MSK: Fractures for the ABR Core Exam Part 1
Review of selected common and uncommon skeletal fractures for the ABR core exam and other radiology board examinations. From www.theradiologyreview.com, your favorite radiology podcast for radiology board review.
Show Notes/Study Guide:
Fracture resulting from abnormal stress on normal bone = stress fracture
Fracture from normal stress on abnormal bone = insufficiency fracture
Scaphoid fracture site with highest risk for avascular necrosis (proximal or distal)? Proximal pole scaphoid fractures are at highest risk for AVN
Comminuted fracture at the base of the first metacarpal = Rolando fracture
Non-comminuted fracture at base of the first metacarpal = Bennett fracture
The pull of which tendon causes the dorsolateral dislocation in a Bennett fracture? The abductor pollicus longus tendon.
Avulsion fracture at the base of the proximal phalanx with ulnar collateral ligament disruption = Gamekeeper’s thumb.
Same fracture but adductor tendon becomes caught in torn edge of the ulnar collateral ligament? Stener’s lesion. If Stener’s lesion is present this won’t heal on its own so you need surgery. You shouldn’t image a Gamekeeper’s thumb with stress views because you can convert it to a Stener’s lesion. Image with MRI instead.
Distal radial fracture with dorsal angulation = Colle’s fracture (C to D= Colle’s is Dorsal)
Distal radial fracture with volar angulation = Smith’s fracture (S close to V alphabetically so Smith’s is Volar)
Fracture commonly associated with posterior elbow dislocation? Capitellum fracture
Fracture of radial head with anterior dislocation of the distal radioulnar joint = Essex-Lopresti Fracture
Fracture of the proximal ulna with anterior dislocation of the radial head = Monteggia fracture
Fracture of the distal radius with anterior dislocation of the ulna at the distal radioulnar joint = Galeazzi fracture
MUGR= Montaggia is fracture of the Ulna (MU) and Galeazzi is fracture of the Radius (GR)
MonteggiA has an A which is proximal in the alphabet and Monteggia is a proximal fracture with a proximal dislocation
GaleaZZi has two Zs which are distal in the alphabet and a Galeazzi fracture is distal with a distal dislocation
Pediatric elbow fracture that can mimic the trochlear ossification center = Medial epicondyle avulsion fracture
CRITOE – I ossifies before T, so if you have a radiograph missing the internal epicondyle ossification but you apparently have trochlear ossification, this is actually an avulsion fracture, most commonly a medial epicondyle avulsion fracture
C = Capitellum (forms around 1 year of age)
R = Radial head
I = internal epicondyle
T = trochlea
O = olecranon
E = external epicondyle (forms around 10-11 years of age)
Fractures associated with an anterior inferior shoulder dislocation = Hill Sachs fracture (posterolateral humeral head impaction fracture), bankart fracture (soft vs bony lesion) at anteroinferior glenolabrum complex, and greater tuberosity avulsion fracture
Posterior shoulder dislocation is most commonly associated with which fracture: reverse Hill Sachs fracture (anteromedial humeral head impaction fracture—need surgery to prevent AVN)
Femoral neck fracture location associated with a stress fracture = medial side
Femoral neck fracture location associated with bisphosphonate use = lateral side
Displaced intracapsular femoral head fracture may result in AVN due to disruption of which artery? Circumflex femoral artery. Higher degree of displacement = higher risk of AVN
