image based Q. 109 - Read this column

Q.    All of these injuries are associated with 'column' in their structures to direct our treatment except?


a. Distal humerus
b. Spine
c. Pelvis
d. Distal radius
e. Proximal tibia
f. Proximal humerus

Answer -
f

Distal humerus has two columns viz. medial and lateral and fixation is done to regain the anatomy of both columns.

Spine has been divided into three column anterior, middle and posterior.

Acetabulam in pelvis also has columns Anterior , posterior apart from similar walls.

Distal radius has also been divided in columns in one of recent classification viz radial column, intermediate and ulnar column.

One if the classification of proximal tibia uses three column concept based on fracture pattern on CT scan. Surgical management for these also refers to ' three column fixation' of tibia.

image based Q. 108 - It sucks

Q.  What in below image arrow indicate ?

a. Dreaded black line
b. Radiolucent line
c. Vacuum phenomena
d. Discitis
e. discography

(click on image to enlarge)
































































































Answer -
c
The degenerative spine with reduced dusc space suggests degenerative disc disease. The rupture of disc and presence of air shows a black line.
It is also related to vertebral osteonecrosis due to various causes.

image based Q. 107 - Growing pains

Q.   Growth arrest is radiologically seen as

a. Zebra lines
b. Dense metaphyseal band
c. Harris lines
d. Radiolucent lines

Answer -
c
Dense metaphyseal band also called as 'lead line'  is seen in lead poisoning.

Zebra lines are seen as alternating pattern of bands of radioopacity seen in metaphyseal area in cases of osteogenesis imperfecta on treatment with bisphosphonates.

Radiolucent lines on the other hand are used for radiological assessment following arthroplasty for loosening of prosthesis.

Harris lines ( after Dr H. Harris) represent growth arrest and are seen as line of increased bone density. These are also called growth resumption lines.

Image based Q. 106 - Line of control

Q.  Which of these is least  useful in radiographic assessment in Trauma settings?

a. Spinolaminar line
b. iliopectineal line
c. radiolucent line
d. anterior humeral line
e. Gilula lines/ arc

Answer -
c

The spinolaminar line helps assessment of spinal injury while iliopectineal line does same for suspected Acetabulam fracture. ( below image line c is spinolaminar line)

Gilula arcs are smooth parallel lines demonstrating any carpal or intercarpal injury if disrupted.

 Anterior humeral line is important landmark to assess initial fracture as well as post reduction assessment after fracture management in cases of pediatric supracondylar fracture of humerus.

Radiolucent lines (RLL) on the other hand are related to joint prosthesis assessment in the follow up after arthroplasty for assessment of loosening.

image based Q. 105 - Watching the back

Q.  All of these disorders are associated with spine except?

a. Kummel's disease
b. Baastrup disease
c. Ponticulus posticus
d. Camurati- Engelmann disease

Answer -
d

Kummel' s disease is osteonecrosis of vertebral body that presents with vertebral body compression. post traumatic avascular necrosis may present radiologically with ibtravertebral 'vacuum phenomenon'.

Baastrup disease is associated with spinous processes that are hypertrophied in adjacent lumbar vertebrae and rub against each other to produce pain and disability. It is also known as ' kissing spine ' disease.


Ponticulus posticus is anomaly consisting of joining of vertebral firaamen in first cervical ( Atlas) vertebra.  It is also known as ar uate There is bony bridge of posterior altantooccipital membrane thus covering g groove of vertebral artery. Also known as Kimmerle' s anomaly.

Camurati- Engelmann disease is a progressive diaphyseal dysplasia involving diaphyseal bones with diffuse thickening and hypertrophy. Usually long bones are involved.

image based Q. 104 - Unlocked

Q.  " pseudodislocations" are found in ?

a. Hip joint
b. Shoulder joint
c. Acromioclavicular joint
d. Distal tibiofibular joint
e. Proximal tibiofibular joint

Answer -
c

 Acromioclavicular (AC) injuries in skeletally immature cases are typically physeal injuries or occult fractures and not ligament injuries, and AC dislocations have been referred to as “pseudodislocations. ”