Diagnostic Imaging Extremities

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What is a sprain?: a ligament injury
Name and describe the 3 classifications of sprains: ⬢ 1st-degree - localized joint pain and tenderness but no joint laxity
⬢ 2nd-degree - detectable joint laxity with localized pain and tenderness
⬢ 3rd-degree - ligaments completely disrupted and joint grossly unstable
What is a strain?: the tearing of a muscle-tendon unit
What is the difference between a dislocation and subluxation?: ⬢ in a dislocation, the normally opposing joint surfaces are completely displaced
⬢ in a subluxation, those surfaces are partially displaced
What is the difference between a volar and dorsal angulation fracture?: ⬢ a volar fracture, the distal portion that is fractured is displaced anteriorly
⬢ a dorsal fracture, the distal portion that is fracture is displaced posteriorly
Name and describe the 3 grades of open fractures: ⬢ Grade 1 - open fractures with wounds less than 1 cm in length
⬢ Grade 2 - wounds are greater than 1 cm, but clean without devitalization of tissue
⬢ Grade 3 - greater than 1 cm in length, or grossly contaminated, or associated with comminuted fractures and vascular injury
What is a salter-harris fracture?: a fracture through the physis (growth plate) in children
Describe the 5 types of salter-harris fractures: ⬢ Type I - through the physis
⬢ Type II - through the physis and metaphysis
⬢ Type III - through the physis and epiphysis
⬢ Type IV - through the physis, metaphysis, and epiphysis
⬢ Type V - crush injury to the physis
What are the 3 principles of fracture care?: ⬢ reduction of deformity
⬢ maintenance of reduction
⬢ rehabilitation of function
What are some common complications of musculoskeletal injuries?: ⬢ acute respiratory distress syndrome (from fat embolism)
⬢ DVT
⬢ atelectasis
⬢ ectopic bone formation
⬢ nerve compression
⬢ osteomyelitis
List 5 types of closed reduction: ⬢ stimson maneuver - pt prone on table with weight on arm
⬢ mitch maneuver
⬢ hippocratic maneuver - examiner places sole of foot in axilla
⬢ traction/countertraction
⬢ scapular manipulation - stimson maneuver with medial manipulation of the tip of scapula
What are 2 lesions associated with recurrent shoulder dislocations?: ⬢ Bankhart lesion - anterior capsular injury associated with a tear of the glenoid labrum
⬢ Hill-Sachs lesion - compression fracture of the articular surface of the humeral head
Name and describe the 3 classes of clavicle fractures: ⬢ Class A - middle third fracture
⬢ Class B - distal third fracture
⬢ Class C - proximal third fracture
What is a Monteggia fracture?: a fracture of the mid or proximal ulna with anterior dislocation of the radial head
What is a Galeazzi fracture?: a radial shaft fracture with associated dislocation of the distal radioulnar joint
What is an olecranon fracture?: like a fractured elbow
What are the different types of fractures that can occur at the distal humerus?: supracondylar, medial epicondyle, and lateral epicondyle fracture
What is a nightstick fracture?: an isolated ulnar fracture
What is a Colles fracture?: ⬢ fracture of the distal radius with dorsal displacement
⬢ "silver fork" deformity
What is a Smith's fracture?: ⬢ a reverse Colles fracture
⬢ fracture of the distal radius with palmar displacement of the distal fragment
⬢ volar displacement of the hand
What is the most fractured carpal bone?: Scaphoid
What is a Game Keeper's Thumb (or Skier's Thumb)?: an injury to the ulnar collateral ligament of the metocarpal-phalange joint of the thumb
What bone is typically fractured in a boxer's fracture?: 5th metacarpal
What is a Bennett's fracture?: a fracture of the 1st metacarpal at the carpo-metacarpal joint
What is a Rolando's fracture?: a comminuted fracture at the base of the 1st metacarpal
What are some characteristics of the anterior cruciate ligament?: ⬢ goes from lateral to the medial
⬢ originates from the intercondylar eminance of the tibia and inserts on the posteromedial aspects of the lateral femoral condyle
⬢ prevents anterior translation of the tibia
What are some characteristics of the posterior cruciate ligament?: ⬢ goes from medial to lateral (originates on the medial femoral condyle and inserts on the tibia)
⬢ prevents posterior translation of the tibia
What are some characteristics of the medial collateral ligament (MCL)?: ⬢ originates on the medial femoral epicondyle and inserts on the proximal tibia
⬢ prevents valgus angulation of the knee (L-shaped leg)
