10) Fracture Clinic

Question 1

Ten commandments of emergency radiology

Answer 1

1. Treat the patient, not the x-ray
2. Take a history and examine the patient before requesting an x-ray
3. Only request a radiograph when necessary
4. Never look at an x-ray without seeing the patient first, and never see a patient without looking at their x-ray.
5. Look at every x-ray, the whole x-ray and the x-ray as a whole: remember the ABC’s of x-ray interpretation (A = Adequacy and Alignment; B = Bone; C = Cartilage and joints; S = Soft tissues).
6. Re-examine the patient when there is an incongruity between the x-ray and the expected findings.
7. Apply the Rule of Twos
8. Take x-rays before and after procedures
9. If an x-ray does not look quite right, ask and listen
10. Try to ensure that you are protected by a variety of “fail-safe” mechanisms: e.g. a green and red label system for prioritizing radiology reporting.

Question 2

The ABC’S

Answer 2

• Alignment
• Bone density/cortical margins
• Cartilage and joints
• Soft tissue

Question 3

Alignment

Answer 3

• Subluxation/dislocation

Question 4

Bone density/cortical margins

Answer 4

• Bony mineralization/demineralization

- Cortex (fractures, erosions, bone production (e.g. osteophytes)

Question 5

Cartilage and joints

Answer 5

• Joint space narrowing/widening

- Subchondral sclerosis

Question 6

Soft tissue

Answer 6

• Soft tissue swelling
• Soft tissue calcification
• Air/gas
• Foreign bodies