Reading Orthopedic X-Rays

Question 1

how many views do you want for anyone who needs any x-ray

Answer 1

2 views

-Orthogonal views (90 degs to one another) of injury to determine exact location

Question 2

Posterior fat pad more sensitive for diagnostic purposes

what fracture for peds and adults

Answer 2

Pediatrics - Supracondylar fracture of distal Humerus

Adults - Radial head fracture

Question 3

*proximal humer fracture

Answer 3

Shoulder (AP, Scapular Y, Axillary vs. Velpeau)

full-length Humerus

Question 4

*elbow fracture

Answer 4

Humerus (AP and lateral)
Shoulder, (AP, Scapular Y, Axillary vs. Velpeau)
Forearm (AP and lateral)

Question 5

*distal radius fracture

Answer 5

Forearm (AP and lateral)

Wrist (AP and lateral)

Question 6

*hand & finger fracture

Answer 6

Hand (AP, lateral, oblique)

special views as needed for specific injuries

Question 7

***ankle fracture

Answer 7

Ankle Films (3 views** - AP, Lateral, **Mortise)
 Stress View (Gravity vs. Manual External Rotation view)
 full-length Tibia/Fibula X-Rays (AP and lateral)

Question 8

*tibia fracture

Answer 8

**Full-length Tibia/Fibula (AP and lateral)

Knee (AP and lateral)

Question 9

*femur fracture

Answer 9

Full-length Femur (AP and lateral)
Hip (AP, Lat, Cross-Table Lateral)
Knee (AP, Lateral)

Question 10

*Hip fracture

Answer 10

Hip
Full-length Femur
AP Pelvis

Question 11

most important thing to describe when there might be a possible fracture

Answer 11

Neurovascular status

Question 12

*tumors that metastasize to bone

Answer 12

BLT w/ a kosher pickle: 
Breast 
Lung
Thyroid 
Kidney (Renal Cell Carcinoma) 
Prostate

Question 13

*Which tumors are blastic and which are lytic?

Answer 13

“PB-KTL” (Lead Kettle)

Prostate and Breast are Blastic
Kidney, Thyroid, and Lung are Lytic

Question 14

*shoulder fracature

Answer 14

you NEED an axillary or the velpeau view to make sure there is no dislocation plus another view at LEAST –> that big lawsuit

Question 15

SALTR (what does the letters stand for)

Answer 15

S = Surrounding Physis
A = Above Physis (in Metaphysis)
L = Lower than Physis (in Epiphysis)
T = Through Physis
R = Ruined Physis

Question 16

*which salter harris fracture is MC

Answer 16

type II

Question 17

what must you order in a knee dislocation

Answer 17

Must order ABI vs. CT Angiogram to document blood flow to remainder of lower extremity

Question 18

*what is the biggest predicting factor for increased mortality for pelvic ring fractures

Answer 18

need for transfusion of >4 units of packed RBCs

Question 19

how many times should the pelvis be inspected (moved) in a suspected pelic ring fracture

Answer 19

ONCE

Question 20

what exam should you do for a suspected pelvic ring fracture

Answer 20

Neurologic: Rectal exam to check for evaluation of sphincter tone and perianal sensation

Question 21

*Treatment of traumatic pelvic ring injuries

Answer 21

Resuscitate patient first; ideally 1:1: 1 (pRBC:FFP:Platelets)

Question 22

femoral neck fractures dx

Answer 22

XR, MRI if very subtle and unsure (NOT CT SCAN!)

Question 23

*causes of Avascular necrosis

Answer 23

A = Alcohol (most common one and he’ll probs test you on this one) 
S = Systemic Lupus Erythematosus, Sickle Cell Anemia
E = Exogenous Steroid use
P = Pancreatitis
T = Trauma
I = Infection
C = Caisson Disease (the “Bends” as seen in deep-sea divers)

Question 24

*Physical Exam for Hip Fxs (esp for leg)

Answer 24

Leg may appear in external rotation and abduction, will appear shortened

Question 25

What do all patients with hip fractures get?

Answer 25

Foley catheter- they cant get up and pee
IV fluids
Pain Control
AP Pelvis, Full Length Femur XRs, Hip XRs, CXR
EKG- for pre op clearance
NWB (non-weight bearing) to affected extremity
NPO (talk with surgeon or Orthopedic team first)

Question 26

mortality risk for geriatrics and hip fractures

Answer 26

Mortality rates are as high as 14-36% at one year in geriatric populations

Question 27

3 potential spaces for major blood loss

Answer 27

thorax
pelvis
thigh