Term
| What is the sens/spec of xrt for imaging bones? |
|
Definition
| intermediate sens w/high spec for bony abnml |
|
|
Term
| You perform an xrt on a bone and the outcome is benign but the pt is sx. How do you proceed? What if the pt is aymptomatic? |
|
Definition
| sx: elective excision. asymptomatic: leave alone. |
|
|
Term
| You perform an xrt on a bone and the outcome is intermediate. How do you proceed? |
|
Definition
|
|
Term
| You perform an xrt on a bone and the outcome is malignant. How do you proceed? |
|
Definition
|
|
Term
| What imaging modality can provide dx infor re: bones and soft tissues and can help dx suspected tumors, fx, and infections? This augments arthrograms and aids in sx planning. What planes does this return images on? |
|
Definition
| ct. axial images only (can get reconstructed views). (ct better @ bones than soft tissues) |
|
|
Term
| What is the modality of choice in assisting w/safe and accurate bx and intervention of boney abnml? |
|
Definition
|
|
Term
|
Definition
| ct that augments arthrograms |
|
|
Term
| What imaging modality is useful in surgical planning? |
|
Definition
|
|
Term
| (what 3 things make for a good mri?) |
|
Definition
| (1. magnet. 2. radiologist reading int. 3. compliance of pt) |
|
|
Term
| What are the 2 most common reasons for ordering mri? |
|
Definition
|
|
Term
| What imaging modality is able to portray info in any plane? What are the 4 planes? |
|
Definition
| mri. sagittal, coronal, axial, oblique. (us and ct are only axial) |
|
|
Term
| What gives detailed info re: soft tissue and aids in dx of tumors, infections, trauma, avn, tendon/lig ruptures, internal jt derangements? |
|
Definition
|
|
Term
| What 2 imaging modalities can augment arthrograms? |
|
Definition
| ct (conray) and mri (gadolinium) |
|
|
Term
| Which is often positive first: xrt or mri? |
|
Definition
| mri often positive before xrt |
|
|
Term
| In which mri view is water white? |
|
Definition
|
|
Term
| In which mri view are bones white? |
|
Definition
|
|
Term
| What is helpful in dx soft tissue lesions like cysts, tendon/lig ruptures, loose bodies, and fb? |
|
Definition
|
|
Term
| What is an excellent choice for congenital displacement of the hip b/c it lmts xrt and has better visualization of *non-ossified* bones? |
|
Definition
|
|
Term
| What imaging modality detects ABNML metabolic activity w/in bone? |
|
Definition
| radioisotobe bone scan (technetium-99m) |
|
|
Term
| What imaging modality involves phosphorus exchange in areas of high turnover (ie osteo, tumors, oa, bone growth)? |
|
Definition
| radioisotobe bone scan (technetium-99m) |
|
|
Term
| What is useful as a primary screening tool for ca mets, child abuse, but is NOT useful in multiple myeloma? |
|
Definition
| radioisotobe bone scan (technetium-99m). (low turnover in multiple myeloma- get ct) |
|
|
Term
| What are the 3 phases of radioisotobe bone scan (technetium-99m)? |
|
Definition
| 1. vasc, 2 blood pool, 3. delayed |
|
|
Term
| Is radioisotobe bone scan (technetium-99m) specific? |
|
Definition
| non-specific (mri very spec and sens) |
|
|
Term
| What imaging modality ID areas of suspected inflammatory activity (ie osteomyelitis, infected implant, etc)? |
|
Definition
| nuclear imaging- labeled wbc (indium 111) |
|
|
Term
| What aids in appreciation of dynamic jt mvmt and injections (vertebral and hip)? |
|
Definition
|
|
Term
| What is the preferred modality for intra-op alignment and implant positioning? |
|
Definition
|
|
Term
| Does fluoroscopy involve ionizing radiation exposure? |
|
Definition
|
|
Term
| What is used to evaluate the vascular supply in the case of traumatic disruption of soft tissue? |
