How to describe a fracture on an x-ray Flashcards
What are the first things to check/look for on an x-ray?
- Right person
- Right time
- Right part of the body
- Right views - i.e are they adequate to diagnose
After doing your initial checks, in general, what do you look for now on the x-ray?
- Cortical outline
- Cancellous architecture - bone make up and pedicles (circles in image - these are usually the first thing to be eroded by secondary tumours)
- Soft tissue
- Joints
- Alignment - spine
What things are you looking for when looking at joints on an x-ray?
- Joint space
- Cortical outline i.e shape of bone
- Cyst
- Osteophytes - additional bone that occurs around OA joints
- Alignment
When describing a fracture what 7 things do you need to know?
- Mechanism & energy of injury
- Skin & soft tissues
- Site
- Shape
- Comminution
- Deformity
- Associated injuries
The 4 in bold are radiological findings, where as the others are clinical findings
What are the rules of 2 for trauma radiographs?
(This is a fundamental principle to avoid errors.)
- 2 views - at 90º to each other (often AP and lateral)
- 2 joints - above and below the fracture
- 2 bones - if appropriate
- 2 occasions - (some fractures may not show up on the initial x-ray, but may be evident 7-14 days later)
Description of a fracture: Site
- Side - right or left
- Limb
- Bone(s) invovled
- Region within bone
- Articular involvement
- intra-articular?
- +/- Dislocation/subluxation
- Ligamentous avulsion - a fragment of bone is pulled away at the ligamentous or tendinous attachment
- Epiphyseal - fracture involving growth plate - in children
Description of a fracture: Shape
- Transverse - straight across - usually due to direct trauma/blow
- Oblique - bit squint - usually due to a bending moment of force
- Spiral - winds its way round - always due to rotational force
- Complex - combination of forces, often causes comminution
X-ray showing Transverse fracture
This is a child’s x-ray
X-ray showing an Oblique fracture
X-ray showing spiral fracture
X-ray showing complex fracture
Lots of separate bits of bone
Often high velocity injury - possibly been hit by a car or fallen from height
Comminution
A break or splinter of the bone into more than two fragments.
Sometimes you can see a buttefly shape in a comminuted fracture (triangular bit).
What are the 4 types of deformity of a fracture?
Displacement (% diameter of bone)
Angulation (º)
Rotation (º)
Axial deformity (cm)
How do you define deformity in terms of a fracture?
It is the movement of the distal fragment with respect to the supposedly stationary proximal fragment i.e description of what has happened distal to the fracture
Displacement examples
Images show lateral and AP views
1 – fracture of femur – distal bone hasn’t moved
2 – distal fragment on AP x-ray has moved laterally
3 – AP – no movement laterally or medially – lateral x-ray moved posteriorly
4 – fracture of the middle and distal 1/3 of femur with 50% lateral displacement and 80% posterior displacement
Angulation
Angulation is when the normal axis of the bone has been altered such that the distal portion of the bone points off in a different direction.
Anterior/posterior/varus/valgus
1 - AP view of femur. The distal fragment should lie in the dotted line but it has moved laterally. A fracture of the middle 1/3 of femur with valgus angulation
2 - Lateral view of tibia and fibula. Distal fragment has moved forwards = Anterior angulation
Deformity: Rotation
- Internal/external
Clinical and radiological examination give clues i.e
- Different diameters of bone above and below the fracture
- Different orientation of joints above & below #, e.g. AP knee & lat. ankle on XR of tibial shaft fracture
- Match or mismatch of fracture configuration, e.g. spike of proximal fragment matching V-defect of distal (see images on right hand side)
What do you look for in soft tissue on x-rays?
- Air (open fractures, gas forming organisms)
- Foreign bodies (open fracture)
- Fluid levels (haematoma) - can see a fluid line
see image - scattering of foreign bodies
Fluid line
