Common Limb Xray Findings (shoulder, wrist, ankle) - Interpretation Flashcards
Introduction
I have the (limb)Xray of (patient name, DOB), taken on (date, time) having presented with a (duration) Hx of (PC)
I would like to request any previous imaging for comparison
Views of
- shoulder
- elbow
- wrist
- knee
- ankle
Shoulder - AP, lateral Y view
Wrist - PA, lateral
Ankle - AP, lateral
- Alignment and adequacy
Adequacy - can you see all relevant structures
Shoulder
-distal clavicle, scapula, GHJ, ACJ
Alignment of GHJ
AP - glenoid fossa medial to humeral head
Y - glenoid fossa behind head, coracoid ant, acromial post
-ribs = anterior
Wrist PA - distal radius, ulna, no overlap Lateral - ulna, radius overlap Alignment of PA -smooth radial contour, cups scaphoid, lunate -2 smooth carpal arcs Alignment of Lateral -straight line through radius, lunate, capitate -smooth radial surface -volar tilt (10)
Ankle
-distal 1/3 tibia, fibula, talus, calcaneus, 5MT base
- Bones
Follow cortex of bones
Shoulder - don’t forget the ribs
Wrist - radius, ulna, carpal bones, metacarpal
- don’t forget styloid
- joint spaces equal
Ankle - thinner cortex, increased lucency => osteoporosis/osteopenia?
- Soft tissue
Swelling, calcification of tendons
Shoulder - Pancoast in lung
Ankle
-loss of tibiofibular overlap => syndesmosis fracture
Anterior shoulder dislocation (MOST COMMON)
- Xray findings
- presentation
- investigations
- management
AP - head inferomedial to glenoid
Y - head anteroinferior to glenoid
Shoulder pain, reduced mv, instability
Asymmetry of shoulders
Neurovascular exam
Elbow, wrist exam - referred pain
Xray other regions - multiple injury?
MRI - soft tissue injury?
Sedation, traction => reduction
Post reduction - repeat shoulder Xray, NVexam to check positioning
Immobilise for 1wk => physio
Recurrence
Adhesive capsulitis
Rotator cuff injury
Posterior shoulder dislocation
- Xray findings
- presentation
- investigations
- management
AP - GHJ wide, lightbulb sign
Y - head post to glenoid
Shoulder pain, reduced mv, instability
Asymmetry of shoulders
Neurovascular exam
Elbow, wrist exam - referred pain
Xray other regions - multiple injury?
MRI - soft tissue injury?
Sedation, traction => reduction
Post reduction - repeat shoulder Xray, NVexam to check positioning
Immobilise for 1wk => physio
Recurrence
Adhesive capsulitis
Rotator cuff injury
Acromio/coraco clavicular joint dislocation
AP
- wide ACJ => AC ligament tear?
- wide CCJ => CC ligament tear?
Fracture of the surgical humeral neck
- Xray findings
- presentation
- investigations
- management
Fracture of the surgical humeral neck
Shoulder pain, reduced mobility
Asymmetrical shoulders, swelling, bruising
Neurovascular exam - axillary nerve damage!
Elbow, wrist exam - referred pain
Xray other regions - multiple injury?
MRI - soft tissue injury?
Analgesia
Conservative - immobilise in sling, physio
Surgical - nailing
Nonunion/malunion risk
Axillary nerve damage
Colles fracture (most common)
- Xray findings
- presentation
- investigations
- management
FOOSH
Distal fracture => dinner fork deformity (dorsal angulation)
Radial shortening
Avulsed styloid, carpal fractures
Tender, reduced ROM
Neurovascular deficit
Reduction and splinting with analgesia => plaster and sling
ORIF if unstable/displaced
Compartment syndrome
Median nerve, vascular injury
Malunion
Smiths fracture
- Xray
- presentation
- investigations
- management
FOOSH
Distal fracture => spade deformity (volar angulation)
Tender, reduced ROM
Neurovascular deficit
Reduction and splinting with analgesia => plaster and sling
ORIF if unstable/displaced
Compartment syndrome
Median nerve, vascular injury
Malunion
Barton fracture
- Xray findings
- presentation
- investigations
- management
Intraarticular oblique distal radius fracture
Can be dorsal or volar
Tender, reduced ROM
Neurovascular deficit
Reduction and splinting with analgesia => plaster and sling
ORIF if unstable/displaced
Compartment syndrome
Median nerve, vascular injury
Malunion
Distal radioulnar joint dislocation
-Xray findings
Widened joint space 2mm+
Scaphoid fracture
- Xray findings
- presentation
- investigations
- management
INCREASED DENSITY OF PROXIMAL SCAPHOID - AVN!!!
Fracture of scaphoid
May have other findings
Pain, tender anatomical snuffbox
SCAPHOID SERIES - if fracture suspected but not found initially
Immobilisation with splint or backslab
Orthopod surgery referral for operative fixation if needed
Malleolar fractures
-classification
Weber A - below syndesmosis
Weber B - at syndesmosis
Weber C - above syndesmosis => unstable, needs surgery
