Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
137 Cards in this Set
- Front
- Back
Congenital Bone Anomalies
|
Transitional vertebrae, osteogenesis imperfecta, osteopetrosis, achondroplasia
|
|
Transitional Vertebrae
|
- takes on characteristics of vertebrae on either side of it
- usually occurs btw. T12-L1 or L5-S1 |
|
Where are "cervical ribs" seen & why are they important?
|
- C7-T1 junction
- may exert pressures on nerves (brachial plexus) & cranial artery |
|
Sacralization
|
- a.k.a. transitional lumbosacral vertebra
- L5 fuses partially or totally w/ sacrum |
|
Osteogenesis Imperfecta (OI)
|
- brittle bone disease
- lack of osteoblastic (bone forming) activity & abnormal collagen formation - bones have thin cortices, can look like they have zebra stripes - Technical factors = derease |
|
Osteopetrosis
|
- deficiency of osteoclasts; fault bone reabsorption
- Marble Bone Disease - Technical factors = increase (increased bone density) |
|
Achondroplasia
|
- failure of cartilage that becomes bone to form properly; disrupts ossification process
- MOST COMMON CAUSE OF DWARFISM - significantly affects long bones - can also see: lordosis, bow legs, bulky forehead w/ saddle nose |
|
Osteoporosis
|
- decrease in bone density due to osteoblastic insufficiency
- calcium deposition is normal - caused by: disuse atrophy, menopause, steroids, Cushing Syndrome - Technical factors = decrease |
|
Osteomalacia/Rickets
|
- decrease in bone density due to lack of calcium & phosphorus
- softening of bones in adults despite normal amount of osteoid being present - caused by: vitamin D deficiency, pregnancy |
|
Paget's Disease
|
- Osteodystrophia Deformans
- inflammatory response to a virus that has 3 stages: 1) increase in osteoclasts (makes "holes") 2) osteoclast/osteoblast mix (create increased trabecular bone) 3) burnout - Radiographic appearance: radiolucent osteolysis & radiopaque osteosclerosis; "COTTON WOOL" appearance - technical factors: can't tell unless an x-ray has already been taken |
|
Acromegaly
|
- hypersecretion of GH or HGH; leads to systematic overgrowth of organs & bones
- Patient: enlarged hands/feet, increase in bone size appearing as generalized swelling - Radiographically: bone thickening on skull, large frontal sinuses, long phalanx |
|
Gout
|
- cause: elevated levels of uric acid in blood which deposits into surrounding joints, tissues, & tendons
- most commonly associated w/ feet (1st digit) - Radiographically: "RAT BITE" erosion associated w/ head of long bones @ joint |
|
Legg-Calve-Perthes (LCP)
|
- common lesion of head of femur
- young males aged 5-10 - leads to ischemic necrosis of femoral head, typically unilateral - Radiographically: flattened femoral head due to epiphysis fracture |
|
Benign Neoplastic Bone Changes
|
Fibrous dysplasia, bone cyst, giant cell tumor, chondroma (exostosis & enchondroma)
|
|
Malignant Neoplastic Bone Changes
|
Chondroma (chondrosarcoma), Ewing Sarcoma, Multiple Myeloma, Osteogenic Sarcoma
|
|
Fibrous Dysplasia
|
- fibrous displacement of osseous tiusse; pathologic fracture are common b/c of expansion of bone causing thin eroded cortices
- involving usually long bones, ribs, & facial bones - Radiographically: layer of thick, sclerotic bone termed as a rind ("RIND SIGN") |
|
Bone Cyst
|
- develop beneath epiphyseal plate, migrate down shaft w/ bone growth; comprised of fibrous tissue containing clear fluid
- Typically occurs in proximal humerus & knee of <18 - may not be seen initially on radiograph, when they are seen they show a lucent focus w/ thin cortex creating a sharp boundary |
|
Giant Cell Tumor (Osteoclastomas)
|
- younger population (early 20s)
- common location: long bones arising from epiphysis after closure - causes extensive local damage to bone, doesn't metastasize - Radiographically: large bubbles separated by thin strips of bone, "SOAP BUBBLE" sign |
|
Chondroma - Exostosis
|
- most common form arising from cortex of bone & growing parallel to bone
- seen as localized bone overgrowth @ a joint (common = knee) - flat exostosis occurs @ pelvis & scapula |
|
Chondroma - Enchondroma
|
- occurs anywhere cartilage is present (common area: hands, feet in adolescents)
- The more centrally located the tumor, the greater the possibility of malignancy - bone slowly replaced by calcified & uncalcified hyaline cartilage - Technical factors: decrease |
|
Chondroma - Chondrosarcoma
|
- malignant tumor of cartilage
