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Clinical Pod Med Exam 1 > 11 - Radiographic Interpretation > Flashcards

11 - Radiographic Interpretation Flashcards

1
Q

Normal radiograph

A
  • Systematic approach
  • First look at the soft tissue going around the foot
  • If you can’t see soft tissue (only see bone), there is a good chance the settings in the tube head wasn’t good
  • If the soft tissue looks similar to the bone, there was probably underpenetration
  • You should be able to see soft tissues, cortices, joint spaces
  • Determination of foot type
  • Foot is a 3-D object
  • So, take 3 views of the foot
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2
Q

3 common views of the foot

A
  • AP
  • Lateral
  • Medial oblique
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3
Q

Foot types

A
  • Normal foot type
  • Supinated foot type
  • Pronated foot type
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4
Q

Things you should NOT see on a normal foot

A
  • Increased soft tissue attenuation & densities (swelling)
  • Breaks in the Cortex (fracture, bone infection)
  • Widening or decreasing of the joint space, and alignment (infection, arthritis)
  • Mechanical Deformities (HAV, Hammertoes, Tailor’s Bunion)
  • Accessory Bones
  • Gas in the Soft Tissues
  • White vessels (this means they have calcification of the vessels which is pathological)
  • Black spots on bottom surface of foot can be ulceration or a breakdown of tissue
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5
Q

Determining the foot type

A
  • X-ray taken in the weightbearing position
  • Standard views include: AP (top), lateral (side), oblique (45 degree angle)

The radiograph should be labeled as weightbearing or non-weightbearing

If the radiograph is taken in the non-weightbearing position you CANNOT determine the foot type * Need a “loaded” foot to determine foot type*

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6
Q

Talus bone

A
  • The position of the Talus is the key to the interpretation of the normal vs. abnormal foot type
  • Talus is a PASSIVE BONE
  • This means there are no tendons attached to the talus ***
  • The talus will ONLY move in relation to the calcaneus ***
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7
Q

Talar position with lateral view

A

The body of the talus is normally parallel with the weight supporting plane

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8
Q

Talar position with AP film

A
  • The head of the talus is closely bound to the calcaneus and is superimposed over the anterior portion of the calcaneus
  • The outline of the sustentaculum tali may be visualized
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9
Q

Cavus foot type

A
  • High arch
  • Increased Calcaneal Inclination Angle
  • Posterior Break in the Cyma Line
  • Bullet Hole Sign (slide 17)
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10
Q

Pronated foot type

A
  • Decreased angle of the Calcaneus
  • Lowered Arch
  • Anterior Break Cyma Line
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11
Q

Calcaneal position lateral view

A
  • Angle of Inclination
  • Density of the sustentaculum tali
  • Lateral tuberosity
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12
Q

Cyma line

A

Representation of the midtarsal articulation

  • Talonavicular Joint
  • Calcaneocuboid Joint
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13
Q

Lateral view of Cyma line

A
  • Should form a smooth S
  • When discussing a deformity it is always in relation to the Talonavicular joint
  • Because the Calcaneocuboid joint is SO stable that it does not move
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14
Q

AP view of Cyma line

A
  • Smooth S curve
  • Not as accurate as the lateral view
  • Less implications
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15
Q

Lis Franc’s ligament

A

Plantar ligament from the Medial Cuneiform to the 2nd Metatarsal Base (strong)

This forms the Lis Franc’s joint or tarsometatarsal joint

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16
Q

Lis Franc’s disruption or injury

A

The bones of the midfoot have very tight articulations - you should NOT see a separation greater than 2 mm between these bones - If you do see a large separation, there is a good chance there has been an injury of the ligaments

Could also see a deviation of the first or other metatarsal

17
Q

Centers of ossification

A
  • Growth plates in locations depending on the particular bone
  • Some bones ossify earlier than others
18
Q

Navicular ossification

A
  • Primary center of ossification will appear between 11 months and 3 years and 8 months
  • The average is 3 years
  • A secondary center of ossification may occur on the tuberosity of the navicular bone

