

What is the best view for elbow trauma?

lateral view

what indicates an elbow fracture in lateral view?

displacement of anterior fat pad or presence of posterior fat pad

what is this?

elbow fracture

what is the most common fracture of the elbow?

radial head

what are the 3 classic fractures of the forearm?

nightstick, motteggia, galeazzi

what is a nightstick fracture?

fx of mid portion of ulna

what is a monteggia fracture?

fx of proximal ulna w/ dislocation of radial head

what is a galeazzi fracture?

fx of distal radius w/ dislocation of ulnar head from wrist

what is this?

monteggia fracture

what is this?

galeazzi fracture

wha tis a greenstick fracture?

incomplete fracture due to flexibility of young bones; common in forearm

what is the most common fracture of the wrist?

colles’ fracture

what is colles’ fracture?

fracture of distal radius w/ dorsal angulation of distal fragment; also includes fracture of ulnar styloid

MOI- falling on outstretched hand (FOOSH)

what is this?

colles’ fracture - distal fragment displaced dorsally

what is a smith fracture?

fx of distal radius and ulnar styloid but distal fragment is angulated towards volar surface

what is a torus/buckle fracture?

compression fracture usually in children

what is a scaphoid / navicular fracture?

most common fracture of carpals, often difficult to see on initial plain films; can lead to avascular necrosis of scaphoid/navicular bone

what is this?

avascular necrosis

what is boxer’s fracture?

fx of 5th metacarpal; often w/ displacement or angulations towards palmer surfaces

what is Bennet and Rolando’s fx?

fx of 1st metacarpal

what is Bennett fracture?

fx of base of 1st metacarpal

what is Rolando fx?

fx that involves base of thumb metacarpal characterized by Y or T shaped intra-articular fracture line

what is gamekeeper’s fracture?

avulsion fx of thumb

MOI: hyperextension of thumb

what is volar plate fx?

avulsion fx of base of middle phalanx on volar surface

what is this?

monteggia fx dislocation of elbow

what is this?

colles fx

what is this?

radial head fx

what is this?

galeazzi fx

what is this?

smith fx w/ volar angulation

what is this?

Rolandos fx (PA shows comminuted intra-articular fx at base of 1st metacarpal)