- typical sites: pelvis, long bones (axial skeleton) - 3x more often in men over age 45 |
|
Ewing Sarcoma
|
- most common primary malignant tumor seen in children aged 5-15; occurs in diaphysis of long bone
- bone has stratified new bone formation, "ONION PEEL" (if seen radiographically, prognosis is very poor) - After diagnosed, staging & follow-ups use MRI |
|
Multiple Myeloma
|
- arises from bone marrow plasma cells (actively hemopoietic [blood-forming] marrow)
- most often seen in adults > 50 - Radiographically: "SWISS CHEESE" appearance (osteolytic lesions) - invariably fatal within a few years (increased risk of paraplegia) |
|
Osteogenic Sarcoma/Osteosarcoma
|
- most common histological form of primary bone cancer
- highly malignant @ 10-30 yrs, second high peak around age 60 if Paget's disease has already manifested - occurs in: distal ends of femur, proximal ends of humerus & radius - metastasizes to lungs early on - Radiographically: "SUNRAY" appearance; dense areas & radiolucent areas creating an arc |
|
Bone Structure: Outer to Inner
|
Periosteum, Cortical, Cancellous, Medullary Cavity Endosteum
|
|
How many bones in the body?
|
206 (Axial = 80, Appendicular = 126)
|
|
Osteoblasts
|
- reside in inner layer of periosteum
- mechanisms of bone growth |
|
Osteoclasts
|
- resides in endosteum
- associated w/ resorption & removal of bone |
|
How do bones grow longer?
|
Results of cells multiplying in the epiphyseal cartilage
|
|
How do bones grow in diameter?
|
By action of osteoblasts & -clasts' working together (as a layer gets cut on inside, layer added on outside)
|
|
Diaphysis
|
- long sections of long bone
- made up of cortical bone - contains marrow within medullary cavity |
|
Epiphysis
|
- round end of long bones
- main contact point for joints |
|
Metaphysis
|
- section of growing bone at either end of diaphysis
- located btw. diaphysis & epiphysis - contains epiphyseal growth plate (physis) - completely ossifies by age 18-25 |
|
Example of Gliding Joint
|
Vertebrae
|
|
Example of Hinge Joint
|
Elbow, knee
|
|
Example of Condylar/Ellipsoidal Joint
|
Wrist or MCP joints in hand
|
|
Example of Saddle Joint
|
Thumb
|
|
Example of Pivot Joint
|
C1/C2 (Dens)
|
|
Example of Ball & Socket Joint
|
Hip, Shoulder
|
|
GO TO SLIDE 14 OF BONE FX & HEALING POWERPOINT
Name the fractures left to right |
Transverse (Simple)
Longitudinal Oblique Spiral |
|
GO TO SLIDE 15 OF BONE FX & HEALING POWERPOINT
Name the fractures left to right |
Longitudinal
Spiral Simple (not complete break of cortical outlines) Compound |
|
GO TO SLIDE 16 OF BONE FX & HEALING POWERPOINT
Name the fractures left to right |
Oblique/Spiral
Communited (3 pieces or more) Impacted Fracture Compression Fracture |
|
Who are compression fractures most often seen in?
|
Postmenopausal women
|
|
GO TO SLIDE 17 OF BONE FX & HEALING POWERPOINT
Name the displacement left to right |
Nondisplaced
Medial Displacement Lateral Displacement Distracted Displacement Superior/Posterior Displacement Distracted w/ Rotation Displacement |
|
When describing a displacement, we are describing a _____________ (proximal/distal) break
|
Distal
|
|
Plastic/Greenstick Fracture
|
- Incomplete fracture w/ opposite cortex intact
- found exclusively in infants & children b/c of softness of cancellous bone |
|
Torus (Buckle) Fracture
|
- 1 cortex is intact w/ buckling or compaction of opposite cortex
|
|
Fatigue/March/Stress Fracture
|
- result of repeated stresses to a bone that would not be injured by isolated forces of the same magnitude
- frequently occur in soldiers during basic ("march" fracture) - Common sites: shafts of 2nd & 3rd metatarsals, calcaneus, proximal & distal shafts of tibia & fibula ischial & pubic rami |
|
Avulsion Fracture
|
- small piece of bone rips away fro bone
- happens often w/ joint dislocation |
|
Pathologic Fracture
|
- occur in bone that has been weakened by a preexisting condition
- most common sites: spine, femur, & humerus |
|
Colles/Smith Fracture
|
- transverse fracture through distal radius w/ posterior angulation & often overriding of distal fracture fragment
- usually associated w/ avulsion fx of ulnar styloid process - usually caused by fall on outstretched hand; most common fracture of wrist |
|
Boxer's Fracture
|
- transverse fracture of neck of 5th metacarpal w/ palmar angulation
- result of a blow struck w/ the fist |
|
What's a good indication of a fracture around the elbow?
