Slide 1

4 June 2014HANDOUT - Outline

CHRISTOPHER CERNIGLIA, DO, MEng

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Slide 2

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Slide 3

Axial Trauma Spine Pelvis

Appendicular Trauma Upper Extremity Lower Extremity

Sequela & Complications

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Slide 4

Clavicle & AC joint Shoulder & GH joint Elbow Forearm Wrist Hand

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Slide 5

Grades of acromioclavicular joint separation Clavicle fracture Sternoclavicular fracture / dislocation Post-traumatic osteolysis

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Slide 6

Anatomic vs. surgical neck humerus fracture

Greater tuberosityhumerus fracture

Scapular fracture Body Glenoid

Dislocations Anterior (a) Hill Sachs fracture (b) Bankart fracture (c) Recurrence

Posterior (a) Reverse Bankart (b) Neurovascular

injuries Other Inferior scapulothoracic

dissociation*

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Slide 7

Rotator cuff tear Labral injury

Patterns of instability SLAP tear

Proximal biceps tear or dislocation

Impingement syndrome Anterior Posterior Coracoid

Adhesive capsulitis

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Slide 8

Radial head fracture Fracture/dislocation Humeral condyle fractures Extensor tendinosis (tennis elbow/lateral

epicondylitis) Flexor tendinosis (pitcher’s elbow/medial

epicondylitis) Ulnar collateral ligament tear Radial collateral ligament tear Biceps avulsion Triceps avulsion

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Slide 9

Galeazzi fracture/dislocation Monteggia fracture/dislocation Isolated ulna (nightstick) fracture

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Slide 10

Colles fracture Smith fracture Radial styloid fracture Isolated carpal bone fracture

Scaphoid fracture Significance of blood supply Osteonecrosis Non-union

Triquetral fracture Hamate fracture Other

Complex carpal bone injuries Perilunate dislocation Lunate dislocation

Ligament tears Interosseous ligaments Triangular fibrocartilage

complex Extrinsic ligaments

Chronic carpal instability Dorsal intercalated

segment instability Volar intercalated segment

instability Scapholunate advanced

collapse Distal radioulnar joint injury Carpal tunnel syndrome Ulnar impaction syndrome

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Slide 11

Phalanx fracture / dislocation Intra vs. extra articular Volar plate fracture Tuft fracture

Metacarpal fracture Bennett vs. Rolando fracture Boxer fracture

Carpometacarpal dislocation Tendon injuries Pulley injuries Capsular and collateral ligament injuries

Gamekeeper (skier) thumb Metacarpophalangeal joint

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Slide 12

Hip Femur Knee Ankle Foot

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Slide 13

Acetabular fracture - fracture patterns Hip dislocation - risk of osteonecrosis Femoral neck fracture Intertrochanteric fracture Femoral head fracture Labral injury

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Slide 14

Femoral condyle fracture

Tibial plateau fracture

Knee dislocation

Patella fracture

Patella dislocation

Meniscal injury Bucket handle tear Parrot-beak tear Horizontal oblique tear Horizontal cleavage tear Vertical longitudinal tear Radial tear Complex tear Root tear Meniscocapsular

separation Fraying and degeneration Displaced fragments Meniscal cyst

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Slide 15

Ligament injury Anterior cruciate Posterior cruciate Medial collateral Lateral collateral

Extensor mechanism injury Quadriceps tear Patellar tendon (ligament)

tear Retinaculum injury

Posterolateral corner injury Popliteus muscle/tendon Arcuate ligament* Popliteofibular ligament* Fabellofibular ligament*

Articular cartilage injury Overuse injuries

Plica syndrome Iliotibial band friction

syndrome Pes anserine bursitis

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Slide 16

Mechanisms of injury Pilon fracture Tilleaux fracture Maisonneuve fracture Ligament injury

