X Ray Interpretation

Question 1

What are the different patterns of fractures?

Answer 1

simple transverse
spiral
longitudinal
oblique
comminuted
impacted 
depressed
varus/valgus
displaced
rotated

Question 2

What is a pathologic fracture?

Answer 2

a fracture through a cyst, tumor, or osteopenic bone

Question 3

What is an avulsion?

Answer 3

a segment of the bone is pulled away from the main portion of bone by a ligament or tendon

Question 4

What is a velar fracture?

Answer 4

palm side

Question 5

What are angulation and displacement?

Answer 5

Angulation: angular deformity in a given plane
Displacement: translation without angulation in a given plane

Question 6

What is a shortened fracture?

Answer 6

length of fractured bone in relation to normal length

Question 7

What do you always palpate?

Answer 7

Always palpate from the joint above to the joint below the area of injury to see what x-ray you need to order

Question 8

What are 4 proximal humeral fractures?

Answer 8

head
greater and lesser tuberosity
surgical neck

Question 9

4 indications for shoulder X-ray

Answer 9

Injury
Pain with movement
Pain with palpation over bony landmarks
Unable to move

At least 2 views to include AP & lateral or Y view

Question 10

Indications for AC joint X-rays

Answer 10

Injury– ppl hit from side and knocked directly onto their shoulder
Pain with palpation
Bilateral AC joints with & without weights

Question 11

Ordering a clavicle of X-rays

Answer 11

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

Question 12

4 indications for elbow X-rays

Answer 12

Injury
Pain with palpation over bony landmarks
Pain with movement
Decreased range of motion
3 views AP, lateral, & oblique

Question 13

Indications of wrist X-rays

Answer 13

Injury (most common is FOOSH)
Pain with palpation over bony landmarks
Pain with palpation of anatomical snuff box
Pain with range of motion

Question 14

xray for wrist views

Answer 14

3 views AP, lateral, & oblique
Lateral view allows you to measure angulation
AP or lateral view allows you to measure displacement

Question 15

3 indications for hand and finger xrays

Answer 15

Injury
Deformity
Inability to flex or extend fingers or thumbs

Question 16

Ordering Hand & Finger XRAYS

Answer 16

Always order hand or fingers separately depending on where the pain or injury is
3 views AP, lateral, & oblique

Question 17

2 indications for a pelvic xray

Answer 17

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

Question 18

2 indications for a hip xray

Answer 18

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

Question 19

6 Different hip fractures

Answer 19

subcapital neck fracture
transcervical neck fracture
intertrochanteric fracture
subtrochanteric fracture
greater and lesser trochanter fracture

Question 20

2 indications of femur fractures

Answer 20

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

Question 21

What would you order for a femur fracture

Answer 21

Femur AP & lateral

May need to include a hip or knee depending on the area of injury

Question 22

Knee xray indications

Answer 22

>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

Question 23

What would you order for a knee X-ray

Answer 23

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

Question 24

Indications for Tib/Fib X-rays

Answer 24

Injury
Pain with palpation
Pain with ambulation

Question 25

What would you order for a Tib/Fib x-ray

Answer 25

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

Question 26

Indications for ankle rules

Answer 26

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

Question 27

indications for midfoot xray

Answer 27

• tenderness at the base of the 5th metatarsal
• bone tenderness at the navicular
• inability to bear weight immediately

Question 28

What X-rays would you order for the ankle?

Answer 28

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

Question 29

3 indications for foot and toe xrays

Answer 29

Injury
Inability to bear weight
Pain with palpation

Question 30

What would you order for foot and toe X-rays?

Answer 30

3 views of the foot AP, lateral, & oblique

Remember if the pain is in the toes do not get a foot

Question 31

Pediatric Fractures= Salter Harris Classification

Answer 31

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