|
Displacement of fat pads (Fat Pad Sign)
|
|
Monteggia Fracture
|
- isolated fracture of the shaft of the ulna associated w/ anterior dislocation of the radius @ elbow
|
|
Galeazzi Fracture
|
Combo of a fx of the shaft of the radius & a dorsal dislocation of ulna @ wrist
|
|
Jones Fracture
|
- transverse fracture of the base of 5th metatarsal
- similar S&S to avulsion fxs - common fracture in foot; occur on short axis of bone |
|
How does cortical bone heal after a fracture?
|
- formation of new bone (callus bridge)
- osseous layer forms new bone |
|
How does cancellous bone heal after a fracture?
|
- directly through osteoblastic activity at fracture site
|
|
Time Frame of Fracture Healing
|
Inflammation 10%
Reparative 40% Remodeling 70% |
|
Malunion of Fractures
|
- occurs when bone ends haven't been properly reduce & are misaligned, impairing normal function
- fracture is united, but there's a degree of angular or rotary deformity |
|
Closed Reduction
|
No surgery needed to repair
|
|
Open Reduction
|
Surgical fixation of a fracture
|
|
Which fractures benefit from fixation?
|
All
|
|
External Fixation
|
Used to maintain closed reductions (ex. cast)
|
|
Internal Fixation
|
Used to maintain open reductions (ex. ORIF)
|
|
Stress Sharing
|
Transmits load across fracture, helps w/ healing process
|
|
Stress Shielding
|
- Protects vulnerable fracture from being further hurt in process
- transfers forces across fixator devices - healing times longer |
|
Mesocephalic Skull
|
Petrous pyramids form 47 degree angle w/ MSP
|
|
Brachycephalic Skull
|
Petrous pyramids form 45 degree angle w/ MSP
- more broad from side to side - shorter from anterior to posterior |
|
Dolicocephalic Skull
|
Petrous pyramids form 40 degree angle w/ MSP
- slimmer, longer skull - taller, deeper vertex down to base of skull |
|
Basal Fracture
|
Fracture @ base of skull
|
|
Blowout Fracture
|
Fracture in floor of orbit (usually involves maxilla & maxillary sinuses)
|
|
Contra-coup Fracture
|
Fx to 1 side of structure caused by trauma to other side
|
|
Depressed Fracture
|
Flat bones of calvarium are pressed into cranial cavit
|
|
Tripod Fracture
|
Fx of zygomatic arch & orbital floor w/ dislocation of frontozygomatic suture ("floating" zygoma)
|
|
Mastoiditis
|
- caused by acute otitis media (middle ear infection)
- mastoid fills w/ infected materials & delicate structure within it may deteriorate |
|
Skull Metastases
|
- carcinomas reach brain by hematogenous spread
- most common metastases that reach brain come from lung or breast |
|
On a PA Skull, where should the petrous ridges be?
|
Filling the orbit
|
|
On a PA skull, if 1 side appears larger/wider, this is the side the patient is turned ______________ (toward/away from)
|
Away from
(to correct, face must be rotated back in that direction) |
|
How would tilt be visualized on a PA Skull?
|
By looking @ long axis of nasal septum w/ regard to long axis of IR OR if 1 orbital margin is above the other
|
|
What does a too flexed PA/PA Axial Skull look like?
|
If petrous ridges are seen superiorly to superior orbital margin (patient tucked too much)
To correct, patient needs to extend back |
|
What does a too extended PA/PA Axial Skull look like?
|
Orbits not completely filled w/ petrous ridges
To correct, tuck their chin more |
|
What adjustments would need to be made to get a PA skull w/ a C-collar on?
|
Put a caudal angle on tube allowing OML to be parallel to IR
|
|
PA Axial Caldwell Angulation
|
15 degrees caudal exiting nasion
|
|
How is rotation detected on lateral skull?
|
Sella turcica not seen in profile; mandibular rami not superimposed
|
|
How is tilt detected on lateral skull?
