CT3 MSK Radiology

1

1• A 39y.o. goalkeeper falls over playing for

the local club.

• Name of fracture?

Galeazzi

• Distinguishing features?# Radius, Dislocated distal ulna

• “Opposite injury?”

Monteggia

2

2

• An 89 yr old lady who has collapsed in the kitchen complaining of a stiff neck.

• 1. What is the injury?

Type 3 Odontoid peg #

• 2. Name 2 systems for clearing neck injuries.

NEXUS, Ottawa rules

3a

3a.

• A 34 yo motorcyclist thrown from his bike at 65mph.

• Spot the injury

Crush # L4, (subtle wedge # L2)

• Is this likely to be stable or unstable?

Unstable as 2 columns are disrupted

3b

3b

The same motorcyclist also has this injury

• What is it?

True dislocation of knee

• What are the two most important management priorities (after ABC and analgesia!)

Relocation

Imaging of popliteal artery

4

4Another knee injury – this lady fell from a

horse

• What type of # is this?Tibial plateau #

• Give three management principlesABCDE – this is a high impact injury

Analgesia – including comfort slab

Orthopaedic Referral (imaging and definitive treatment)

5a

5a

• 57 yr old man falls off a ladder onto hand

• Name (or describe) of #

Bennett’s fracture

• What is the definitive management?

Requires operative stabilisation

5b

5b

He also sustains this injury.

• In which other specific area do you look for injury?

Spine

6

6• A man falls off his bike straight onto his

shoulder

• Name the injuryA-C joint Dislocation

• What is the prognosis?Good

• What other potentially life threatening injury might you be able to see?

Pneumothorax

7 7a

7

It’s Saturday night…

• Name the xRay

Jug Handle view

• What is the fractured bone?

Left zygomatic arch

7b

7b

He also complains of pain in his Right hand

• What specific factor must you assess to ensure function?

Presence / absence of rotational deformity

8a

818 month old boy who wakes crying in the

night – may have got foot caught in cot sides

Well child, not walking on Lt leg

• Give 2 differential diagnoses?Toddler’s fracture, Hip pathology, Septic arthritis /

osteomyelitis

• What is your management?

Analgesia, make arrangements for review.

8b

He is seen again 2 days later. He is mardy and pale. He is not eating and “feels hot” – having regular calpol.

What 2 differential diagnoses must you consider?

Osteomyelitis

Septic Arthritis

9

9

A 57 yr old lady falls downstairs and has a swollen foot.

• What is the name of injury?Lis-Franc Injury (T-MT # / dislocation)

• What other view do you need?True lateral xRay

10

10Another goalkeeper – a 10 yr old playing in

goal making a crucial save.He is now complaining of a sore wrist

• What is the diagnosis?Torus (buckle) # distal radius

• Give two management points?Splint (or PoP) for analgesia and home

Do not play football for 4-6 weeks

11

11

A 13 y.o. who twisted his ankle and is tender over the base of the 5th Metatarsal

• What is the diagnosis?

Ligamentous injury

12

12

A 27 yr old who fell off a step in a nightclub wearing high heels, and has a swollen ankle.

• What is the injury?

Fracture base of 5th Metatarsal

13

13

A 22 yr old on the 1st day of summer.

• What is the likely mechanism?

• Give 3 things that this man needs?

Analgesia

Tetanus / antibiotics

Urgent debridement and wound toilet

14

14

• Where is the abnormality?

Middle phalanx, ring finger

• What is the most likely diagnosis?

Enchondroma

15

15

An 8 month old baby who got her foot trapped under sofa and was unable to free herself.

She is refusing to W/B.

• What is the injury?

Toddler’s fracture (buckle fracture distal tibia)

16

16• What is the injury?

Fractured surgical neck of humerus

• What other structure is at risk?Axillary nerve

• Give 2 definitive ED management strategies

Collar & CuffHanging U slab

17

17A 67 yr old man who tripped up a kerb

• What 3 radiological signs are there?Elevated anterior fat pad

Visible posterior fat pad

Fracture radial head

• Give 2 options for pain relief?Medication

Collar & cuff

Aspiration of elbow

18

18

• And finally…

Find 3 Abnormalities

Pathological fracture tibia

Missing fibula

Lucencies in distal tibia