Interpreting X rays Flashcards
When interpreting radiographic imagining, what is meant by the OLD ACID approach?
Open or closed
Location
Degree (complete vs incomplete)
Articulation involvement
Intrinsic bone quality
Displacement, angulation, rotation
What 2 standard views are used in radiographic imaging of hip joint?
Anteroposterior (AP)
Lateral
Before interpreting an X-ray, what do you need to confirm?
Confirm that this is the x ray of the correct patient
What 3 pieces of info do you need to confirm out loud in order to make sure that this X-ray is of the correct patient?
Patient personal details such as name, DOB, hospital number
Date and time at which radiograph was taken
What anatomical site was imaged and in what view eg. AP view of pelvis
If the pelvis is perfectly aligned in a X-ray, what 2 structures should be in the midline?
Pubis symphysis
Coccyx
What structures can you outline to identify bony fragments or fractures?
Cortical outlines of bone surfaces, if outline doesn’t run smoothly then it is often due to a fracture breaking the cortical outline or a fragment projecting outwards
What 2 features of an x-ray provide good adequacy?
Image shows above and below the area of concern
Beam penetration is neither under or over exposed
What are the 4 types of femoral fractures in the hip joint, and explain the location of each fracture?
Subcapital: immediately under femoral head, on femoral neck
Transcervical: middle of femoral neck
Intertrochanteric: across intertrcohanteric line between greater and lesser trochanter
Subtrochanteric: under femoral neck and lesser trochanter
Describe this x-ray?
Subcapital fracture of left neck of femur
Describe this x-ray?
Transcervical fracture of right neck of femur
It is Transcervical as the fracture is on the neck but still above intertrochanteric line, so is not intertrochanteric fracture
Describe this x-ray and what each of the arrows point to?
Blue arrow shows comminuted intertrochanteric fracture of right femur
White arrow shows fragments of greater trochanter
Red arrow shows fragments of lesser trochanter
Describe this x-ray?
Subcapital simple fracture of left femur
Describe this x-ray, and what 4 conditions could be the cause of this finding?
Lytic/lucent lesions in right femoral head and left femoral shaft
Osteomyelitis
Bone cyst
Metastasis of myeloma
Osteoblastoma
Describe this x-ray?
Sclerotic lines on posterior surface of calcaneus suggests stress fracture
What do sclerotic lines on an x-ray suggest?
Stress fracture or new bone growth due to fracture
Describe this x-ray?
Transverse stress fracture of right distal fibula due to sclerotic line
Describe 3 findings on this x-ray and what conditions these suggest?
Sclerotic borders of phalanges as proximal interphalangeal joints, suggests new bone growth
Narrowed joint space
Osteophytes at proximal interphalangeal joints
These affect all signs of OA
Describe this x-ray?
Narrowed joint space between distal femur and proximal tibia in medial compartment of left knee and lateral compartment of right knee
Sclerotic borders of proximal tibia suggests compression of bone
Osteophytes of right femur and tibia
Suggests knee OA
What is a comminuted fracture?
Fracture that causes the bone to split into 3 or more fragments
Because bone is broken in at least 2 places
What is a complete fracture?
Bone completely broken into separate pieces
What is an incomplete/partial fracture?
Crack in the bone that doesn’t break bone into separate pieces
What is a stable/non-displaced fracture?
Broken ends of the bone line up, no dislocation or subluxation
Maintains proper alignment
What is a greenstick fracture, and is it more common in adults or children?
Incomplete fracture where bone is partially broken and bent
More common in children
What is a closed fracture?
Fracture doesn’t pierce overlying skin so isn’t exposed to air
What is a compound/open fracture?
Broken bone pierces into/through skin so is exposed to air
What is a transverse fracture?
Fracture line is straight and almost horizontal
What is an oblique fracture?
Fracture line is straight but angled across bone
What is an spiral fracture?
Bone broken with twisting motion, produces fracture line that wraps around shaft line corkscrew
What is a longitudinal fracture?
Fracture line is parallel or runs along long axis of bone
What are Salter-Harris fractures, and do they occur in children or adults?
Fracture through a growth plate (physis)
Only occur in children as adults don’t have growth plates
Describe the appearance of a Type 1 Salter-Harris fracture?
Fracture line is straight across growth plate
Describe the appearance of a Type 2 Salter-Harris fracture?
Fracture line starts going along growth plate, then goes above growth plate
Describe the appearance of a Type 3 Salter-Harris fracture?
Fracture line starts going along growth plate, then goes lower than growth plate
Describe the appearance of a Type 4 Salter-Harris fracture?
Fracture line goes through everything: Above growth plate, across growth plate, lower than growth plate
Describe the appearance of a Type 5 Salter-Harris fracture?
Growth plate is crushed: Erasure of growth plate
What it meant by describing the angulation of a fracture, and what are the 5 common types?
The position of the distal bone fragment compared to the proximal fragment
Rotation, angulation, translation, longitudinal displacements: impaction, distraction
In translation angulation of a fracture, describe the position of the proximal and distal bone fragments?
Distal fragment has moved horizontally away from proximal fragment
In rotation angulation of a fracture, describe the position of the proximal and distal bone fragments?
Distal fragment has rotated, so will not fit with proximal fragment anymore
In only angulation of a fracture, describe the position of the proximal and distal bone fragments?
Normal axis of the bone has been altered such that the distal portion of the bone points off in a different direction
eg. medial (varus), lateral (valgus), radial, ulnar
In impaction of a fracture, describe the position of the proximal and distal bone fragments?
Torus/buckle fracture
Proximal and distal ends compressed together
In distraction of a fracture, describe the position of the proximal and distal bone fragments?
Proximal and distal ends pulled apart in opposite directions