** 3 YEARS **

19
Q

Lateral cuneiform ossification

A
  • Lateral cuneiform ossification will occur within the first year

** 1 YEAR **

20
Q

Intermediate cuneiform ossification

A
  • Intermediate cuneiform ossification will occur between 1 year and 2 years and 11 months

** 2 YEARS **

21
Q

Medial cuneiform ossification

A
  • Medial cuneiform ossification will occur between 11 months and 2 years and 11 months

** 2.5 YEARS **

22
Q

Print the chart on slide 32

A

Said we will focus on this but only went over bones above (navicular, cuneiforms)

Went through x-rays on 33 and 34 to determine the age of the individual based on the ossification centers that were present on x-ray

23
Q

Accessory ossicles

A
  • Small bones usually from a secondary ossification center that fail to unite with the remaining portion of the bone
  • Often times confused with fractures
  • Certain locations on an X-ray that occur more frequently than others
  • Always check with Bilateral Films
  • Most often asymptomatic
24
Q

Common accessory ossicle

A
  • Accessory navicular (Os tibiale externum)
  • Os peroneum
  • Os trigonum
25
Q

Os trigonum

A
  • Failed fusion of the Posterior Process of the Talus
  • Confused often with a fracture “Shepherd’s Fracture” where you fracture off this process
  • Typically the fracture will have a little sharp point or a 90 degree angle whereas a process would be rounded
  • Ossicles are typically bilateral, so this can help you differentiate as well
26
Q

Bipartite sesamoid

A
  • Often confused with a fracture of a sesamoid bone
  • You can get a sharp edge, which would mean a fracture of this has occurred
  • If you have a cartilagenous surface between the bones, you may be confused as to what you are looking at
  • May need to use a bone scan to figure it out
27
Q

Gas formation in the soft tissue

A
  • Gas forming bacterial infection
  • Looks like bubbles
  • Look at other views to confirm
  • Clinically, you may see some hemmorrhagic blistering associated with this (blood blister)
  • If you rub you fingers over top of this tissue, it may sound like crinkling
28
Q

Hallux abducto valgus deformity

A
  • Many angles involved
  • Angle between first metatarsal and second metatarsal will be increase (increased IMA)
  • Because of the high IMA, it will cause the position of the hallux to change
  • The hallux will go into an abducted position (pointing away from the midline of the body)
  • You will see the valgus deformity
  • Look for an irregular edge and bump on the medial side of the first metatarsal head
29
Q

Fractures

A
  • Breaks in the cortex of the bone

- Can be described in a variety of ways

30
Q

Extra-articular fracture

A

Extra articular, non comminuted, nondisplaced fracture of the 5th metatarsal shaft

Slide 44

31
Q

Intra-articular fracture

A

Intraarticular (within the joint)
Non comminuted

Slide 45

32
Q

Hammertoe deformity

A
  • Joint contractures are noted
  • The superimposition of the other digits
  • Might be able to see arthritic changes associated with the hammertoe deformity
  • This will correlate with the reason that the deformity is rigid, semi-rigid or flexible
  • Due to long-term adaptation, we see long term adaptation within the joint
  • Patient may need soft tissue procedure, implant, fusion, etc. based on arthritic changes
33
Q

Calcaneal fracture

A
  • Non-weightbearing
  • Slide 47 is a “text book” example of a calcaneal fracture
  • There are other ways to determine if there is a subtle fracture that we cannot see radiographically
34
Q

Calcified vessel

A
  • Tunica media
  • Does not narrow the lumen
  • Example: Calcified dorsalis pedis
35
Q

NOTE: went back to this at very end of lecture

A
  • Can’t always see the lateral cuneiform
  • You can see superimposition of the cuneiforms
  • Take your time and try to trace the individual bones
  • Especially if there has been trauma
  • Make sure you actually do see a fracture and it isn’t just a joint space

Clinical Pod Med Exam 1 (17 decks)

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