Interpreting X-rays

Question 1

Systematic order to follow when interpreting an x-ray?

Answer 1

1. Name of patient
2. Date
3. 2 views: lateral and AP
4. 2 joints above and below the fracture
5. Name the bone
6. Name the part of the bone thats fractured
7. type of fracture
8. describe the deformity

Question 2

What are the 2 x-ray views?

Answer 2

1. AP - Anterior-Posterior: x-ray passes from the anterior to the posterior of the patient
2. lateral - may be obtained as a mediolateral view or lateromedial view depending
   Note: views are taken at right angles

Question 3

Why do we take 2 views?

Answer 3

To not miss the fracture - might be seen in one view and not the other

Question 4

Why do we take 2 views of joints above and below the fracture?

Answer 4

prevent missing dislocation of joints

Question 5

How to name the part of the bone thats fractured?

Answer 5

1. Intra-articular fracture/ epiphysis
2. Metaphysis fracture
3. Diaphysis fracture

Question 6

Name and describe the types of fractures?

Answer 6

1. SIMPLE fracture - one fracture line
   > spiral
   > oblique
   > transverse
2. WEDGE fracture - butterfly segment
3. COMPLEX fracture - comminuted

Question 7

When does a spiral fracture usually happen?

Answer 7

when you twist the leg
- especially in children

Question 8

What is the difference between transverse and oblique fractures?

Answer 8

oblique fractures = >30 degrees
transverse fractures = <30 degrees

Question 9

What is a segmental fracture?

Answer 9

when the bone is broken in at least 2 places leaving a segment of your bone totally separated by the breaks

Question 10

What is a wedge fracture?

Answer 10

results from two oblique fracture lines meeting to create a large triangular or wedge-shaped fragment located between the proximal and distal fracture fragments
Note: known as butterfly segment fracture

Question 11

What is a comminuted fracture?

Answer 11

bone is broken into more than 2 pieces

Question 12

What is a greenstick fracture?

Answer 12

occurs when a bone bends and cracks instead of breaking completely into separate pieces

Question 13

Describe the difference in bone healing between segmental and wedge fractures?

Answer 13

segmental fracture cant heal without middle piece where as in wedge fracture you can remove the wedge and healing will still take place

Question 14

What criteria do you use to describe deformity?

Answer 14

DAMS
1. Displacement
2. Angulation
3. Malrotation
4. Shortening

Question 15

What is displacement?

Answer 15

bone ends have moved relative to one another

Question 16

How do you describe displacement?

Answer 16

1. Use distal fragment to describe displacement
2. Describe displacement in both planes - where
3. Estimate % of contact - how much
   i.e. 25, 50, 75, 100%
   e.g. lateral displacement with 50% bone apposition

Question 17

What is angulation?

Answer 17

bone fragments are angulated relative to each other

Question 18

How do you describe angulation?

Answer 18

1. with respect to tilt of distal fragment
2. Estimate angle between fragments
   e.g. Distal fragment angulated laterally at 25 degrees

Question 19

How do you calculate angulation?

Answer 19

1. draw an axis through what would be the normal unfractured bone
2. drawn an axis through the distal fractured bone
3. measure the angle between them

Question 20

What is malrotation?

Answer 20

bone fragments have rotated relative to one another

Question 21

How do you describe malrotation?

Answer 21

Very important to have two joints in the X-ray
e.g. femur
At hip it looks AP
Knee it looks lateral
> Therefore rotated by 90 degrees
Note: joint positions will tell the rotation

Question 22

What is shortening?

Answer 22

proximal migration of the distal fracture component results in shortening of the overall bone length
Note: an oblique fracture is more readily shortened than transverse fracture

Question 23

What is diastasis?

Answer 23

separation of bone

Question 24

What is distraction?

Answer 24

a fracture resulting in increased overall bone length due to widening of space between bone components

Question 25

What is impaction?

Answer 25

if there is shortening of bone without loss of alignment
- the bone substance of each component is driven into each other

Question 26

Describe the rule of 2’s in x-rays?

Answer 26

1. 2 views or more eg oblique views
   - AP and lateral
2. 2 joints
   - above and below the fracture
3. 2 sides
   - left and right side
4. 2 times
   - take x-ray twice in case of artifact
5. 2 opinions
   - more than one opinion just in case