Radiology

Question 1

How many X-Ray views should be undertaken on a trauma case?

Answer 1

at least 2 different views

Question 2

In what special cases do you require more than two different X-Ray views?

Answer 2

Cervical spine
(open mouth X-Ray to visualise upper Cervical Spine)

Scaphoid

Question 3

How does a fracture usually appear on an X-Ray?

Answer 3

Can vary:
=> Lucency crossing bone
=> Cortical extension
=> Spiral
=> joints can be involved
=> angulation evident
=> displacement of bones

Question 4

How do you tell the difference between an avulsion fracture fragment and a mimic of this?

Answer 4

Avulsion fracture fragments = incompletely corticated around edge

Mimics (e.g. sesamoid bone/ ossification centres) = completely corticated around edges

Question 5

Explain the normal bony alignment of the clavicle and the acromion

Answer 5

acromion is parallel to the lateral end of the clavicle

Question 6

Explain the normal bony alignment between the radius and the capitulum of the distal humerus that should be seen on X-Ray

Answer 6

A line through the centre of the radial shaft should hit the capitulum

otherwise this indicates a displacement

Question 7

How should the bones in the lateral wrist align?

Answer 7

Should sit:
Capitate
Lunate
Radius

during scaphoid fracture it can move to the lunate’s position, displacing it

Question 8

What sign can be seen posterior to the distal humerus, on an X-Ray where there has been trauma causing an effusion?

Answer 8

displaced fat pad

AKA “the posterior fat pad sign”

Question 9

What types of fracture are more common in kids and why?

Answer 9

buckle fracture
plastic bowing
greenstick fracture

due to softer bones that will bend rather than snap

Question 10

How do growth plates in childrens bones appear on X-Rays?

Answer 10

lucency between the epiphysis and metaphysis that may simulate a fracture

Question 11

What should be suspected if the carer of a child gives a history which doesnt match the radiological picture?

Answer 11

Non-accidental injury (NAI)

Question 12

What areas of the body count as “bony rings”?

Answer 12

pelvis
radius and ulna
tibia and fibula

bony rings = prone to fracture in more than one place

Question 13

What type of foreign bodies will not show up on x ray?

Answer 13

Plastic and wood

Question 14

If an elderly lady with osteoporosis fell onto an outstretched hand, what type of fracture would she most likely acquire?

Answer 14

Colles Fracture

• dorsal angulation of radius
• associated ulnar styloid #

Question 15

If a young child were to fall onto an outstretched hand, what type of fracture would they most likely acquire?

Answer 15

Radial buckle fracture

Question 16

If a young (ish) male were to fall onto an outstretched hand, what fracture is he most likely to get?

Answer 16

Scaphoid fracture
pain in anatomical snuffbox
commonly mid-scaphoid

Question 17

If a middle aged/older lady were to fall onto an outstretched hand, what fracture is she most likely to get?

Answer 17

Surgical neck humerus #
post-menopausal females
sclerosis indicates impaction
often comminuted
can damage axillary nerve