By :DR

HASSAN ALQARNI

Supervised by

DR. munawar

How to comment on Skeleton -X rays

When looking on an X ray of a part of the skeleton, check for: Name of patient Date of examination Side (Rt or Lt): check marker What part the film is centered on Does the film cover the whole area

required Include one joint above and one joint below

Is there more than one view (should be two views at right angle)

Quality of the film (penetration) Abnormalities:

Trace around the bone margins looking for steps or cracks

Look for soft tissue swelling Compare how the appearance changed from last

film Conclude:

Is the diagnosis clear Is further images needed

How we describe fractures on X ray ?

By the direction of the fracture line

Longitudinal oblique Transverse spiral

By the number of fracture fragments

Two fragments –Simple More than two

fragments-Comminuted

By the relationship of the fracture to the atmosphere Closed Open or compound Best evaluated clinically

By the relationship of one fracture fragment to another Displacement Angulation Shortening Rotation

Most fractures display more than one of these abnormalities

By convention, abnormalities of position describe the relationship of the distal fragment relative to the proximal fragment

Displacement The amount of

antero-posterior or lateral movement of the distal fragment relative to the proximal

There is lateral displacement of the distal fracture fragment (femur)

Angulation The abnormal angle

that the distal fragment makes with the proximal

In this case the distal fragment is angulated medially

Shortening Overlapping of the

ends of the fracture fragments

Shortening is usually described by the number of centimeters of overlap

Rotation Almost always

involves long bones (humerus and femur)

Knee joint is in AP position (points forward) but ankle points lateral, in this case

Colle’s fracture Fracture of the distal

radius with dorsal angulation

Caused by a fall on the out stretched hand

Common Fracture Eponyms

Smith’s fracture fracture of the distal

radius with anterior displacement and palmar angulation

Caused by a fall on a flexed hand

Examples of easily missed fractures

scaphoid fractureBuckle fracture

Supracondylar fracture of the humerus

Posterior dislocation of the shoulder

Humeral head looks like “light bulb”

Usually need lanother view like axillary or Y view

Hip fractures

May be very subtle and require bone scan or MRI for diagnosis

In this case, white zone of sclerosis is an impacted subcapital fracture

Start by commenting on: The view: AP or lateral view The part examined: femur, tibia and fibula… The side: right or left The abnormality seen

Example: this is an AP View of the right femur. There is a transverse or oblique or comminuted fracture of the middle 1/3 or the upper third of the shaft , There is lateral displacement and medical angulation

If you are provided with one view, you may say that I need another view to complete my comment

-Fractured ribs marked

Monteggia_Fracture

_left Clavicle fracture

X-ray showing the distal portion of a fractured tibia and intramedular nail.

An old fracture with nonunion of the fracture fragments.