Reading Orthopedic X Rays Lecture Powerpoint Flashcards
Who gets an x ray in ortho?
Everyone - x rays are limited doses of radiation so there should be little concern for exposing patients to excessive doses of radiation with basic x rays, limit in pediatrics and pregnancy to only essential studies
ABC’S of reading x rays
Adequacy, alignment
Bones
Cartilage
Soft tissues
What to order in an ankle fracture for x ray?**
AP, lateral, mortise views, possible stress view (dorsiflex and externally rotate or gravity), full length fibula and tibia (AP and lateral)
Open vs closed fracture
Closed is simple, bone doesn’t break skin and is contained in normal anatomic soft tissue envelope vs open is when bone does break skin and communicate with outside world
Acronym to remember common cancers that metastasize to bone
BLT with kosher pickle Breast Lung Thyroid Kidney Prostate
Simple vs comminuted fracture
Simple breaks the bone into 2 pieces, comminuted 3 or more pieces
Avulsion fracture
Fracture where a tendon or ligament pulls off a piece of bone
Axillary view vs velpeau x ray
Important components of shoulder x ray to prove shoulder isn’t dislocated as it is a source of lawsuit, axillary has shoulder up vs velpeau has patient leaning back (if they cannot raise their shoulder above their head) in order to get visual sense of the shoulder joint
Neurovascular status assessment
Must be assessed on every patient and documented thru arterial pulse checks of extremity, nerve exams of extremity, strength testing, and special testing
Salter Harris classification system for pediatric fractures
Describes injuries to pediatric physis,
S=surrounding the physis (growth disturbance uncommon, very subtle on x ray, treat cautiously with immobalization and followup)
A=above the physis (in metaphysis (may cause deformity and limitation in size if large but not usually in mild)
L=Lower than physis (in the epiphysis) (more disabling because fracture has potential to disrupt further growth at physis and may involve joint surface)
T=Thru physis (can cause significant deformity to growth plate and to articular surface of joint, requires operative fixation to treat)
R=ruined physis, crushed (grow ht disturbances and premature closure of physis, may not show up on growth plate)
Bayonet apposition
Seen in bone fractures where the two ends oppose each other and overlap creating a shortening of the bone (aligned side by side rather than end to end)
Why does a knee dislocation require CT angiogram?
To ensure blood flow is remaining in the lower extremity as popliteal vessels can be torn from force by dislocation and cause vascular compromise requiring urgent surgical intervention
C spine imaging techniques (2)**
- CT scan unless really not urgent
- Need to be able to see down to T1 completely
Clay shovelers fracture
Occurs with powerful hyperflexion at neck in combo with powerful pull of paraspinous muscles causing avulsion of C7 spinous process, visible on x ray
What to order for a proximal humerus fracture on x ray?
Shoulder (AP, scapular, axillary or velpeau), full length humerus
