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Clinical Pod Med Exam 1 > 3 - Lower Extremity Positioning > Flashcards

3 - Lower Extremity Positioning Flashcards

1
Q

Three planes

A
  • Sagittal
  • Frontal
  • Transverse
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2
Q

Sagittal

A

Divides the body into right and left halves

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3
Q

Frontal

A

Divides the body into anterior (front) and posterior (back) portions

Coronal

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4
Q

Transverse

A

Divides the body into superior (upper) and inferior (lower) portions

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5
Q

Positions of the body

A
  • Erect or Vertical (Standing or sitting)
  • Supine (Lying on back)
  • Prone (Lying on stomach)
  • Lateral Recumbent (Lying on side)
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6
Q

Proximal

A

Nearest to the trunk or point of origin

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7
Q

Distal

A

Farthest from the trunk or point of origin

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8
Q

Terms for x-ray

THIS WILL BE ON THE BOARDS

A
  • View

- Projection

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9
Q

View

A

That portion closest to the film cassette

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10
Q

Projection

A

That portion which the X-ray beam enters

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11
Q

Example of view and projection

A

Anterior-Posterior (AP) projection can also be considered a Posterior-Anterior (PA) view

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12
Q

Osseous anatomy of the lower limb

A
  • Lower Leg
  • Tarsal (Rearfoot)
  • Metatarsals (Forefoot)
  • Sesamoids
  • Phalanges
  • Accessory Bones
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13
Q

Lower leg bones

A
  • Tibia (forms medial malleolus)

- Fibulat (forms lateral maleolus)

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14
Q

Tarsal bones (rearfoot)

A
  • Calcaneus
  • Talus
  • Navicular
  • Cuboid
  • Cuneiforms (Medial, Intermediate, Lateral)
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15
Q

What was a AP radiograph of the foot previously called?

A

DP = Dorsal Plantar

No longer used

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16
Q

Metatarsals (forefoot)

A

First through fifth metatarsals

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17
Q

Sesamoids

A
  • Bones within a tendon

- Sesamoids under the first metatarsal are constant

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18
Q

Phalanges

A
  • Proximal
  • Middle
  • Distal
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19
Q

Ankle joints

A
  • Tibia
  • Fibula
  • Talus
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20
Q

Talocalcaneal joint (subtalar joint)

A
  • Talus

- Calcaneus

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21
Q

Talonavicular joint

A
  • Talus

- Navicular

22
Q

Calcaneocuboid joint

A
  • Calcaneus

- Cuboid

23
Q

Medtarsal or choparts joints

A

Talonavicular Joint and Calcaneocuboid Joint

24
Q

Tarsometatarsal or lisfrancs joint

A

Joint between tarsal bones and five metatarsals

25
Q

Metatarsal phalangeal joint

A

Joint between metatarsal and phalanges

26
Q

Interphalangeal joints

A

Joints between phalanges

27
Q

Now we are moving on to the standard radiographic images of the foot and ankle

A

Just so you know…

Seems like this is the “heart” of the lecture (what you need to know for exam)

Looking at the pictures and radiographs on the slides will likely be useful for this

28
Q

Anterior-posterior (AP) radiograph

A
  • Structures Demonstrated: Phalanges, Sesamoids, Metatarsals and Tarsal Bones
  • Central ray: Angle 15° Cephlad, Base of Third Metatarsal
29
Q

Patient positioning for AP radiograph

A

Standing with foot on exposable side of film in angle and base of gait on Orthoposer

This is therefore an AP projection

30
Q

Medial-oblique (MO) view

A
  • NOTE: An MO view is the same as a lateral oblique projection
  • Structures Demonstrated – Phalanges, Metatarsals, Tarsal Bones and Sesamoids
  • Central Ray – Angle tube 45° aim at Lateral Cuneiform
31
Q

Patient positioning for a MO view

A

Patient Position – Standing in angle and base of gait on Orthoposer

32
Q

Lateral-oblique (LO) view

A
  • NOTE: this is the same as a medial-oblique projection
  • Structures Demonstrated – Phalanges, Metatarsals, Tarsal Bones and Sesamoids
  • Central Ray – Angle tube 45° aim at Medial Cuneiform
33
Q