|
Orbital roofs & EAMs not superimposed
Can use magnified mandibular body to ID direction to correct |
|
AP Axial (Towne) Angulation
|
30 degrees for OML
37 degrees for IOML Enters 2.5" above glabella going through EAMs |
|
How is rotation detected on a Towne/Haas?
|
Measure the space between posterior clinoid processes & lateral aspects of foramen magnum
Larger space = rotate towards that side to correct |
|
How is tilt detected on a Towne/Haas?
|
Verified w/ MSP and/or nasal septum parallel to long axis of IR
|
|
Which is seen more, not enough flexion or not enough extension, on a Towne?
|
Not enough flexion (posterior clinoid processes seen superiorly to foramen magnum)
|
|
PA Axial - Haas Method
|
- 25 degree cephalic angle
- enters 1.5" inferior to inion (bump @ back of head) - good method for hypersthenic or trauma Haas is to Towne as PA Skull is to AP Skull |
|
Anatomy to be seen in Haas images
|
Dorsum sellae, posterior clinoid processe within foramen magnum
|
|
SMV (Schuller)
|
(IOML parallel to IR)
- CR perpendicular to IOML directed through sella turcica (right in front of EAM) |
|
What anatomy should be seen in a SMV/Schuller image?
|
Cranial base structures (foramen ovale & foramen spinosum)
|
|
How is rotation detected in SMV/Schuller images?
|
Nasal septum & mental point not parallel to long axis of IR
|
|
How is tilt detected in SMV/Schuller images?
|
Distance btw. TMJ & lateral aspect of skull is skewed (patient is tilted toward side w/ biggest space btw. TMJ/lateral aspect; to correct, tilt away from that side)
|
|
How many cranial bones are there?
|
8 (Calvarium & Floor)
|
|
Calvarium consists of...
|
1 Frontal, 2 Parietal, 1 Occipitl
|
|
Floor consists of....
|
2 Temporal, 1 Sphenoid, 1 Ethmoid
|
|
How many facial bones are there?
|
14
|
|
Tragus
|
Anterior aspect of EAM (little flap of ear on inside of ear, hurts a lot to get pierced)
|
|
How is rotation detected in lateral facial bone images?
|
Sella turcica not in profile, mandibular rami not superimposed
|
|
How is tilt detected in lateral facial bone images?
|
Orbital roofs not superimposed
|
|
Nasal Bone Image
|
(IOML parallel to transverse axis of IR)
- CR 1/2" distal to nasion on bridge - shows side nearest to IR Want to see: acanthion (anterior nasal spine) & frontonasal suture |
|
What common imaging errors are seen in nasal bone images?
|
- overpenetrated/overexposed (tech. factors too high)
- improper collimation - make sure MSP is parallel to plane of IR |
|
Angulation of OML to IR for Waters
|
37 degrees
CR perpendicular exiting the acanthion |
|
Where should the petrous ridges be in a Waters view?
|
Immediately below maxillary sinuses
|
|
What does an Open-Mouth Waters show that a normal Waters view doesn't?
|
Sphenoid sinuses within oral cavity
|
|
What does an Exaggerated Waters show that a normal Waters doesn't?
|
Zygomatic arch fractures
|
|
How is not enough extension detected in a Waters view?
|
Petrosae visualized within maxillary sinuses
|
|
How is rotation detected in Waters/Modified Waters views?
|
Unequal distances from lateral border of orbit to lateral border of skull
|
|
Modified Waters ("Shallow Waters")
|
- OML is 55 degrees angled to IR (trying to place orbital floor perpendicular to IR & parallel to CR)
- CR perpendicular exiting acanthion Want to see: petrosae below inferior orbital margin |
|
Reverse Waters (AP)
|
- OML forms 37 degree angle w/ plane of IR
- CR perpendicular to IR, ENTERING acanthion Want to see: superior facial ones (same as Waters but magnified) |
|
How would a reverse waters be performed in a trauma situation?
|
CR parallel to MML (about 30 degrees), still entering acanthion
|
|
SMV for Arches
|
(IOML parallel to IR)
- CR perpendicular to IOML, entering MSP 1" posterior to outer canthi Want to see: Symmetric arches (how they lay w/ respect to rest of face), no rotation |
|
What common imaging errors are seen in SMV for arches?
