How to Describe a Fracture (X-rays)

Question 1

What are the first things that should be looked for in an x-ray?

Answer 1

• Right person
• Right time
• Right body part
• Right views to diagnose

Question 2

What do we look at in general in an x-ray?

Answer 2

• Cortical outline
• Cancellous architecture
• Soft tissue
• Joints
  
  • Joint space – defined by tracing cortical outline
• Alignment

Question 3

What are the 7 points interested in for describing a fracture?

Answer 3

1. Mechanism and energy of injury
2. Skin and soft tissues
3. Site
4. Shape
5. Comminution
6. Deformity
7. Associated injuries

Question 4

What are the different shapes of fracture?

Answer 4

1. Transverse (usually directly below trauma)
2. Oblique (usually due to bending moment of force)
3. Spiral (always due to rotational force)
4. Complex (combination of forces, often cause comminution)

Question 5

What are the following shapes of fracture usually due to:

• transverse
• oblique
• spiral
• complex

Answer 5

Transverse (usually directly below trauma)

Oblique (usually due to bending moment of force)

Spiral (always due to rotational force)

Complex (combination of forces, often cause comminution)

Question 6

What are different kinds of comminution?

Answer 6

1. None
2. Butterfly
3. Communuted +, ++ or +++
4. Segmental

Question 7

What does comminution mean?

Answer 7

Break or splintering of bone into 2 or more fragments

Question 8

What is meant by deformity when describing a fracture?

Answer 8

1. Deformity (movement of distal fragment with respect to supposedly stationary proximal fragment)

Question 9

What are the different aspects of deformity when describing a fracture?

Answer 9

1. Displacement (% diameter of bone, anterior/posterior/medial/lateral)
2. Angulation (degrees)
   
   1. Distal segment relative to proximal
   2. Anterior/posterior/varus/valgus
3. Rotation (degrees)
   
   1. Internal/external
   2. Radiological clues from
      
      1. Different diameters of bone above and below
      2. Different orientation of joints above and below
      3. Match or mismatch of configuration
4. Axial deformity (cm)
   
   1. Impaction
   2. Distraction
   3. Overlapping

Question 10

What is the rules of 2 for trauma radiographs?

Answer 10

• 2 views
  
  • At 90 degress to each other
• 2 joints (above and below)
• 2 bones (if appropriate)
• 2 occasions
  
  • Such as scans different times apart

Question 11

What is looked for in soft tissue?

Answer 11

• Air
  
  • Open fractures or gas forming organisms
• Foreign bodies
  
  • Open fractures
• Fluid levels
  
  • Haematoma