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Hallux valgus

Right (degrees) Left (degrees) 1st metatarsophalangeal angle 25 24 1st intermetatarsal angle 15 10

Urinary bladder diverticulum

Os Trigonum and Achilles enthesophyte

Celery stalk – anterior cruciate ligament

Persistent styloid ossicle


Superior accessory fissure

Viral encephalitis



Subgaleal hemorrhage, cephalhematoma and caput succedaneum

Subgaleal hemorrhage Cephalhematoma Caput succedaneum

shaken baby syndrome

Pediatric hydrocephalus

Pediatric hydrocephalus

Understanding terminologies Pathophysiology Etiology Clinical presentation Sites of narrowing in ventricular system Communicating hydrocephalus CSF diversion Imaging findings Sulcal spaces Shunt dysfunction

Placenta previa

If the placental edge is >2 cm away from internal os, it is considered normal. Only two terminologies prefereed.

Nuchal cord

Acute abdomen in pregnancy


Biophysical profile score

Check 4 parameters in 30 minute duration. Scoring system used gives 0 or 2 points for each parameter 6/8 or 8/8 is considered normal If score is <6 on 8, do additional test like non-stress test BPP suggests good fetal tissue oxygenation. Abnormal BPP means fetal acidemia Parameter 2 points Thoracic movement 1 or more…

Amniotic fluid index – gestational age

Gestational age (weeks) Amniotic fluid index (cm) 5th percentile 50th percentile 95th percentile 24 9.8 14.7 21.9 25 9.7 14.7 22.1 26 9.7 14.7 22.3 27 9.5 14.6 22.6 28 9.4 14.6 22.8 29 9.2 14.5 23.1 30 9.0 14.5 23.4 31 8.8 14.5 23.8 32 8.6 14.4 24.2 33 8.3 14.3 24.5 34 8.1…

Aspiration pneumonia

Mycobacterium tuberculosis pneumonia

Staphylococcus pneumonia

Secondary pulmonary nodule disease


Cystic lung lesions

Lower zone lung disease

Upper zone lung disease

Ventriculus terminalis

5th ventricle Dilatation of terminal spinal cord canal

Altman surgical classification of sacrococcygeal teratoma

Type I: primarily external – best prognosis 47% Type II: Dumbell shape with equal external and internal component 34% Type III: mainly internal within abdomen and pelvis 9% Type IV: internal completely 10%, worst prognosis

L2 hydroxyglutaric aciduria

hyperintensity of subcortical white matter normal periventricular white matter hyperintense basal ganglia putamina bilateral cerebellar nuceli hyperintensity

Alexander disease

hyperintensity in subcortica, deep and periventricular white matter hyperintense basal ganglia

Vanishing white matter disease

hyperintensity of deep white matter normal subcortical white matter areas of cavitation

GM2 gangliosidosis

hypomyelination of white matter T1 thalmic hyperintensity, T2 hypointensity

Glutaric aciduria type I

hypoplasia of frontal and temporal insulae open sylvian fissures hyperintensity of posterior putamina

Late infantile neuronal ceroid lipofuscinosis LI-NCL

Diffuse cortical atrophy, sulcal, lateral ventricle enlarged, marked cerebellar atrophy, enlarged 4th ventricle


Clefts in brain that extende from cortex to ventricle lined by dysplastic gray matter


arrested neuronal migration thick 4 layer cortex hourglass or figure of 8 cerebral hemisphere shape posterior > anterior involvement


dilated atrium/occipital horns of lateral ventricle absent corpus callosum vertical posterior course of anterior cerebral artery

Tennis leg

partial or complete tear of plantaris myotendon

Discoid meniscus

More than 14 mm medial to lateral meniscal width commonly involves lateral meniscus failure of resorption of central portion Watanabe classification Complete Incomplete Wrisberg type: no posterolateral meniscal attachment to tibia

Meniscofemoral ligament

From posterior horn of lateral meniscus to medial wall of intercondylar notch Humphrey: ligament passes anterior to posterior cruciate ligament Wrisberg: ligament posterior to posterior cruciate ligament

