What Radiology Residents Need to Know: Musculoskeletal Radiology

390 Pages·2022·19.282 MB·English

by  Ronald L. Eisenberg

What Radiology Residents Need to Know
Series Editor: Ronald L. Eisenberg
Ronald L. Eisenberg
What Radiology
Residents
Need to Know:
Musculoskeletal
Radiology
What Radiology Residents Need to Know
Series Editor
Ronald L. Eisenberg, MD, JD
Department of Radiology
Beth Israel Deaconess Medical Center
Boston, MA, USA
The books in the What Radiology Residents Need to Know series act as an
introduction to radiology, specifically designed for the needs of residents on their
first rotation in a specific subspecialty. Radiology residents are asked to learn
significant amounts of information at a fast and unrelenting space. The current
available literature for residents, though, is dense and includes more information
than they can easily digest, while the number, variety, and quality of images is
often limited. This forces residents to turn to quick searches on the internet to seek
out information that often is not at their exact level of knowledge and leaves gaps
in their learning. What Radiology Residents Need to Know answers resident needs
for each radiology rotation, presenting the material in bullet fashion and dividing it
into convenient sub-units, such as introductory clinical information followed by
“imaging findings” and, when appropriate, “management.” In most cases, an
individual pathological condition is presented in one page or less, allowing
residents to quickly review the essential information on a specific pattern or
disease. Books in the What Radiology Residents Need to Know series contain a
large number of high-quality images, as well as a downloadable set of additional
images that give readers a comprehensive library of illustrations. With both
readable text and a broad spectrum of images, the books in the What Radiology
Residents Need to Know series serve as an ideal guide for radiology residents.
More information about this series at http://www.springer.com/series/16552
Ronald L. Eisenberg
What Radiology Residents
Need to Know:
Musculoskeletal Radiology
Ronald L. Eisenberg, MD, JD
Department of Radiology
Beth Israel Deaconess Medical Center
Boston, MA
USA
ISSN 2662-9569 ISSN 2662-9577 (electronic)
What Radiology Residents Need to Know
ISBN 978-3-030-72381-1 ISBN 978-3-030-72382-8 (eBook)
https://doi.org/10.1007/978-3-030-72382-8
© Springer Nature Switzerland AG 2022
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To Zina, Avlana, and Cherina
Preface
Each first-year rotation is a scary experience for new radiology resi-
dents. A contributing factor is the lack of a textbook specifically
geared to their needs. When asked by several residents what they
should read during their first chest rotation, I realized that I had no
good answer. Current available series have far too much material for
a generation that does not like to read books and wants to receive
information in a shorter and simpler format. Although some residents
read at night about topics they encountered in cases interpreted during
the day, this is ineffective, since first-year residents need to know
something about the many conditions that they never will see during
a four-week rotation.
My solution was to develop What Radiology Residents Need to
Know: Chest Radiology, a new approach to meet the needs of resi-
dents during their first rotation on thoracic imaging. When this proved
to be a success, I decided to continue this approach by developing this
second book, What Radiology Residents Need to Know:
Musculoskeletal Radiology, which is divided into 15 parts. Using an
easy-to-read bullet format, the book includes all the necessary mate-
rial for a first-year resident. In addition, it provides valuable tips on
how to approach and interpret musculoskeletal images based on
decades of practical experience and teaching residents at the
workstation.
All books suffer from a limitation on the number of images due to
space requirements and cost. To address this problem, a critical com-
ponent of What Radiology Residents Need to Know: Musculoskeletal
Radiology is the accompanying e-platform. This contains additional
images to fully illustrate points made in the text.
Boston, MA, USA Ronald L. Eisenberg
vii
Acknowledgments
Special thanks to Frank Gaillard, MD, founder and editor-in-chief of
Radiopaedia, for generously allowing me to use images from this
incredible radiology teaching resource that our residents use every
day, as well as to the radiologists and radiology trainees from across
the world who have contributed cases to it. Thanks for image editing
go to Michael Larson for adding arrows and cropping the large num-
ber of illustrations in the print and electronic formats, as well as ensur-
ing that all images have been transformed into a resolution level
suitable for printing. I also want to thank Drs. Jim Wu and Jennifer Ni
Mhuircheartaigh for contributing valuable images, checking parts of
the manuscript for accuracy, and general encouragement during the
preparation of this book.
ix
Contents
1 Trauma: Introduction and Spine . . . . . . . . . . . . . . . . . . . 1
General Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Fracture Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Fracture Site . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Position of the Distal Fragment . . . . . . . . . . . . . . . . . . . . 4
Angulation: Two Approaches . . . . . . . . . . . . . . . . . . . . . . 6
Special Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Chronicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Intra-articular Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Fracture Healing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Normal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Delayed Union . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Nonunion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Malunion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Stress Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Cervical Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Imaging Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Atlantoaxial Subluxation . . . . . . . . . . . . . . . . . . . . . . . . . 16
Jefferson Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Odontoid Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Hangman’s Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Flexion Teardrop Fracture . . . . . . . . . . . . . . . . . . . . . . . . . 21
Extension Teardrop Fracture . . . . . . . . . . . . . . . . . . . . . . . 22
Locked Facet Joint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Clay Shoveler’s Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Thoracolumbar Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Anterior (Wedge) Compression Fracture . . . . . . . . . . . . . 26
Burst Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Chance Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
xi
xii Contents
Sacral Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Coccyx Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
2 Trauma: Upper Extremity . . . . . . . . . . . . . . . . . . . . . . . . . 33
Shoulder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Acromioclavicular (AC) Separation/Dislocation . . . . . . . 33
Anterior Dislocation of the Shoulder . . . . . . . . . . . . . . . . 34
Bankart Lesion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Hill-Sachs Deformity . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Posterior Dislocation of the Shoulder . . . . . . . . . . . . . . . . 37
Inferior Dislocation of the Shoulder . . . . . . . . . . . . . . . . . 38
Distal Humerus, Elbow, Forearm . . . . . . . . . . . . . . . . . . . . . 39
Supracondylar Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Radial Head Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Complex Forearm Fracture-Dislocations . . . . . . . . . . . . . 42
Greenstick Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Wrist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Colles’ Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Smith Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Chauffer (Hutchinson) Fracture . . . . . . . . . . . . . . . . . . . . 48
Wrist Dislocations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Triquetral Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Scaphoid Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Rotary Subluxation of the Scaphoid . . . . . . . . . . . . . . . . . 55
Hand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Bennett Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Rolando Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Gamekeeper’s Thumb . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Mallet Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Boutonniere Deformity . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Volar Plate Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Boxer’s Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
3 Trauma: Pelvis, Hip, Lower Extremity,
and Avulsion Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Pelvis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Pelvic Insufficiency Fracture . . . . . . . . . . . . . . . . . . . . . . 63
Fractures Involving the Rami . . . . . . . . . . . . . . . . . . . . . . 64
Acetabular Fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66