Perilunate dislocation-Capitate and all other carpal bones lie posterior to lunate on lateral radiograph . Lunate still articulates with the radiusLunat should line up with the radius then capitate then 3rd metacarpal.
Lunate dislocationSpilled teacup sign
Biventricular tachycardia-Digoxin toxicity
Liz Franc fracture: The Lisfranc fracture is a fracture and dislocation of the joints in the midfoot. The Lisfranc joint, which represents the articulation between the midfoot and forefoot, is composed of the 5 tarsometatarsal (TMT) joints. The Lisfranc ligament is attached to the lateral margin of the medial cuneiform and medial and plantar surface of second metatarsal. This is the only ligamentous support between first and second ray at midfoot level. Provides focal point for the tarsometotarsal articulation and supporetSwelling out of proportion with a normal radiographPlantar midfootecchymosisPain along the TMT joints with palpation, motion, and/or weight bearingMidfoot instabilityHomolateral-all 5 in same directionisolated-1 to 2 bones in same directionIf more than 2mm displacement, requires operationCan have fleck sign in the middle
. Dorsal dislocation of the proximal base of the second metatarsal (small arrow) when the foot is placed in extreme plantar flexion with an axial load (large arrow). This dislocation occurs because the base of the second metatarsal extends beyond the horizontal axis.
Jefferson fracture: Burst fracture of the ring of C1· Typically caused by an axial-loading force on the occiput of the head like diving in the pool and landing on the head· Classically, it involves fractures of the anterior arch of C1 on both the right and left sides and the posterior arch of C1 on both the right and left sides (4 fractures)o But fracture variants may include two or three-part fractures Classically there is bilateral, lateral offset of C1 on C2 on odontoid viewminimally displaced fracture (and overhang is < 7 mm), then frx is stable and should be treated in a rigid support, such as a cervicothoracic brace, for 3 month;separation of lateral masses implies that transverse ligament is ruptured, and is therefore unstableCan injure vertebral artery at times
EtiologyRemains unknown Ischemia and/or reperfusion injury may play a role Cluster cases and outbreaks in nurseries imply an infectious etiology A single causative organism has not been found Translocation of intestinal flora across compromised mucosa may play a role Incidence and age at onsetMore common in premature infants But can also be seen in term babies Clinical findingsInitial symptoms may be subtle and can include the following Feeding intolerance Delayed gastric emptying Abdominal distention and/or tenderness Ileus/decreased bowel sounds Imaging findingsAcute disease most commonly affects the terminal ileum Plain film of the abdomen remains method in which disease is diagnosed most often Findings include Dilated loops of bowel Thickened bowel walls Fixed and dilated loop that persists is especially worrisome Absence of bowel gas PneumatosisintestinalisPathognomonic of NEC in newborn Linear radiolucency parallels bowel lumen within bowel wall Represents air that has entered from the lumen
Retropharyngeal abscessMost likely caused my strep, staph, peptostrep, bacteroidesReading xray: Soft tissue swelling if C2 is >7mm and C6>22mm some say 14mmNext study: CT scanComps: resp. distress, sepsis, mediastinitis
Elbow dislocation: Most common posteriorly; if anterior, can cause disruption of the brachial artery/median nerveTo read the radiograph: 1) anterior-humeral line that should intersect the middle third of the capitellum 2) radiocapitullar line which should be drawn from the middle of the radius and bisect the capitellum
angle formed by intersection of line drawn from most cephalic point on tuberosity to highest point of posterior facet w/ line from latter to most cephalic part of posterior process of calcaneus; - measures height of the posterior facet; - normal range is 20-40 deg, hence comparison views of opposite calcaneus can be helpful; If less than 20 degrees, has calcaneal fracture
highest point of the anterior process of the calcaneous to the highest point of the posterior facet and a line drawn tangential to the superior edge of the tuberosity. Decrease indicates posterior facet has collapsed.
Hangman’s fracuture which is a fx of the pedicless of C2 displacing C2 anteriorly on C3. Caused by sudden hyperextension.
