Rad 2B week 9 (quiz 9 - Final)

Lower rib fx are common or not common

Not common

If lower ribs fx, what do we evaluate

Kidneys, ask pt if they have blood in urine

Cough (post-tussive) fx def

Stress fx of lower anterior rib (rib 6-7 mc)

Sternal fx MOI

Blunt compressive impacts like hitting the steering wheel

What do we suspect also if we see sternal fx based on the MOI

T/L spine compression fx due to hyperflexion that happens when hitting the steering wheel

Where on the sternum is MC fractured

Body or manubriosternal junction

What do we also need to evaluate with sternal fx

Cardiac complications

Traumatic pneumothorax

Pleura is torn —> pressure is lost —> lung collapse

What kind of pressure is in the pleura

Negative

Chylothorax

lymph in pleural cavity

Hemothorax def and what 3 things may we see on xray (same as chylothorax)

Blood accumulates from ruptured blood vessels

1. Blunt costophrenic sulcus

2. Widening of paraspinal space

3. Apical capping

What is apical capping

Collection of ST or fluid density that go into lung apex

Spontaneous pneumothorax def

Pleural blister (bleb/bullae) suddenly bursts (filled with air) —> air in pleura —> takes away negative pressure —> lung collapse

What xray name sign do we see with pleural effusion (fluid collecting)

Meniscus sign

Tension pneumothorax def

Tear in pleura —> air can go in but not out —> compresses mediastinum —> compress heart (displaces heart to right)

Lung complications from fx

Pneumonia, rupture of spleen, diaphragm, tracheabronchial tree, esophagus, kidney, heart, aorta, lung, thoracic spine

Pneumonia mc location in lung

Right middle lobe

What sign on xray indicates pneumothorax

Air bronchogram sign (fluid around bronchioles)

What xray views are needed for shoulder girdle injuries (5)

AP int rot

AP ext rot

Baby arm (abduction)

Grashey (45 degree to see GH jt)

Scapular Y-view

Clavicular fx is MC skeletal injury during ___ and ___

Birth and childhood

Since the S shape of clavicle overlap with upper ribs makes it difficult to evaluate, what do we add for optimal visualization

15 degree cephalad (tube tilt)

Where on clavicle is mc fx and WHY

Middle because theres no muscle, its where it changes shape and it is also the thinnest

Lateral is ___mc which makes medial ___ common

2nd, least

When middle clavicle is fx, we see it displaced ___ due to action of which muscle

Superior due to SCM

When lateral clavicle is fx, we evaluate which ligament

Coracoclavicular ligament integrity

We see non union of clavicle fx in __% of cases

5

Medial fx can cause what complication

Neurovascular damage of subclavian artery and vein and brachial symp chain

Post-traumatic osteolysis of distal clavicle MOI

Macrotrauma or rep microtrauma (overhead lifting)

Distal clavicular osteolysis is common in which sport

Weight lifters

Osteolysis of distal clavicle is possibly also due to

Synovial hypertrophy (synovitis) —> resorption of bone

What will we see on xray for osteolysis of distal clavicle (3)

1. Resorption of cortex

2. Wide AC joint (more than 3mm)

3. Frayed, irregular, cup shaped distal clavicle

___% of scapular fx have other associated injuries (pneumothorax, flail chest, pleural effusion)

80%

Greater tuberosity fx AKA

Flap fx

Moi of flap fx (2)

1. Ground level fall in osteoporotic pt

2. Ant dislocation (supraspinatus avulses off greater tub)

When flap fx doesn't displace in osteoporotic pt, it is called what and can lead to what

Hidden fx —> frozen shoulder

Displacement of more than 1cm of a flap fx associated with...

Rotator cuff tear (supraspinatus)

Lesser tuberosity fx occurs with

Proximal humeral fx

Humeral surgical neck fx moi

Osteoporotic pt falls directly on it

Surgical neck is the ___ site for humeral fx

MC

Where do we see surgical neck displace due to the pull of pec muscle

Anteromedial

GH dislocations are most commonly in which direction

Anterior

MOI of GH ant dislocation

Forceful ext rotation and abduction

60% of ant GH dislocation has what

Hill sachs lesion

Hill sachs lesion def

Impaction fx of posterior lat humeral head

How to ddx hill sachs with flap fx

Hill sachs is impaction fx while flap fx is avulsion fx

What other lesion do we see with ant GH dislocation

Bankart lesion

Bankart lesion

Ant inf GH cavity injury

ant GH dislocation reoccurrence is common in which age group

Young pt (under 40) —> very unstable

What defect can we see on xray with hill sachs lesion

Hatchet defect

Posterior dislocation of humerus is the mc missed traumatic injury in the ER, so what xray view MUST we use to see

Scapular Y-view

MOI for posterior humeral dislocations (4E's)

1. Epilepsy

2. Electric shock

3. Extreme trauma

4. Hyperelasticity

What arm position will the pt be stuck in for posteiror humeral dislocations

Internal rotation

Loss of half moon shape on xray means whar

Loss of humeral head - glenoid fossa overlap

How many mm of joint space will be widened in post humeral dislocations

More than 6mm

Reverse hill sachs

Anterior medial impaction fx on humeral head

Reverse Bankart lesion

Posterior glenoid labrum

Trough sign

Anterior aspect of humoral head becomes impacted against posterior glenoid rim (2 articular surfaces)

(Reverse Hill-sachs deformity)

Inferior and superior shoulder dislocation are

Rare

Moi for inf shoulder dislocations

Humerus locks into hyperabducted position from hyperabduction blow

AC sep accounts for ___% of all shoulder injuries

10

Males or females more affected by AC sep

Males (5x more)

MOI for AC separation (2)

1. Direct blow to acromion with abducted shoulder

2. Fall on elbow

Which sports MC affected by AC sep

Contact sports

What classification system do we use to diag AC sep

Rockwood classification system

Type 1 AC sep def

1. Sprained AC lig, intact CC lig

2. X-rays are normal (may see widening of AC jt)

Type 2 AC sep def

1. Ruptured AC lig, sprained CC lig

2. More than 6mm of AC joint

3. Greater than 2mm compared to uninjured side

4. 50% upward displacement of clavicle relative to acromion

Do we take weighted xrays with AC sep

Yes, both weighted and unweighted

Do we take xrays of both AC joints if we suspect AC sep

YES, to compare, normal variance is no more than 2mm

Type 3 AC sep

Clavicle dislocation with rupture of AC and CC lig

CC lig interspace is more than ___mm in type 3 AC sep

12mm

MC elbow fx in adults

Radial head fx

MC elbow fx in children

supracondylar fx

Supracondylar fx displaces fx frag ant or post

Posterior

What line of mesuration is abnormal with supracondylar humeral fx

Abnormal anterior humeral line

Anterior humeral line

-Drawn along the anterior surface of the humerus

-Should intersect the trochlea in the middle 1/3rd

Radial head fx aka

Chisel fx

Chisel fx is usually on what side of radial head

Lateral side

What xray sign do we see with radial head fx

Double cortical sign

MOI for radial head and supracondylar fx

FOOSH

Why are fat pads seen in elbow fx

Intracapsular effusion due to synovial joint filling with fluid and pushing fat pads outward

Should you normally see posterior fat pad

No

Anterior sail sign is seen with elbow fx, what does this mean on xray

Anterior fat pad effusion

Radial neck fx happen where

Junction of head and neck