What are some characteristics of the lateral collateral ligament (LCL)?: ⬢ originates on the lateral femoral epicondyle and inserts on the lateral aspect of the fibular head
⬢ prevents varus angulation of the knee (R-shaped leg)
What is the most common knee injury requiring surgery?: ⬢ meniscal tear is most common
⬢ medial meniscal tear is 3x more likely than lateral meniscal tear
What is a McMurray test?: ⬢ a test for injury to meniscal structures of the knee in which the lower leg is rotated while the leg is extended
⬢ pain and a cracking in the knee indicates meniscal injury
What causes an ACL sprain?: caused by twisting of knee while foot is firmly planted on ground
What can cause of PCL sprain?: caused by hyperextension of knee or direct blow to anterior aspect of flexed knee
What is the unhappy triad?: ACL tear, MCL tear, Medial meniscus tear
What tendon is above the patella? below the patella?: ⬢ the quadriceps tendon is above the patella
⬢ the patella tendon is below the patella
What is a common physical finding of a patella tendon rupture?: ⬢ patient cannot actively extend knee
⬢ patella alta (patella is pulled superiorly by quadriceps tendon)
A patella dislocation/subluxation is usually displaced in which direction?: the patella is usually displaced laterally
Which bone in the foot articulates with the tibia?: talus
What is plantar fasciitis?: inflammation due to repeated overstretching of the plantar fascia ligament (fat pad on the bottom of the foot)
What is a Hallux Valgus?: ⬢ most common deformity of the foot
⬢ results in excessive valgus angulation of the big toe
What does the Lisfranc's ligament attach?: the 2nd metatarsal to the medial cuneiform
What is a Lisfranc fracture?: dorsal dislocation of the proximal base of the 2nd metatarsal
What is a Jones Fracture?: transverse fracture of the 5th metatarsal at the junction of the proximal metaphysis and diaphysis
What is an avulsion fracture?: ⬢ 5th metatarsal (more proximal than Jones Fx)
⬢ aka Pseudo-Jones Fx, dancer Fx, tennis Fx
What is a March fracture?: ⬢ stress fracture usually of the middle of the shaft of the 3rd or 4th metatarsal
⬢ history of having gone on a long walk or march with no clear history of trauma
Name and describe the 3 classes of metatarsal fractures?: ⬢ Class A - neck fracture
⬢ Class B - shaft facture
⬢ Class C - proximal metatarsal fracture (ex Jones fx)
What radiologic studies should be ordered with a calcaneus fracture?: ⬢ CT scan to review extent of fracture
⬢ xray of lumbar spine due to associated fractures
Which bones makes up the ankle?: tibia, fibula, talus
What is the Ottawa Ankle Rules?: ⬢ determines whether the patient will need an xray
⬢ if patient meets all the criteria, does not need an xray
⬢ 3 components:
1. patient has to be between 18-55 years old
2. able to walk 4 steps at the time of injury and at the time of evaluation
3. no tenderness over the posterior edge of either malleolus
What is the Ottawa Foot rules?: if the patient does not have tenderness at the base of the 5th metatarsal or navicular, you don't have to xray the foot
What is the most common mechanism of injury for ankle sprains?: inversion injury
Which ligaments are sprained in the ankle, from most common to least common?: 1. Anterior talofibular ligament (tears first)
2. Posterior talofibular ligament (tears second)
3. Calcaneofibular ligament (tears last)
What additional xrays should be ordered if a patient has a medial malleolar fracture?: proximal knee xray
What is Maisonneuve fracture?: fracture of the proximal fibula with syndesmosis rupture and associated medial malleolus fracture or deltoid ligament rupture
What is a Tibial Pilon fracture?: an explosion fracture of the tibia, produced primarily by rotational force
What is the Thompson test?: ⬢ tests for Achilles Tendon rupture
⬢ squeeze calf and the foot should plantarflex
⬢ if plantarflexion does not occur, then Achilles tendon is ruptured
What are the 3 types of tibial shaft fractures?: ⬢ Type I - slightly displaced 0-50% and non-comminuted; 90% chance of union
⬢ Type II - >50% displacement, but continued bony contact, may be slightly comminuted, may be open or closed
⬢ Type III - complete displacement with comminution, may be open or closed, 70% chance of union
What is a tibial plateau fracture?: a fracture of the proximal articular surface of the tibia
What is the most common hip dislocation?: posterior dislocation

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