Orthopedic Xray Presentation Flashcards
Introduction
Patient details - name, age, DOB, date of Xray
Projection - AP, lateral?
Technical adequacy
-is the entire area of concern covered?
-adequate exposure => differentiation between soft tissue and bone
-rotation?
Xray interpretation approach
ABCS
Alignment and joint space
Bone texture
Cortices
Soft tissues
Alignment and joint space
Fracture
Subluxation (partial dislocation)
Dislocation
When describing displacement -Position of the fragment distal to fracture site
Joint space narrowing
- cartilage loss
- cartilage calcification
- osteophytes
Bone texture
Altered density/disruption in trabeculae and cortex => pathology
Cortices
Trace around the outline of each bone
- steps - fracture/pathology
- bony destruction - infection, tumours
- periosteal reaction - new bone formation in response to injury or periosteal stimulation
Soft tissues
Swelling, foreign bodies, effusions
Describing fractures
Bone involved
Location within bone - proximal, middle, distal
Articular involvement
Complete fracture types
- transverse
- oblique
- spiral
- comminuted
- impacted
Incomplete - more common in children
- torus/buckle
- bowing
- greenstick
- SalterHarris - involvement of growth plate
Open or closed
Displacement?
-dorsal/volar angulation
Cervical spine
- views
- what are you assessing in A
Lateral - C1-T1 4 curves -ant vertebral line -post vertebral line -spinolaminar line -spinous processes
AP - C1-7
2 lines lateral to vertebral bodies
Spinous process line
Open mouth/peg view
Alignment of lateral masses of C1-2
Alignment of space between peg and C1 lateral mass
Cervical spine
- B
- C
- S
Cortex of each bone
Intervertebral discs roughly similar in height
Prevertebral tissue
Above C4 - 1/3d of vertebral body width
Below C4 - 1 vertebrae wide
-if abnormal => prevertebral hematoma from cervical fracture?
Thoracolumbar spine
-A
Lateral 3 column model -Ant - ant half of vertebral body -Middle - post half of vertebral body -Post - post ligament, bone arch
AP
- 2 lines lateral to vertebral bodies
- Spinous process line
Thoracic spine - kyphosis
Lumbar spine - lordosis
If 2 of 3 columns disrupted => instability
Thoracolumbar spine
- B
- C
- S
B
- cortex of each vertebrae
- pedicles - if not visible => bony destruction?
- height of vertebrae should be equal
C
-intervertebral discs similar in height - reduced => degenerative disease?
S
-can be difficult to assess
Shoulder
-A
AP - glenoid fossa and humeral head visible
Lateral/scapula Y - Y intersection coming out of humeral head
Possible shoulder pathologies
- anterior shoulder dislocation
- post shoulder dislocation
- acromioclavicular joint
- humeral shaft fracture
Ant dislocation MORE COMMON
AP - humeral head medially inferior to glenoid
Lateral - humeral head out of line from Y
Post dislocation
AP - lightbulb, widened joint space
Lateral - humeral head post to glenoid
Acromioclavicular joint dislocation
AP - misalignment/widened gap of clavicle and acromion
Coracoclavicular joint dislocation
AP - widened gap of clavicle and coracoid
Humeral shaft fracture
- often spiral
- radial nerve often involved
Shoulder
- B
- S
Outline of cortex
- clavicle
- scapula
- ribs
Soft tissue
- dark areas - blood, fat => hidden fracture
- white areas - calcification of tendons?
- lungs - Pancoast, pneumothorax?
Elbow
-A
AP
Radiocapitellar line
-if not => radial head dislocation (Monteggia?)
Lateral
Anterior humeral line intersects middle 1/3 of capitellum on distal humerus
-if not => distal humeral fracture
Radiocapitellar line intersects radius and capitellum
-if not => radial head dislocation (Monteggia?)