|
- overpenetration/overexposure w/ high tech. factors
- too much tilt - rotation (MSP not parallel to long axis of IR) |
|
Unilateral/Tangential for Arches
|
- IOML parallel to IR, CR 1" posterior to outer canthus
- rotate 15 degrees towards affected side, tilt 15 degrees away (ex. if imaging left arch, extend back like normal, turn head left 15 degrees, tilt away 15 degrees) |
|
AP Axial (Modified Towne)
|
- OML perpendicular to IR; CR 30 degrees caudal entering glabella 1" above nasion
Want to see: arches lateral to mandibular rami |
|
How is rotation corrected in a Modified Towne?
|
Rotating away from the side w/ the larger gap between arch & mandible
|
|
Axiolateral Oblique (Modified Law) for Mastoid
|
- IOML parallel to IR, Interpupillary line perpendicular to IR
- CR 15 degrees caudal exiting downside mastoid tip 1" posterior to EAM; 15 degree head rotation Want to see: downside EAM & mastoid air cells posterior to it |
|
What are common imaging errors for Modified Law images?
|
Superimposing auricle (needs to be taped forward), lack of collimation (decreases contrast, increases dose)
|
|
Stenvers Axiolateral Oblique - Posterior Profile
|
- MSP of head makes 45 degree angle w/ IR (placing petrous ridges parallel to IR)
- CR 12 degrees cephalic entering 3-4" posterior & 1/2" inferior to upside EAM Want to see: profile of petromastoid portion closest to IR, petrous ridges 2/3 up the lateral border of orbit |
|
Arcelin Axiolateral Oblique - Anterior Profile
|
- IOML perpendicular to IR, patient's head forms 45 degree angle to IR (Rotate away from side being imaged)
- CR 10 degrees caudal, entering temporal region 1" anterior to EAM & 3/4" above it Want to see: Petrous portion of temporal bone farthest from IR, petromastoid portion in profile |
|
What's a common pathology of the mastoid?
|
Mastoiditis: occurs in mastoid antrum which communicates w/ tympanic cavity (prone to infections)
|
|
What's the largest movable facial bone?
|
Mandible
|
|
PA Mandibular Rami
|
- OML perpendicular to IR, CR exits acanthion
- mental point & nasal septum parallel to long axis of IR Want to see: for a rami fx, demonstrates lateral/medial displacement |
|
PA Axial Mandibular Rami
|
- same positioning as normal PA, 20-25 degree cephalic CR angulation
- Want to see: rami w/ less distortion, slight elongation of body |
|
Axiolateral Oblique Mandible
|
- mandibular body parallel w/ transverse axis of IR (preventing superimposition of Cspine)
- for RAMUS: head in true lateral - for BODY: head 30 degrees towards IR - for SYMPHYSIS: head 45 degrees toward IR - CR 25 degrees cephalic passing through region of interest |
|
What adjustment should be made for muscular/hypersthenic patients for Axiolateral Oblique Mandible images?
|
Adjust MSP of skull 15 degrees, open inferiorly, reduce CR angle to 10 degrees
|
|
AP Axial TMJ (Bilateral)
|
- obtain both closed & open mouth images
- OML perpendicular to IR - CR 35 degrees caudal entering midway btw TMJs, 3" above nasion Want to see: condyles of mandible & mandibular fossae of temporal bones |
|
Axiolateral Oblique TMJ (Bilateral)
|
- obtain both closed & open mouth images
- AML parallel w/ transverse axis of IR, center 1/2" anterior to downside EAM - CR 15 degrees caudal exiting through TMJ closest to IR, 1.5" superior to upside EAM Want to see: condyles & necks of mandible |
|
What anatomy should be seen in closed mouth Axiolateral Oblique TMJ?
|
Condyle within mandibular fossa
|
|
What anatomy should be seen in an open mouth Axiolateral Oblique TMJ?
|
Condyle inferior & anterior to mandibular fossa
|
|
What's the main purpose for imaging the orbits?
|
Foreign body localization or fracture identification
|
|
Parietoorbital Oblique (Rhese Method)
|
3 POINT LANDING: zygoma, nose, & chin rest against IR
- AML perpendicular to IR, CR perpendicular entering 1" superior & posterior to upside TEA Want to see: optic canal @ end of sphenoid ridge ("on end"), lying in inferior & lateral quadrant of orbit |
|
What's the most common positioning error for orbits?
|
Insufficient extension (optic canal too far superior)
Another one: insufficient rotation from midline (orbit too medial) |
|
Parietoacanthial (Modified Waters) for Eye
|
- OML forms 50 degree angle w/ IR (center IR to orbits, rest patient's chin on IR)
- CR perpendicular through mid-orbits (have patient clos eyes & keep closed to keep from moving) Want to see: petrous ridges below orbital shadows, orbital margins free of superimposition |