|
Definition
|
|
Term
| What is infrequently used for localization of tumor vessels (embolization or chemo)? |
|
Definition
|
|
Term
| What aspect of radiographic imaging involves the cortex, cancellous, and regions? |
|
Definition
|
|
Term
| What aspect of radiographic imaging involves the interarticular area and para-articular area? |
|
Definition
|
|
Term
| What aspect of radiographic imaging involves the fat pads and cartilage? |
|
Definition
| What aspect of radiographic imaging involves the |
|
|
Term
| What are 2 types of cortex? |
|
Definition
|
|
Term
| What are 2 types of cancellous bone? |
|
Definition
|
|
Term
| What are 2 types of cartilage? |
|
Definition
| articular (lines bones) and fibrocartilage (meniscus, labium) |
|
|
Term
| How many views do you always start w/in m/s fx xrt? |
|
Definition
|
|
Term
| What should you relate xrt finding w/? |
|
Definition
| relate what yo *see* w/what you *hear*- xrt should match moi |
|
|
Term
| What is better than 2 eyes? |
|
Definition
|
|
Term
| How do skeletal lesions compare when located in different parts of the body? |
|
Definition
| incidence varies but appearance is similar |
|
|
Term
| What should also be evaluated in bone fx? |
|
Definition
| eval the jt above and below |
|
|
Term
| What is crucial regarding anatomical considerations in xrt? |
|
Definition
| thorough knowledge of anatomy (and nml variants). know the lingo |
|
|
Term
| To what area of the bone is blood flow greates? |
|
Definition
|
|
Term
| In response to what does bone form? |
|
Definition
|
|
Term
| What is involved regarding trabecular patterns and distribution of cortical/cancellous bone? |
|
Definition
| bone formation is the body's response to stress |
|
|
Term
| What are the abc's of bony xrt interpretation? |
|
Definition
| Anatomic Alignment and Appearance. Bony mineralization and texture. Cartilage (jt space) abnormalities. Soft Tissue abnormalities |
|
|
Term
| What 3 problems cause difuse pattern of bony abnml? |
|
Definition
| metastasis, osteoporosis, hyperpth |
|
|
Term
| What are the following: age/gender/ethnicity. behavior of lesion. bone/jt involved. jt space involved. locus w/in bone. margins. shape. bony rxn. matrix production. soft tissue changes. trauma/sx hx? |
|
Definition
| 11 m/s predictor variables. these are only clues. many radiologists are content to classiy a lesion as simply aggressive or nonaggressive for further w/up |
|
|
Term
| 80% of malignancies can be dx how? |
|
Definition
|
|
Term
| How do neoplastic dzs and inflammatory processes differ regarding jt space? |
|
Definition
| neoplastic dzas typically respect the cartilage of the physes and the jt space. inflammatory processes will often cross jts. |
|
|
Term
| What should you consider if bo cortical margins are intact? |
|
Definition
| consider polyostic disorder |
|
|
Term
| What are 3 types of bony rxn predictors? |
|
Definition
| sclerosis, buttressing, periosteal rxns. |
|
|
Term
| Which type of bony rxn attempts to wall off diseased area? |
|
Definition
|
|
Term
| Which type of bony rxn attempts to reestablish architecure (eg osteophytes, syndesmophytes, and enthesiophyte? |
|
Definition
|
|
Term
| Which type of bony rxn can be solid, laminated (onion skin), spiculated (hair on end), aor codman triangle? |
|
Definition
|
|
Term
| Which lesion behavior involves infection or neoplasm, stimulates giant cells to make room? |
|
Definition
| osteolytic: osteoCLast CLeave cells |
|
|
Term
| What are 3 types of osteolytic lesion behaviors? |
|
Definition
| geographic, moth-eaten, permeative |
|
|
Term