Possible elbow pathology
- supracondylar humerus fracture
- radial head dislocation
- radial head fracture
- Monteggia
- olecranon fracture
Supracondylar humerus fracture - V COMMON IN PAEDS
- post fat pad
- displaced ant humeral line
- ant humeral line
- broken champagne flute
Radial head dislocation
-disrupted radiocapitellar line
Radial head fracture
-post fat pad with no obvious fracture
Monteggia - paeds
-proximal ulnar fracture + radial dislocation
Olecranon fracture
-Highly avulsed due to attachment to triceps
Elbow
- B
- S
Bone cortex especially
- radial head
- distal humerus
- coronoid
- olecranon
Champagne flute sign - humerus not fractured
-flute broken => supracondylar fracture (Gartland)
Effusion
Ant fat pad - small
-if massive => effusion
Post fat pad - not visible
-if visible => effusion
If any effusions are present => look for fracture
If no fracture found => radial head fracture likely
Wrist
-A
Distal ulnar and radius with NO OVERLAP
PA - radius, capitate, 3rd MC in a line
-2 smooth arcs in proximal and distal rows of carpal bones
Lateral - radius, lunate, capitate in a line
-slight palmar tilt in radius
Wrist pathologies
Colles - EA, distal radial
-dorsal radial angulation
Smith - distal radius
-volar radial angulation
Bartons - IA, distal radius
-dorsal or volar angulation
Galeazzi - distal radial fracture, ulnar dislocation
Distal radioulnar joint dislocation
-increased joint space between radius, ulnar
Scaphoid fracture - scaphoid series to comprehensively assess
-proximal - poorest prognosis
Wrist
- B
- C
- S
B - cortical margin, trabecular pattern
- radius
- ulnar
- carpal bones
- metacarpals
Joint spaces - should all be similar
Soft tissue - assess for overt abnormalities
Pelvic and hip
- A
- B
AP - 1/3d femoral shaft <=> ilium
-coccyx tip inline with pubic symphysis
Bones
- cortical outline
- bony texture
- symmetry
Femur
-proximal, head, NOF, greater trochanter, lesser trochanter
Shenton’s line - disrupted => fracture
Pelvic bones -ischium, ilium, pubis, sacrum Pelvic brim Obturator foramen -if 1 fracture found => look for 2nd
Types of hip fracture
-classification
Intracapsular - above intertrochanteric line
-risk of AVN, nonunion
Extracapsular - below intertrochanteric line
Garden
-3, 4 unstable displaced
Pelvic and hip
- C
- S
Cartilage and joint space
Acetabular joint
-reduced - OA?
-increased - dislocation?
Pubic symphysis
Sacroiliac joint - joint space and end plates
-sacroilitis - sclerosis of iliacs, irregular end plates, wide joint spaces
Soft tissue and others
Effusion - hyperdense fluid level (inflammatory joints)
Periosteal reaction - irritation from healing or tumour
Calcification of tissue
Foreign bodies - THRs
Knee
- A
- B
- C
- S
AP
-lateral femoral line passes through midline of fibula, next to tibia
Lateral
Bones Tibial plateau -lateral plateau fracture Patella Fibula Femur
Cartilage, joint space
Knee joint
-decreased => OA?
Soft tissue
Suprapatellar fat pad
-effusion => patella displaced
Ankle
-A
Penetration adequate, clear distinction between bone and soft tissue
AP - distal 1/3 tibia, fibula, talus
Lateral - distal 1/3 tibia, fibula, talus, calcaneusm 5th MC
Ankle
- B and classification of fractutures
- C
- S
Bones
Cortical outline of fibula, tibia, talus, calcaneus
-thinner cortex - OP?
Top of talus should be smooth
Weber
A-fibula fracture below syndesmosis
B-fibula fracture at syndesmosis
C-fibula fracture above syndesmosis
Cartilage and joint space
Ankle joint space should be equal all around talus
Tibiofibula overlap
-loss => syndesmosis injury?
Soft tissue
-swelling, effusion => fracture
Salter Harris classification
-types and mnemonic
1 - straight across 2 - above 3 - lower 4 - through 5 - erasure of growth plate or crush