Read at the anterior longitudinal line, then posterior longitudinal ligament line, then the spinolaminar line and then the spinous processes-You need to see all 7 vetebral bodies. Evaluate the proper alignment. Evaluate the prevertebral soft tissue distance
Clay Shoveler’sfx. An avulsion of the spinous process of the lower cervical spine, classically C7 caused by intense flexion againsted contracted posterior erector spinal muscles. Stable.
Jonesfx. Transverse fx through the base of the 5th metatarsal 10 to 20 mm distal to the poximal part of the metarsal. Frequently complicated by nonunion or malunion
Boxer’s fracture with volarangulation. Angulation of less than 20 degress in the 4th digit and less than 40 degrees in the 5th digit will not result in impairment. If greater angulation occurs, then reduction should be attenmpted to become less than 15 degrees.
-Posterior hip dislocation most likely occurs (80-90% of hip dislocations) usually by dashboard injuries. Complications include sciatic nerve injury and avascular necrosis of the femoral headStimson maneuver for reduction of posterior hip dislocations: have pt. lying flat prone with legs hanging off of bed and provide downward pressure on pelvis while external and internal rotating affected legAllis maneuver for anterior dislocations: pull interior and superior on the leg below the knee and then upward pressure on the femur (while internal and external rotating the leg) and downward pressure on the pelvis.
Supracondylar fracture of the humerus. On the left is a type I fracture. You can see a posterior and anterior fat pad sign. The posterior fat pad sign is the fat from the olecranonfossa (displaced posteriorly) by hemarthrosis. Posterior fat pad signs are NEVER visible unless there is an injury. There may be a normal thin lucent anterior fat pad in normal radiographsType II supracondylar fracture of the humerus on the right which shows some displacement. Tx for type I is a long arm posterior splint and orthopedic outpt. ConsultType II is closed reduction in the OR and pinning.
The typical presentation is a previously healthy infant boy aged 6-12 months with sudden onset of colicky abdominal pain with vomiting.Paroxysms of pain occur 10-20 minutes apart.Initially, loose or watery stools are present concurrent with vomiting and, within 12-24 hours, blood or mucous is passed rectally.Early in the course, the patient appears completely well between the episodes of abdominal pain.Lethargy may dominate the initial presentation. However, lethargy usually occurs later in the process.
Brugada syndrome characterized by one of several ECG patterns characterized by incomplete right bundle branch block and ST elevations in the anterior precordial leads.
Perforated viscous
Monteggia fracture which is a fracture of the proximal 1/3 of the ulna with associated anterior radial head dislocation. Mostly stable, but needs reduction. If unstable or open-surgery’The Galeazzi fracture-dislocation is an injury pattern involving a radial shaft fracture with associated dislocation of the distal radioulnar joint (DRUJ)
Hill Sachs deformity: cortical depression in the head of the humerus bone. It results from forceful impaction of the humeral head against the anteroinferiorglenoid rim when the shoulder is dislocatedanteriorly.Bankart lesion: a Bankart lesion is an injury of the anteriorglenoidlabrum due to repeated (anterior) shoulderdislocation
Colles fracture is a distal radius fracture with dorsal displacement of the distal fragments.Opposite is smith’s fracture
Legg Calve perthes diseaseLegg-Calvé-Perthes disease (LCPD) is the name given to idiopathic osteonecrosis of the capital femoral epiphysis of the femoral head(when the femoral head is most susceptible to interruption of vascular supply). The condition is often associated with skeletal immaturityEarly findings: Widened joint space With joint effusion or synovial hypertrophy Subchondral linear lucencyCrescent sign Best seen on frog-leg views Represents fracture through necrotic bone Late findings: Fragmentation of femoral epiphysis Increased sclerosis/lucency of femoral epiphysis Loss of height (collapse) of femoral epiphysis Chronic findings: Broad, overgrown femoral head (coxa magna) Short femoral neck Physeal arrest
On plain radiographs, the femoral head is seen displaced, posteriorly and inferiorly in relation to the femoral neck and within the confines of the acetabulum.7 Treatment is primarily operative internal fixation. The goal is to prevent complications such as avascular necrosis (AVN).2,8,9,10 Bilateral SCFE
