Film Critique
1st year 5th class
ToesStandard views
*AP
*Oblique (medioblique)
*Lateral (mediolateral/lateromedial)
Structures shown AP projection of the phalanges of the foot
(*1st toe only has 2 phalanges the 2nd-5th have 3 phalanges) ***We need from distal phalanx to the distal end metatarsal.
AP Right 1st Toe
Sesamoids
Check the film for: No rotation of phalanges Interphalangeal and
metatarsophalangeal joint spaces open (no bent toes)
Toes should be separated from each other so there is no soft tissue overlap
Soft tissue and bony trabeculation (this is to check for a good technique)
AP
Rotation of toe
Soft tissue overlap
AP left 1st toe
Oblique Toes
Oblique left 1st toe
Structures shown **** We do a medioblique:
An oblique projection of the phalanges
The Interphalangeal joints and 2nd -5th metatarsophalangeal joints open
***Distal phalanx to the distal end of the metatarsal
Toes should be separated from each other
Both soft tissue and bony trabeculation should be seen (techn)
Oblique left 2nd toe
Cadaver bone
LT
Lateral left 1st toe
Might need tape, straw or tongue depressor to separate toes
Lateral toes
Do lateromedial (1st-3rd) and mediolateral (3rd-5th) to get the toe closest to the film
lateromedial Mediolateral
Lateral left 2nd toe Lateral left 3rd toe
Structures shown: Lateral toe A lateral projection of the phalanges: Phalanges in profile
(toenail should appear lateral)
The interphalangeal joints spaces open. The MTP joints will be overlapped but may be seen in some patients.
***The distal phalanx to the distal ends of the metatarsals
Phalanx, without superimposition of adjacent toes. When superimposition cannot be avoided, the proximal phalanx must be demonstrated.
Toes should be separated from each other
Soft tissue and bony trabeculation (techn)
Lateral left 1st toe
Lateral left 2nd toe
Tongue depressor
Lateral Left 2nd toe
Foot Standard views
*AP
* AP Oblique (medioblique)
*Lateral (mediolateral)
Base of the 5th
Common area for a foot fracture base of 5th Jones fracture
AP Right Foot
Intermediate
AP Right foot
**In this view you Will not see theCalcaneus!!
Structures shown: Dorsoplanter (AP) projection of the
tarsals anterior to the talus, the metatarsals,and the phalanges
You will not see the whole calcaneus on this view. Why?
Some people angle 10 degrees toward the heel on this view
***You want all of the phalanges, metatarsals and tarsals distal to the talus on your image
Check film for:
Motion
Rotation: there will be overlap of second- fifth metatarsal bases
Open joint space between medial and intermediate cuneiform
No overlap of toes
Density- are the toes burned out
Oblique Right foot
Oblique Right Foot
medioblique
Structures shown: AP medioblique projection of the
phalanges and metatarsals Interspaces open between the cuboid
and calcaneus, the cuboid and the 4th and 5th metatarsals, the cuboid and the lateral cuneiform and the talus and the navicular
Cuboid is in profile Sinus tarsi, calcaneus, navicular,&
base of the fifth are seen
Oblique Left Foot
Calcaneus?
Check for: Enough rotation when the 3rd – 5th
metatarsals bases are free from superimposition
The lateral tarsals with less superimposition than in the AP
Joint spaces open Base of the fifth metarsal is seen Density: are the toes seen and are
the tarsal seen Tip of toes to calcaneus on the image
Lateral Right Foot
Lateral Right Foot
mediolateral
R
Structures shown: Mediolateral projection of the entire
foot. ***You need distal ends of the tib/fib, ankle joint, calcaneus to the distal phalanges.
Bad lateral foot
Check for: Tip of toes to calcaneus and distal
tib/fib on the image
Metatarsals nearly superimposed
Density to see toes, metatarsals and tarsals
Good Positioning
Poor : knee elevated
Poor : heel not flat
Poor : foot not flat
NO!
CALCANEUS Standard views
*AP axial (plantodorsal)
*Lateral (mediolateral)
Sustentaculumtali
tuberosity
Trochlear process
Structures shown: An axial projection of the calcaneus
***from the tuberosity to the sustentaculum tali and trochlear process
AP Axial Right Calcaneus
Check for: Calcaneus should be visualized to
include the talocalcaneal joint No rotation of calcaneus (check the
first or fifth metatarsals) Density to see joint without burn out
of tuberosity (two films if not using DR or CR)
Rotation / foot flexion
GoodRotation : can see 4th & 5th metatarsals
Too much flexionCan’t see joint space
Structures shown: Lateral projection of the ankle joint
and the calcaneus and adjacent tarsals.
Lateral Left calcaneus
Check for: No rotation of the calcaneus Density can you see soft tissue and
bone Sinus tarsi seen Ankle joint and adjacent tarsals
should be on the film
Ankle
Standard views
*AP
*OBL (mortise)
*Lateral (mediolateral)
AP Right Ankle
Structures shown AP projection of the ankle joint,
***distal ends of tib/fib and the proximal portion of the talus
Dorsal flexAP Left ankle
Check for: Talotibial joint space should be seen
Ankle joint should be centered
Moderate over lapping at the tibiofibular articulation is normal
***Area from the distal tibia and fibula to the talus should be included
Oblique Left Ankle
Structures shown: Distal ends of the tib/fib with the
entire ankle mortise joint demonstrated in profile.(all three sides of the mortise joint should be open.)
AP OBLIQUE ANKLE The entire ankle mortise joint should be
demonstrated in profile. We oblique 15-20 degrees to open all three joints.
AP Toomuch
Oblique Right Ankleis it open?
Don’t just dorsiflex the foot, roll the leg
Check for: Entire ankle mortise joint No overlap of the anterior tubercle of
the tibia and the superolateral portion of the talus with the fibula
Talofibular joint space in profile Talus demonstrated with proper
density
Lateral Right Ankle
Lateral ankle (mediolateral) A true lateral image of the lower
third of the tib/fib, the ankle joint and the tarsals including the base of the 5th metatarsal
Lateral Right AnklePoor positioningDorsiflex the foot
Check for: Ankle joint should be centered Talotibial joint should be well
visualized Fibula should be over the posterior
half of the tibia Density of ankle should be sufficient
to see the outline of the distal portion of the fibula
Fifth metatarsal should be seen to check for a Jones fracture
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