| Which type of lesion behavior is often reparative or reactive to another tissue (eg trauma)? |
|
Definition
| osteoBlasts Build Bone. Osteoblastic |
|
|
Term
| What is teh area/border btw nml and abnml? |
|
Definition
|
|
Term
| What is the single most important predictor of aggressiveness? |
|
Definition
|
|
Term
| What indicates the growth rate of teh lesion and ability of bone to react? |
|
Definition
|
|
Term
| What are 3 types of transition zones? |
|
Definition
| abrupt/well defined=non-aggressive benign.. broad/poorly-defined=agressive. fuzzy/sclerotic=inflammatory |
|
|
Term
| Besides lesion margin, what is another indicator of growth rate of a lesion? |
|
Definition
|
|
Term
| Which is more aggressive: longer>wider or wider>longer? |
|
Definition
| longer>wider=non-agressive. wider>longer=aggressive. |
|
|
Term
| Which lesion shape may also break out of cortex and extend into soft tissue? |
|
Definition
|
|
Term
| What are 3 processes that produce "matrix"? |
|
Definition
| chondroid, osteoid, fibrous |
|
|
Term
| What matrix production process appears as fine, stippled calcification, rings and popcorn and often occurs in bulky masses in soft tissues? |
|
Definition
| chondroid (cartilaginous) |
|
|
Term
| What matrix product appears as fluffy, cloud or cotton-like densities (similar to bone) and varies in portion calcified (tumors ossify centrally, myositis or bone infarct ossify peripherally)? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Where does myositis or bone infarct? |
|
Definition
|
|
Term
| What matrix product has no mineralization; ground glass appearance? |
|
Definition
|
|
Term
| What do the 7 following signs predict: mm wasting, swelling, fat lines, lipohemarthosis, calcifications, fb, and gas? |
|
Definition
| predictors of soft tissue changes |
|
|
Term
| What soft tissue change would be indicated by the following dz: paralysis, ms, chronic dz? |
|
Definition
|
|
Term
| salter harris regards physis or growth plate. 1 epyphiseal lysis: fx thorough physis. 2. a: above throught physis and above physis metaphyseal fragment 3. epiphyseal lysis and fragment 4. through metaphyseal through physis through epiphysis fragment 5. rammed together physes |
|
Definition
| SALTER only works if end of bone down |
|
|
Term
| What soft tissue change would be indicated by the following dz: mass, hemorrhage, inflammation, edema? |
|
Definition
|
|
Term
| What soft tissue change would be indicated by the following dz: loss or displacement=injury? |
|
Definition
|
|
Term
| What soft tissue change would be indicated by the following dz: fat-fluid level in jt=fx? |
|
Definition
|
|
Term
| What soft tissue change would be indicated by the following dz: previous injury or connective tissue disorder? |
|
Definition
|
|
Term
| What soft tissue change would be indicated by the following dz: previous injury? |
|
Definition
|
|
Term
| What soft tissue change would be indicated by the following dz: trauma, recent surgery, infection, gas gangrene? |
|
Definition
|
|
Term
| Does a well-defined, sclerotic border indicate benign or malignancy? |
|
Definition
|
|
Term
| Doepreserved cortical margins indicate benign or malignancy? |
|
Definition
|
|
Term
| Does no soft tissue mass indicate benign or malignancy? |
|
Definition
|
|
Term
| Does solid periosteal rxn indicate benign or malignancy? |
|
Definition
|
|
Term
| Does geographic bone destruction indicate benign or malignancy? |
|
Definition
|
|
Term
| Does a poorly defined border and wide transition zone indicate benign or malignancy? |
|
Definition
|
|
Term
| Does cortisol destruction indicate benign or malignancy? |
|