Chondral injury classification

grade 0: normal grade 1: softening grade 2: partial thickness defect, <50% cartilage depth grade 3: partial thickness defect, >50% cartilage depth grade 4: full thickness defect with or without underlying bone changes

Sinding Larson Johannson syndrome

chronic traction or avulsion of proximal patellar tendon at inferior pole of patella

Osgood Schlatter disease

repetitive traction/avulsion at patellar tendon insertion on tibial tubercle

Sever disease

fragmented sclerotic apophysis of posterior calcaneal process

Kager fat pad

Pre Achilles fat pad

Haglund deformity and triad/syndrome

Deformity: enlarged superior margin of posterior process of calcaneus Triad/syndrome

Check rein deformity

tethering of flexor hallucis longus tendon by flexor retinaculum

Master knot of Henry

place where flexor hallucis longus crosses flexor digitorum longus in foot

Weinstabi classification of achilles injury

Type I: inflammatory response Type II: degenerative changes Type III: partial tear Type IV: complete tear

Skimboarder toe

rupture of dorsal joint capsule due to hyperdorsiflexion

Sand toe

rupture of dorsal joint capsule due to plantar flexion

turf toe

rupture of plantar plate due to hyperdorsiflexion

Chaput Tillaux fracture

avulsion of anterior inferior tibiofibular ligament from lateral margin of anterior tibia

Volkman fracture

Earle fracture posterior inferior tibiofibular ligament avulsion from lateral aspect posterior malleolus

Freiberg infraction

2nd metatarsal head osteonecrosis or osteochondral fracture Mottled sclerosis and lucency flattening of head bone marrow edema Smillie classification Stage I: epiphyseal fissure surrounded by sclerosis Stage II: mild subchondral collapse Stage III: prominent medial and lateral projection of MT head Stage IV: MT head projection fracture, central area of collapse Stage V: extensive articular…

Stress response, fatigue and insufficiency fractures

Stress response: bone marrow edema, long segment periosteal reaction but no fracture line Fatigue fracture: abnormal stress on normal bone Insufficiency fracture: normal stress on weak bone

5th metatarsal fractures

Tuberosity avulsion fracture Jones: metadiaphyseal junction traumatic fracture Stress: similar to Jones, more distal

Lisfranc fracture dislocation types

Homolateral: all metatarsals displaced laterally Divergent: 1st metatarsal displaced medially with rest displaced laterally Partial: not all TMT joints involved Isolated: single TMT joint dislocation Longitudinal: medial displacement of first MT and TMT from rest of Lisfranc joint

Lisfranc ligament

Three components

Sangeorzan classification of navicular body fractures

Type I Coronal fracture, no dislocation Type II Dorsolateral or plantar medial fracture with medial forefoot displacement Type III Comminuted fracture with lateral forefoot displacement

Sanders classification of calcaneal fractures

Two categories Based on number of fracture lines Type I non displaced, no matter how many fracture lins Type II single displaced fracture line – 2 part Type III two displaced fracture lines – 3 part Type IV comminuted Based on position of main fracture line A: lateral 1/3 of joint B: middle 1/3 of…

Hawkins classification of talar neck fractures

Type 1 Non-displaced Type 2 Displaced with posterior subtalar joint disruption Type 3 Displaced with disruption of both ankle and posterior subtalar joints Type 4 Displaced with disruption of ankle, posterior subtalar and talonavicular joints

Osteochondral lesion of ankle

The two common sites posteromedial and anterolateral talar dome Focal injury of articular cartilage and underlying bone sclerotic fracture line concavity of subchondral bone

Weber classification of malleolar fractures

Type A fracture below level of tibial plafond Type B fracture at level of tibial plafond Type C fracture above level of tibial plafond

Os Vesalianum

accessory centre of styloid process base of 5th metatarsal

Os Peroneum

Peroneus longus sesamoid Near lateral margin cuboid ostitis in psoriatic or reactive arthritis, tendinopathy

Ossicles around the navicular bone

Os supranaviculare at dorsal proximal margin Accessory navicular type 1: sesamoid in tibialis posterior tendon type 2: os tibiale externum. at plantar margin of median eminence of navicular. tibialis posterior inserts on this os type 3: enlarged median eminence

