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نسخ من How to read x ray of the skeleton 2008 2009

نسخ من How to read x ray of the skeleton 2008 2009






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    نسخ من How to read x ray of the skeleton 2008 2009 نسخ من How to read x ray of the skeleton 2008 2009 Presentation Transcript

      • By :DR
      • 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 fracture Buckle 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.