Definition
|
|
Term
| Does soft tissue mass indicate benign or malignancy? |
|
Definition
|
|
Term
| Does an interrupted periosteal rxn indicate benign or malignancy? |
|
Definition
|
|
Term
| Does a moth-eaten or permeative bone destruction indicate benign or malignancy? |
|
Definition
|
|
Term
| What predictor includes timing of pain, surgery, radiation, and hx of trauma? |
|
Definition
| pt hx/moi: timing of pain can change what you "see". sx can change bony anatomy and appearance. xrt has effect on bone as well. hx of trauma (acute or remote) also important. |
|
|
Term
| What aspect of pt hx/moi is involved w/osteotomy, bone graft harvest, and knowledge of implant (metal and biological)? |
|
Definition
| sx can change bony anatomy and appearance |
|
|
Term
|
Definition
| soft tissue injury in which bone is broken |
|
|
Term
| What is a break in the continuity of bone/cartilage? |
|
Definition
|
|
Term
| Location, type and position describe what? |
|
Definition
| general description of fx |
|
|
Term
| Salter-Harris-Ogden or orthopaedic trauma association describes what? |
|
Definition
|
|
Term
| What fx occurs in the main or mid section (shaft) of a long bone? |
|
Definition
|
|
Term
| What type of fx occurs in the wider portion of a long bone adjacent to the epiphyseal plate? |
|
Definition
|
|
Term
| What fx occurs at the rounded end of a long bone, at its joint with adjacent bone(s)? |
|
Definition
|
|
Term
| What fx occurs at a synovial joint between the superior articular process of one vertebra and the inferior articular process of the vertebra directly above it? |
|
Definition
|
|
Term
| What type of fx occurs at a jt? |
|
Definition
|
|
Term
| Which type of fx is determined by integrity of overlying skin and has higher assoc w/infection and osteomyelitis? |
|
Definition
| open (compound) v. closed |
|
|
Term
| Which type of fx is determined by positioning of fragments and soft tissue injury? |
|
Definition
|
|
Term
| What type of fx is due to abnml activity on nml bone? |
|
Definition
|
|
Term
| What type of fx is due to nml activity on abnml bone? |
|
Definition
| insufficiency fx (pathologic fx) |
|
|
Term
| What type of fx occurs due to direct force? |
|
Definition
|
|
Term
| What tpe of fx occurs due to indirect force? |
|
Definition
|
|
Term
| What type of fx occurs due to indirect force? |
|
Definition
|
|
Term
| What type of fx is is a collapse of a vertebra. It may be due to trauma or due to a weakened vertebra in a patient with osteoporosis or Osteogenesis Imperfecta? |
|
Definition
|
|
Term
| What type of fx occurs when a fragment of bone tears away from the main mass of bone as a result of physical trauma? |
|
Definition
|
|
Term
| What fx classicly presents as fx on one side, bent on other? |
|
Definition
|
|
Term
| What fx classicaly presents in a young pediatric pt whose bones are more plastic? |
|
Definition
|
|
Term
| Which type of fx occurs w/buckling of cortex on both sides of bone? |
|
Definition
|
|
Term
| What is the most common type of greenstick fx? |
|
Definition
|
|
Term
| What type of fx occurs as one side buckled and one side cracked? |
|
Definition
|
|
Term
| In describing fx do you describe distal relative to proximal or vice versa? |
|
Definition
| always describe distal fragment in relation to proximal fragment |
|
|
Term
What is defined as 1. formation of a sharp obstructive bend, as in the intestine, ureter, or similar tubes.
2. deviation from a straight line, as in a badly set bone? |
|
Definition
|
|
Term
What is defined as 2. separation of joint surfaces without rupture of their binding ligaments and without displacement.
