X Ray Interpretation Flashcards
What are the different patterns of fractures?
simple transverse spiral longitudinal oblique comminuted impacted depressed varus/valgus displaced rotated
What is a pathologic fracture?
a fracture through a cyst, tumor, or osteopenic bone
What is an avulsion?
a segment of the bone is pulled away from the main portion of bone by a ligament or tendon
What is a velar fracture?
palm side
What are angulation and displacement?
Angulation: angular deformity in a given plane
Displacement: translation without angulation in a given plane
What is a shortened fracture?
length of fractured bone in relation to normal length
What do you always palpate?
Always palpate from the joint above to the joint below the area of injury to see what x-ray you need to order
What are 4 proximal humeral fractures?
head
greater and lesser tuberosity
surgical neck
4 indications for shoulder X-ray
Injury
Pain with movement
Pain with palpation over bony landmarks
Unable to move
At least 2 views to include AP & lateral or Y view
Indications for AC joint X-rays
Injury– ppl hit from side and knocked directly onto their shoulder
Pain with palpation
Bilateral AC joints with & without weights
Ordering a clavicle of X-rays
Injury– kids that fall and land directly on the shoulder
1 view= AP view of clavicle
Pain with palpation
Clavicle x-ray should be ordered separately from the shoulder unless its distal
4 indications for elbow X-rays
Injury Pain with palpation over bony landmarks Pain with movement Decreased range of motion 3 views AP, lateral, & oblique
Indications of wrist X-rays
Injury (most common is FOOSH)
Pain with palpation over bony landmarks
Pain with palpation of anatomical snuff box
Pain with range of motion
xray for wrist views
3 views AP, lateral, & oblique
Lateral view allows you to measure angulation
AP or lateral view allows you to measure displacement
3 indications for hand and finger xrays
Injury
Deformity
Inability to flex or extend fingers or thumbs
Ordering Hand & Finger XRAYS
Always order hand or fingers separately depending on where the pain or injury is
3 views AP, lateral, & oblique
2 indications for a pelvic xray
Injury
Pelvic x-ray should be obtained any time you order a hip x-ray so that you can compare the hips side by side
AP pelvis
2 indications for a hip xray
Injury, fall or hip arthritis
Pain with range of motion
AP & lateral hip
Always include a pelvic x-ray so that you can compare hips from side to side
6 Different hip fractures
subcapital neck fracture transcervical neck fracture intertrochanteric fracture subtrochanteric fracture greater and lesser trochanter fracture
2 indications of femur fractures
Usually occurs from high impact injury i.e. MVC, trauma, etc…
Can be a subtle injury in a bone with underlying disorder also called occult fx
What would you order for a femur fracture
Femur AP & lateral
May need to include a hip or knee depending on the area of injury
Knee xray indications
>55 year old isolated patella tenderness tenderness at the head of the fibula inability to flex the knee at 90 degrees inability to bear weight (4 steps) immediately after injury
What would you order for a knee X-ray
3 views AP, lateral, & oblique
Sunrise view of the patella are only for alignment of the patella & a question of longitudinal fractures
If you suspect a transverse fracture of the patella do not get a Sunrise view as you may turn a non-displaced fx into a distracted fx & therefore a non-surgical case into a surgical case
Indications for Tib/Fib X-rays
Injury
Pain with palpation
Pain with ambulation
What would you order for a Tib/Fib x-ray
At least 2 views AP & lateral
You may need to get a knee as well if the pain is in the proximal 1/3 and an ankle if the pain is in the distal 2/3
Indications for ankle rules
a series of ankle films required only if there is malleloar zone and any of these findings
- bone tenderness at the lateral malleolus
- bone tenderness at medial malleolus
- inability to bear weight
indications for midfoot xray
- tenderness at the base of the 5th metatarsal
- bone tenderness at the navicular
- inability to bear weight immediately
What X-rays would you order for the ankle?
3 views AP, lateral, & mortise
Rule of thumb is to palpate for tenderness & draw a line across the top of the foot from the base of the 5th metatarsal to the navicular & if it hurts behind the line get an ankle, if it hurts in front of the line get a foot
3 indications for foot and toe xrays
Injury
Inability to bear weight
Pain with palpation
What would you order for foot and toe X-rays?
3 views of the foot AP, lateral, & oblique
Remember if the pain is in the toes do not get a foot
Pediatric Fractures= Salter Harris Classification
Salter I: There is tenderness to palpation over the growth plate on exam, but no obvious fx may be seen or there is a shifting of the growth plate
Salter II: The fx is proximal to the growth plate
Salter III: The fx is through the epiphysis distal to the growth plate
Salter IV: The fx starts proximal & goes distal through the growth plate
Salter V: The growth plate is crushed or compressed