Patient positioning for a LO view

A

Patient Position – Standing in angle and base of gait on Orthoposer

34
Q

Lateral projection of the foot

A
  • NOTE: this is the same as a medial view of the foot (because it is against the cassette)
  • Structures Demonstrated – First Metatarsal, Hallux, Medial Cuneiform, Navicular, Talus and Calcaneus
  • Central Ray - 90° or perpendicular to the Lateral Cuneiform
35
Q

Patient positioning for a lateral projection of the foot

A

Standing in angle and base of gait on Orthoposer

36
Q

Raised lateral hallux projection

A
  • Structures Demonstrated – Proximal and Distal Phalanges of the Hallux
  • Central Ray - 90° or perpendicular to the center of the Hallux
37
Q

Patient position for raised lateral hallux projection

A

Standing in angle and base of gait on Orthoposer with foam under Hallux to decrease overlap of other toes

38
Q

Sesamoid or plantar axial radiograph

A
  • Structures Demonstrated - Inferior aspect of the Metatarsals and Sesamoids
  • Central Ray - 90° or perpendicular to the film and aim at inferior heel
39
Q

Patient positioning for sesamoid or plantar axial radiograph

A

Standing with foot on block

40
Q

Calcaneal axial radiograph

A
  • Structures Demonstrated – Subtalar or Talocalcaneal Joint and the Calcaneus
  • Central Ray - 45° aimed at the posterior Subtalar or Talocalcaneal Joint
41
Q

Patient position for calcaneal axial radiograph

A

Patient standing on the film in angle and base of gait

42
Q

Anterior-posterior of the ANKLE

A
  • Structures Demonstrated – Tibia, Fibula, Talus and Ankle Joint
  • Central Ray – Anterior Ankle Joint
43
Q

Patient position for AP of the ankle

A

Patient standing on Orthoposer with back of leg against the film

44
Q

Ankle mortise

A
  • Structures Demonstrated – Tibia, Fibula, Talus and Ankle Joint: Decreases overlap between Tibia and Fibula
  • Central Ray – Anterior Ankle Joint
45
Q

Patient position for ankle mortise

A

Same as Anterior-Posterior (AP) with foot rotated toward midline 15°

46
Q

What is the difference between an AP ankle and an ankle mortise?

A

The angle of rotation of the foot is the only difference between AP ankle and ankle mortise - know that the AP ankle is the more natural foot position and when we do an ankle mortise, we have to internally rotate the foot 15 degrees

There is MORE overlap with an ankle AP, there is LESS overlap when internally rotating for the ankle mortise (see slide 61)

47
Q

Lateral projection of the ankle

A
  • Structures Demonstrated – Tibia, Fibula, Talus, Calcaneus and Ankle Joint
  • Central Ray - 90° or perpendicular to the film with ray entering Lateral Malleolus
48
Q

Patient position for lateral projection of the ankle

A

Standing with Medial Malleolus against film

49
Q

Ottawa rules

A

Established in 1992

Uses an instrument for assessment of foot and ankle

  • Ability to walk 4 steps
  • Pain in posterior edge or tip of malleoli
  • Pain at navicular or base of fifth metatarsal

Designed to rule out fractures

50
Q

Describe a study done to assess accuracy of the Ottawa rules

A
  • Level 2 – Systematic review of prospective level 2 studies
  • 27 studies with 15,581 patients
  • Evidence demonstrated that Ottawa rules are accurate in excluding fractures of the ankle and mid-foot. Greater than 98% sensitivity.
  • Should reduce unnecessary radiographs by 30-40%

Not really used in the US because the 2% will get you into trouble because you will miss them and it will be malpractice

51
Q

Test questions

A
  • Pretty basic
  • Know the difference between the different types of radiographs
  • Know the difference between projection and view definition
  • What type of radiograph would you order to see certain bones
  • Know AP ankle and ankle mortise, what the difference is, and why you would select one over the other
  • The position of the patient is more of a “skill” so it is not going to be focused on as much

Clinical Pod Med Exam 1 (17 decks)

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