3. surgical separation of the two parts of a bone after the bone is transected? |
|
Definition
|
|
Term
| Which type of salter-harris fx occurs through epiphysiolysis? |
|
Definition
| 1. Same level: fx and physis |
|
|
Term
| Which type of salter-harris fx occurs through epiphysiolysis + metaphyseal fragment? |
|
Definition
| type 2: fx through and Above physis-metaphyseal |
|
|
Term
| Which type of salter-harris fx occurs through physis + epiphyseal fragment? |
|
Definition
| type 3: fx Lower than epiphysis |
|
|
Term
| Which type of salter-harris fx occurs through epiphysis, metaphysis, and physis? |
|
Definition
| 4: Three: Through epiphysis, physis, metaphysis |
|
|
Term
| Which type of salter-harris fx occurs with physeal compression? |
|
Definition
| 5. Rammed epiphysis into methaphyseal region |
|
|
Term
| How is the epiphysis positioned for SALTR? |
|
Definition
|
|
Term
| Which type of salter-harris fx is the most common? |
|
Definition
|
|
Term
| Which type of salter-harris fx is the least common? |
|
Definition
|
|
Term
| What comprises the largest source of malpractice claims in the er? |
|
Definition
|
|
Term
| When are most ortho injuries missed? |
|
Definition
| off hours- 63% 6pm-1am on weekends. midnight to 7am weekdays |
|
|
Term
| Is there a significant interpretation discrepancy btwn er and radiologists? |
|
Definition
|
|
Term
| What imaging modality is universally available and relatively inexpensive w/small dose of xrt? |
|
Definition
|
|
Term
| In what pt populations should xrt be avoided when possible? |
|
Definition
| peds and pregnant females |
|
|
Term
| What imaging modality involves image in position of function/pain (wt bearing gripping etc)? |
|
Definition
|
|
Term
| What provides clues to occult systemic inflammatory, metabolic, or neoplastic disease? |
|
Definition
|
|
Term
| What is the goal w/more further and more detailed studies of xrt? |
|
Definition
| to decrease the indeterminate category and confidently be able to increase those in malignant or asymptomatic benign categories? |
|
|
Term
| What is the difference in ionizing radiation w/conventional vs. spiral ct? |
|
Definition
| spiral ct aquired rapidly w/dramatic decreases in radiation doses |
|
|
Term
Some now suggest this should be done in those w/ joint pain before
undergoing any invasive procedure |
|
Definition
|
|
Term
Cannot penetrate beyond cortical bone so limited to only surface of bone (not
intramedullary). |
|
Definition
|
|
Term
Which phase of radioisotope bone scan (technitium-99m) involves serial images (q 2-5 sec) to follow flow of isotope through
vasculature; indicates either inc or decflow? |
|
Definition
|
|
Term
| Which phase of radioisotope bone scan (technitium-99m) involves static images to determine areas of hyperemia |
|
Definition
|
|
Term
Which phase of radioisotope bone scan (technitium-99m) involves static images 2-3 hrs after isotope given to determine areas of inc or
decuptake/remodeling |
|
Definition
|
|
Term
Which phase of radioisotope bone scan (technitium-99m) is only w/ vert compression fx and taken 24 hrs later to compare nml to
abnml vert |
|
Definition
|
|
Term
| Which view is aka frontal? median? horizontal? |
|
Definition
Coronal = Frontal
Sagittal = Median
Axial = Horizontal/Transverse |
|
|
Term
| Why is the nutrient foramen important? |
|
Definition
Nutrient foramen is important d/t possibility that it appears to be a fracture on
the radiograph. |
|
|
Term
| When can you ID osteoporosis? How do you differentiate b/t osteoporosis and osteomalacia? What is it typically termed? |
|
Definition
Bony mineralization:
•Unable to identify osteoporosis until 30-50% loss of bone mass
•Cannot differentiate b/t osteoporosis and osteomalacia
•Typically termed “osteopenia” |
|
|
Term
| Where do primary tumors appear? |
|
Definition
Primary tumors appear in areas of rapid bone growth (i.e. distal femur,
proximal tibia, humerus) |
|
|
Term
| Where in bone do metastases most commonly occur in axial and appendicular skeleton? |
|
Definition
Metastases tend to occur in the red bone marrow in the spine and iliac wings;
in extremities they occur in the metaphyses most commonly |
|
|
Term
| What violates the rule that neoplastic dzs typically respect the cartilage of physes and jt space? |
|
Definition
osteosarcomas may cross the
plate into the epiphysis in 70 -80 % of cases and Ewing's tumor in about 20
%. |
|
|
Term
What represents ossification along the joint corners and grow hor
before vert |