Os trigonum

Posterior process of talus Anterior apex Tear drop shape

Sesamoid bone

Ossicle within a tendon Arises to provide a mechanical advantage

Talar axis

Longitudinal line through talus It is aligned with a longitudinal line through the first metatarsal When talar axis below 1st MT axis, pes planus When talar axis is above 1st MT axis, pes cavus

Ankle joint space

Evaluate joint in mortise view Look at medial, lateral and superior components Normal space: <4 mm Equivocal: 4-6 mm Abnormal: >6 mm, suggests ligament injury

Standard foot MRI protocol

Sagittal T1 and STIR Axial T1 and PD fs Coronal PD and T2 fs

Standard views ankle radiograph

AP Mortise Lateral

Lisfranc joint and ligament

Collective name for tarsometatarsal joints Lisfranc ligament maintains stability. Consists of 3 bands that extend from 1st cuneiform to medial base of 2nd metatarsal Injured in forcible plantar flexion of midfoot. Seen as lateral subluxation of 2nd TMT on weight bearing radiograph

Chopart joint

Components: talonavicular and calcaneocuboid joints Both are separate joint cavities but together called the Chopart joint Supination and pronation occurs here

Subtalar joint

3 facets: anterior, mid and posterior The anterior and mid facets form the anterior subtalar joint Posterior subtalar facet forms the posterior subtalar joint which is a separate joint cavity. It bears 50% of the weight and in 15% of population communicates with ankle joint. Inversion, eversion and gliding motion permitted in this joint Anterior…

Components of foot

Forefoot: metatarsals and phalanges Midfoot: all tarsal bones other than talus and calcaneum Hindfoot: talus and calcaneum

Lateral collateral ligament of ankle

Components: anterior and posterior talofibular ligament and calcaneofibular ligament Protects from inversion, anterior translation and rotation stress

Syndesmotic ligaments of ankle

Components include: anterior inferior and posterior inferior tibiofibular ligaments and interosseous ligament Anterior inferior tibiofibular ligament has an accessory band called the Basset ligament slightly inferior to it Posterior inferior tibiofibular ligament has another component inferiorly called the transverse (intermalleolar) ligament Injured in eversion or pronation stress or a rotational injury Keeps fibula in fibular…

Pilon fractures

Axial load injuries Articular surface of tibia is disrupted

Extramedullary hematopoiesis

Compensatory mechanism to increase bone marrow function Seen in thalassemia, hereditary spherocytosis, sickle cell anemia Typically in lower thorax Symmetrical, bilateral Marrow bursts out of bone and appears as soft tissue mass May have fatty content within

Lateral thoracic meningocele

Rare Redundant spinal meninges protrudes through intervertebral foramen Contains CSF Asymptomatic Difficult to distinguish from neurogenic tumors

Ideberg classification of intraarticular glenoid fractures

Kuhn classification of acromion fractures

Thompson classification of scapula fractures

Zdravkovic and Damholt classification of scapula fractures

Classification of acromioclavicular joint injury

Neer classification of distal clavicle fractures

Allman classification of clavicle fractures

Foreign body

Foreign body

Grading of muscle injuries

Delayed onset muscle soreness

Delayed onset muscle soreness (DOMS)

MR grading of muscle injury

Non accidental trauma / child abuse

Common sites of fracture

Mondor disease

Superficial thrombophlebitis Just under the skin Clinically visible Should distinguish from dilated ducts with intraduct content Vein cannot be compressed due to thrombosis Often not detected on mammogram

Sternalis muscle

Rare variant Triangular or round in shape Seen medially adjacent to sternum Look for it in the CC view of mammogram Knowledge of this is imperative to rule out a mass

Poland syndrome

Varying degress of hypoplasia or even absence of Costosternal component of pectoralis major Serratus anterior External oblique Costal cartilages May be associated with syndactyly, other upper limb deformities Ipsilateral breast maybe hypoplastic or absent

Polythelia, polymastia

Polythelia: accessory nipples Polymastia: accessory breasts

Levels of axillary lymph nodes

Level I Inferior and lateral to pectoralis minor Level II Rotter nodes – beneath pectoralis minor Level III Superior to pectoralis minor Level I and II usually removed in full dissection


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