CT3 MSK Radiology

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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

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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

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

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4 Another knee injury – this lady fell from a horse What type of # is this? Tibial plateau # Give three management principles ABCDE – this is a high impact injury Analgesia – including comfort slab Orthopaedic Referral (imaging and definitive treatment)

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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

He also sustains this injury. In which other specific area do you look for injury? Spine

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6 A man falls off his bike straight onto his shoulder Name the injury A-C joint Dislocation What is the prognosis? Good What other potentially life threatening injury might you be able to see? Pneumothorax

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7 It’s Saturday night… Name the xRay Jug Handle view What is the fractured bone? Left zygomatic arch

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He also complains of pain in his Right hand What specific factor must you assess to ensure function? Presence / absence of rotational deformity

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8 18 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.

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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

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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

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Another 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

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A 13 y.o. who twisted his ankle and is tender over the base of the 5 th Metatarsal What is the diagnosis? Ligamentous injury

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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 5 th Metatarsal

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A 22 yr old on the 1 st day of summer. What is the likely mechanism? Give 3 things that this man needs? Analgesia Tetanus / antibiotics Urgent debridement and wound toilet

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Where is the abnormality? Middle phalanx, ring finger What is the most likely diagnosis? Enchondroma

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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)

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What is the injury? Fractured surgical neck of humerus What other structure is at risk? Axillary nerve Give 2 definitive ED management strategies Collar & Cuff Hanging U slab

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A 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

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And finally… Find 3 Abnormalities Pathological fracture tibia Missing fibula Lucencies in distal tibia