Anterior talofibularligament

Deltoid ligament Syndesmotic/anterior

tibiofibular ligament

Talar fracture Dome fracture Neck fracture Lateral process

fracture

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Slide 17

Calcaneal fracture -anterior process fracture

Fifth metatarsal base fracture

Metatarsal fracture

Lisfrancfracture/dislocation

Phalanx fracture Cuboid fracture Navicular fracture

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Slide 18

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Slide 19

Osseous Lesions Benign Malignant Primary Secondary

Soft Tissue Lesions Benign Malignant Primary Secondary

Tumor-Like Lesions

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Slide 20

Cartilaginous Enchondroma Multiple (Ollier disease) Maffucci syndrome

Osteochondroma -Multiple hereditary exostoses

Chondromyxoid Fibroma Chondroblastoma Chondroma - Periosteal

(surface, juxtacortical)

Fibrous Fibroxanthoma (non-ossifying

fibroma) Fibrous cortical defect Benign fibrous histiocytoma

Fibrous dysplasia - McCune-Albright

Chondromyxoid fibroma Desmoplastic fibroma Osteofibrous dysplasia

(ossifying fibroma)* Osteogenic

Enostosis (bone island) -Multiple

Osteoma - Multiple Osteoid osteoma Osteoblastoma

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Slide 21

Lipoid Lipoma Liposclerosing myxofibrous

tumor (LSMFT)*

Vascular Hemangioma - Multiple

(Osler-Weber- Rendu) Hemophilic pseudotumor Lymphangioma Glomus tumor Hemangiopericytoma* Gorham disease*

Other Unicameral bone cyst (simple

bone cyst) Aneurysmal bone cyst

(a) Primary (b) Secondary

Giant cell tumor of bone Langerhans cell histiocytosis

(eosinophilic granuloma) Chordoma Intraosseous ganglion Reactive lesions

Giant cell reparative granuloma Bizarre parosteal osseous

proliferation (BPOP)* Epidermoid inclusion cyst

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Slide 22

PRIMARY Cartilaginous - Chondrosarcoma

Central Peripheral Dedifferentiated Mesenchymal Clear cell

Fibrous Fibrosarcoma Malignant fibrous histiocytoma

Osteogenic - Osteosarcoma Conventional Surface

Periosteal Parosteal High grade surface

Telangiectatic Low grade central

Vascular Angiosarcoma Hemangioendothelioma

Other Chordoma Multiple myeloma (plasmacytoma) Ewing sarcoma Primitive neuroectodermal tumor

(PNET) Adamantinoma Lymphoma Leukemia

chloroma

SECONDARY Radiation Pagets Metastatic

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Slide 23

Fibrous Fibroma Fibromatosis Desmoid Elastofibroma

Neural Neurofibroma Schwannoma Neurofibromatosis Neuroma Lipomatosis of nerve

(fibrolipomatoushamartoma)

Post-resection neuroma Morton neuroma

Cartilaginous - soft tissue chondroma

Vascular Hemangioma Hemangioendothelioma Glomus tumor Vascular malformations Lymphangioma

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Slide 24

Lipoid Lipoma Angiolipoma Hibernoma Lipoblastoma

Muscle Rhabdomyoma Leiomyoma

Dermal/subcutaneous Sebaceous cyst /

Epidermoid cyst Dermatofibroma Granuloma annulare Granular cell tumor*

Other Myxoma Giant cell tumor of

tendon sheath Pigmented villonodular

synovitis Ganglion

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Slide 25

PRIMARY Fibrosarcoma Malignant fibrous

histiocytoma (high-grade undifferentiated pleomorphic sarcoma)

Synovial sarcoma Rhabdomyosarcoma Malignant peripheral nerve

sheath tumor Epithelioid sarcoma* Liposarcoma

(a) Myxoid (b) Well-differentiated (c) Dedifferentiated

Melanoma

SECONDARY Metastasis Leukemia Lymphoma Soft tissue extension of

bone lesion

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Slide 26

Outline Adapted from: Appendix: Musculoskeletal Radiology

Curriculum Guide of the Musculoskeletal Radiology Curriculum for Radiology Residents Revised by the Residency and Fellowship Education

Committee of the Society of Skeletal Radiology, 2003-2005

Advanced concepts indicated by an asterisk (*) Highlighted Cases were presented.

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