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  • 1.
    • By :DR
    • HASSAN ALQARNI
    • Supervised by
    • DR. munawar
  • 2. How to comment on Skeleton - X rays
  • 3.
    • 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
  • 4.
      • 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
  • 5.
    • How we describe fractures on X ray ?
  • 6. By the direction of the fracture line Longitudinal oblique Transverse spiral
  • 7.
    • By the number of fracture fragments
    • Two fragments –Simple
    • More than two fragments-Comminuted
  • 8.
    • By the relationship of the fracture to the atmosphere
      • Closed
      • Open or compound
      • Best evaluated clinically
  • 9.
    • By the relationship of one fracture fragment to another
      • Displacement
      • Angulation
      • Shortening
      • Rotation
    • Most fractures display more than one of these abnormalities
  • 10. By convention, abnormalities of position describe the relationship of the distal fragment relative to the proximal fragment
  • 11.
    • 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)
  • 12.
    • Angulation
      • The abnormal angle that the distal fragment makes with the proximal
      • In this case the distal fragment is angulated medially
  • 13.
    • Shortening
      • Overlapping of the ends of the fracture fragments
      • Shortening is usually described by the number of centimeters of overlap
  • 14.
    • Rotation
      • Almost always involves long bones (humerus and femur)
      • Knee joint is in AP position (points forward) but ankle points lateral, in this case
  • 15.
    • Colle’s fracture
      • Fracture of the distal radius with dorsal angulation
      • Caused by a fall on the out stretched hand
    Common Fracture Eponyms
  • 16.
    • Smith’s fracture
      • fracture of the distal radius with anterior displacement and palmar angulation
      • Caused by a fall on a flexed hand
  • 17. Examples of easily missed fractures
  • 18. scaphoid fracture Buckle fracture
  • 19. Supracondylar fracture of the humerus
  • 20. Posterior dislocation of the shoulder
    • Humeral head looks like “light bulb”
    • Usually need lanother view like axillary or Y view
  • 21. 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
  • 22.
    • 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
  • 23.  
  • 24. -Fractured ribs marked
  • 25. Monteggia_Fracture
  • 26. _left Clavicle fracture
  • 27. X-ray showing the distal portion of a fractured tibia and intramedular nail.
  • 28. An old fracture with nonunion of the fracture fragments.
  • 29.