|
Definition
|
|
Term
What represent ossification of Sharpey fibers in Vert discs;
always vertical |
|
Definition
|
|
Term
What represents a variant of both and are ossification of
tendinous/ligamentous attachment points |
|
Definition
|
|
Term
What periosteal rxn is (wavy, uninterrupted, organized) > 2 mm indicated benign process; also
seen in osteomyelitis and fxs |
|
Definition
|
|
Term
What periosteal injury indicates repetitive injury; thought to be pathognomonic of Ewing's
(thin, irregular) but also seen in child abuse or osteo (thicker and wavy) ? |
|
Definition
|
|
Term
What periosteal rxn is almost always assoc w/ malignant bone lesions (most commonly
osteosarcoma); often occurs from repeated breaking through of new periosteal
bone growth |
|
Definition
|
|
Term
What periosteal rxns involve triangular ossification of a piece of periosteum that has been
elevated |
|
Definition
|
|
Term
What osteolytic lesion is Visible w/ the naked eye and large; circumscribed; sclerotic
border means slow growing; ill defined borders mean more moderately
aggressive |
|
Definition
|
|
Term
What osteolytic lesion is discrete small holes in cortical and trabecular bone (indicates
more aggressive activity) |
|
Definition
|
|
Term
What osteolytic lesion has fine bony destruction often seen only on magnification; process
infiltrating the Haversian system; VERY aggressive (Ewing tumor, myeloma,
reticulum cell sarcoma, osteomyelitis) |
|
Definition
|
|
Term
Which transition zone occurs whenthe lesion has time to retreat and lay down new bone
around lesion (geographic lesions) |
|
Definition
|
|
Term
What transition zone occurs when bone retreats w/o laying down new bone
(moth-eaten) |
|
Definition
|
|
Term
What transition zone occurs in aggressive lesions where the boundary b/t NML &
ABNML is lost |
|
Definition
|
|
Term
| What is Substance from which something is made or develops |
|
Definition
|
|
Term
Which 2 fx types require a torque component in the MOI
For non-ambulating children, consider child abuse |
|
Definition
|
|
Term
Which type of fx occur in peds b/c of the pliability of their bony structure
Begin as a cartilaginous template |
|
Definition
|
|
Term
Which fx involves repetitive activity that involves micro-trauma w/o sufficient
time to heal & remodel |
|
Definition
| stress fx- abnml activity |
|
|
Term
Which fx is Associated with vigorous and repetitive activity (e.g. running)
Common sites: proximal post medial tibia, distal fibula,
metatarsal shafts, calcaneus, pars interarticularis, pubic rami, or
femoral neck
Initial x-ray may be negative Treat sxs and repeat x-rays in 7-10
days (look for increased callus at fx site)
Bone scan or MRI may be helpful in those unable to wait
Tx: avoid offending activity |
|
Definition
|
|
Term
Which type of fx Causes include metastasis (lung prostate, or breast CA),
osteoporosis, osteomalacia, syphilis, osteomyelitis, and osteitis
deformans (Paget’s dz)
Tx the fx and the underlying cause |
|
Definition
|
|
Term
| Which fx position involves degree of angular deformity created by fragments |
|
Definition
|
|
Term
| Which fx position involves degree of distal fragment in relation to nml position |
|
Definition
|
|
Term
Which fx involves change in anatomic axis of fragments (side-to-side)
Measure shaft width or % |
|
Definition
|
|
Term
| Which fx position involves amount of separation of fragments pulled apart axially |
|
Definition
|
|
Term
| Which fx position involves amount of overlap or collapse |
|
Definition
|
|
Term
| Which fragment position involves amount of overlap of fragments axially |
|
Definition
|
|
Term
Which salter-harris type •X-ray may be negative
•If visible, physis may be widened, distorted, or displaced
•Confirmation made at f/u w/ stress view or visible bone formation along physis w/in 7-10 days |
|
Definition
|
|
Term
Which salter harris type •Most frequent > 10 yoa
•Treated w/ Closed Reduction
•Excellent Prognosis |
|
Definition
|
|
Term
Which salter harris type •Caused by intra-articular shearing force
•Common in distal tibia
•Treatment: CR
•Prognosis: good d/t blood supply and if redux maintained |
|
Definition
|
|
Term
Which salter harris type Common around distal humerus (lat condyle)
•Treatment: Anatomical Open Redux and IF (ORIF)
•Prognosis: poor unless redux maintained |
|
Definition
|
|
Term
Which salter harris type •Common at ankle and knee
•Initial x-rays often NML; HICS
•Treatment: NWB
•Prognosis: poor d/t early closure of physis |
|
Definition
|
|
