Teaching - T&O x-ray

Question 1

What to start with?

Answer 1

• This is a radiograph of:
• Name and date of birth
• Date and time taken
• Body part
• Side
• Projection - AP, PA or lateral
• Adequacy

Obvious findings first

Question 2

Adequacy

Answer 2

• Is body part intended to be x-ray included - is there any cut off?
• Is the exposure ok?
• Is it aligned well? - not rotated?

Question 3

Wrist x ray

Answer 3

• Shoulder abducted 90 degrees
• Elbow flexed 90 degrees
• Hand pronated onto x-ray plate
• Always PA

Question 4

Fracture

Answer 4

• Which bone
• Part of bone
• Type of fracture

Question 5

Parts of bone

Answer 5

• Diaphysis - shaft
• Metaphysis - distal shaft, proximal to physis
• Physis - growth plate
• Epiphysis - distal to growth plate

DMPE

• Apophysis - knobbly sections, tendon inserts so bone grows here eg greater trochanter

Question 6

Type of projection x-ray for knee

Answer 6

• Usually AP

Question 7

Sub grouping diaphyseal fracture

Answer 7

• Proximal middle and distal third
• Sometimes can say junction of proximal middle third etc

Question 8

When involves metaphysis what else to say?

Answer 8

• Is it intra-articular or extra-articular
• Eg does it extend to joint line of articular surface

Question 9

Types of #

Answer 9

• Simple one fracture line, two parts - transverse, oblique (bending usually) or spiral (torsional, twisting)
• Comminuted - multiple fragmented
• Open - communication between air and bone, usually VERY high energy
• Greenstick fracture - incomplete #, common in paeds, more elastic bone

Question 10

How many views for x-ray

Answer 10

• AT LEAST TWO
• 2nd view 90 degrees to original view

Question 11

Describing displacement

Answer 11

• Describe where distal fragment has gone compared to proximal
• Rotation, angulation, translation, shortening eg STAR
• If 100% translated - offended

Question 12

In lateral view, how can you describe anterior and posterior apex of #

Answer 12

• Recurvartum
• Procurvartum

Question 13

HBL meaning on lateral

Answer 13

• Horizontal beam lateral - patient lying flat - can see fluid level in capsule sometimes (blood from #)
• For OA - usually standing up, useful to see if loss of joint space when joint loaded

Question 14

What happens when # and see fluid level

Answer 14

• Blood - settles closer to floor
• Fat settles on top
• Lipohaemoarthrosis
• Whether patient is lying down or standing up is important in identifying where fluid level is

Question 15

If see lucency around bone what can this suggest?

Answer 15

• Subcutaneous emphysema = open #
• Or malignancy?

Question 16

Key for displaced #

Answer 16

• Full NV exam - need to check blood supply is intact
• Check distally to #

Question 17

How to refer to fingers for radiograph

Answer 17

• Ring
• Little
• Middle
• Index
• Thumb

Question 18

Management of #

Answer 18

• Reduce it - put it back
• Hold it there - until heal, some dont have these eg proximal humerus use sling instead
• Rehabilitate when heals - move limb

Reduce Hold Rehabilitate

Only need reduction if displaced - can do in a&E or in surgery

Question 19

Ways of reduction

Answer 19

• Closed reduction - eg manipulation in a&e
• Open reduction - use incision and then eyes to see bone and how to position back

Question 20

Ways of holding # still

Answer 20

• External fixation - splint, cast
• Internal fixation - open reduction and then fixation eg screws/intramedullary nailing

Question 21

Rehabilitation

Answer 21

• Ensure other joints are exercised and moved
• Then load healing # - partial then full weight bearing
• Light activities then work then sport