Intro lecture
What are the priveleges of Military PTs?
1. Diagnostic imaging
2. Prescribing analgesics, NSAIDs, muscle relaxants
3. Restricting pts to living quarters for 12 hours
4. Restricting work and training up to 30 days
5. Referring pts to other medical specialties
Who discovered x-rays?
Wilhelm Conrad Rontgen (1895)
-Awarded Nobel Prize for Physics in 1901
Simple vs. Comminuted fx
Simple=2 bone fragments
Comminuted=greater than 2 fragments
Malgaigne vs Bucket Handle fx
Malgaigne fx: ipsilateral SIJ and ipsilateral ischio-pubic rami, unstable pelvis, shortening of ipsilateral LE (clinically)-->IPSILATERAL involvement
Bucket handle fx: crosses one side to other, SIJ with contralateral superior and inferior pubic rami fxs-->CONTRALATERAL involvement
ABCDE Screening for Melanoma
Asymmetry
Border (even vs uneven)
Color (one color vs multiple)
Diameter (>1/4 inch)
Evolving (changing in size, shape, color)
Countries where physiotherapists have imaging rights:
England (UK), Australia, South Africa, Netherlands, Norway
5 Basic Radiographic Densities
Metal (hardware)=bright white
Mineral (bone)=white
Fluid/soft tissue (organs)=gray
Fat (adipose)=dark gray
Air (lungs)=black
Torus fx
Axial forces cause cortex to buckle
-occurs most frequently in metaphysis
Maisonneuvre fx
Fx of proximal 1/2 of tibia, greater damage to interosseous membrane, result of very strong INVERSION of ankle
Risk factors for melanoma
-Hx of previous melanoma
-Male
-Age >50
-Changing mole
-Presence of many moles
Ottawa Knee Rules
If pt has any of following, need to get an x-ray:
-Older than 55 yo
-Tenderness at fibular head
-Isolated tenderness at patella
-Unable to flex knee >90 deg
-Inability to WB 4 steps immediately after injury and in ER
Analysis of Structure on an X-Ray (ABCs)
Alignment
Bone density
Cartilage spaces
Soft tissues
Extension teardrop vs flexion teardrop fx
Extension teardrop fx: STABLE, result of extension injury, anterior inferior avulsion of vertebrae (usually higher level, C2/C3)
Flexion teardrop fx: UNSTABLE (severe), result of flexion injury, results in disruption of ligaments and intervertebral discs (posterior displacement of body itself), often results in anterior spinal cord compression (see irregularity of posterior portion of vertebral body, possibly lower segments)
Jones fx
1-2 cm distal to styloid, 5th metatarsal
(if true Jones fx is not immobilzed, non-union is concern)
Growth plate injuries (Salter Harris Classification)
Type 1: fx through growth plate
Type 2: most common, extends through metaphysis (producing a chip fx of metaphysis)
Type 3: most likely to cause growth problems (extends through epiphysis)
Type 4: physeal fx PLUS epiphysis and metaphysis fxs
Type 5: SEVERE, compression fx of growth plate
SPECT (what are they good for and what is a limitation?)
-Found to be much more sensitive than plain radiographs in detected pars defects
-Shows evidence of STRESS REACTIONS or subacute pars injuries before development of radiographic changes
-Important limitation: cannot reliably differentiate between spondylosis and other pathology at the pars (ie. osteomas, facet arthritis, infections, neoplasms)
**Picks up activity but does NOT specify what's going on
Osteoblastic (radio-opaque, opacity, sclerosis, increased radio density, blastic lesion)
Osteoclastic (radiolucent, lucency, osteopenia, decreased radio density, lytic lesion or "lysis", demineralization)
Osteoblasts (build up), osteoclasts (break down)
Monteggia vs Galliazzi fx
Monteggia fx: fx of ulna with accompanied radial head dislocation, elbow pain, fall or direct elbow (pronated forearm)
Galliazzi fx: proximal radius fx with associated distal radioulnar jt dislocation
*GRUM*
Easily missed fxs
Scaphoid fx
Buckle fxs of radius/ulna
Radial head fx
Supracondylar fxs in children (3-8 yo)
Posterior dislocation of shoulder
Hip fxs
SCFE
Slipped Femoral Head Epiphysis
-Salter Harris Type 1*
High risk of morbidity (risk of AVN)
RED FLAGS
-Immunosuppressed, recent infection/surgery
-Hx of trauma with onset, steroid use, hx of osteoporosis or compression fx
-Insidious onset of pain
-Pain that cannot be provoked
-No relief at bedtime, night pain
-Progressive neurological deficit
-Recent bowel/bladder dysfunction
-Saddle anesthesia
**HOT (fever, night sweats)
**TIRED (fatigue, night pain, weakness)
**HUNGRY (loss of appetite, weight loss)
What are X-Rays used to identify?
Fractures, growth plate injuries, jt dislocations, arthritis, edema, bone density (osteoporosis), tumors, foreign objects, infection (osteomyelitis), anatomy during surgical procedures
What is the most common elbow fx in adults?
Radial head fx
-FOOSH
-anterior fat pad sign=SAIL'S sign
What are the benefits AND limitations AND risks of x-ray?
Benefits: fastest/easiest way to view/assess broken bones and jt injuries, relatively inexpensive/available, useful in emergency dx and tx
Limitations: provide little info about adjacent soft tissues-->MRI is more useful in identifying soft tissue injuries
Risks: always slight chance of damage to cells or tissue from radiation, pt exposed to ~20 milli rontgens of radiation per single x-ray
Hill Sachs lesion