investigation of orthopedic

1. Investigations in OrthopedicsInvestigations in Orthopedics
by Dr. hayder ameen merzah

2. classificationclassification
Laboratory
 1.blood 2.urine 3.synovial (aspiration)
Radiography (1.plane radiograph 2.DEXA
3. Fluoroscopy 3. Arthrogram 5.CT scan 6.
Bone scan )
MRI
US (+Doppler)
Arthroscopy ( diagnostic and therapeutic)
Biopsy 1.FNA 2.true cut 3.incisional
4.excional

3. laboratorylaboratory
Blood
Hematology cbc,esr,crp,pletet,rh
Chemstry b.sugar,Hba1c,burea/screatin,SUA,lipid
profile,Ca,ph,Mg
Coagulogram BT,Clooting,T,Pt,ptt,thrombine time
Hormonal T3,T4,TSH,PTH,vit D,
Imunological widal, rose bengal,letex ,ANF
Virology HIV HCV HBV
Tumer marker and enzyme S.ALP

4. laboratorylaboratory
Urine
GUE,electrolyte,bence jonce
protien,u.albumin,cytology,urea and
nitrogin

5. laboratorylaboratory
synovial (aspiration)

6. RadiologicalRadiological
Plane radiograph (x ray)
Simple,cheap,and informative
it is an imaging technique using X-rays, gamma rays, or similar radiation to view the internal form
of an object. The difference between soft and hard body parts stems mostly from the fact that carbon has a very low
X-ray cross section compared to calcium.
Role of two
AP, PA , LAT , Oblique, axial, special
views
Conventional ---shadow on florecent screen
CR ---laser on phosphorus screen
DR---use digital camera

8. DEXADEXA
Dual energy X-ray absorptiometry
 act by 2 narrow beams that are scanned across the patient, 90 degrees from
each other
 used primarily for osteoporosis
Other uses fellow up of therapy of
nutritional rickets, lupus.
Lower dose of radiation than x ray
T score -1.0 to -2.5 mean posative

10. FluoroscopyFluoroscopy
 moving projection radiographs in the operating theatre
using a portable fluoroscopy machine called a C-arm can
move around the surgery table and make digital images for
the surgeon.
 Used for spine surgery, replacement, and FB removal

11. ArthrogramArthrogram
 series of images of a joint after injection of a contrast medium, usually done
by fluoroscopy or MRI. The injection is normally done under a local
anesthetic. The radiologist or radiographer performs the study using
fluoroscopy or ultrasound to guide the placement of the needle into the joint.
 Used for rotator cuff tear , DDH , acetabula
labrum tear.
 Now less used replaced by CT and MRI
 Risk of allergy and radiation

12. CT scanCT scan
 Digital geometry processing is used to further generate a three-
dimensional volume of the inside of the object from a large series of
two-dimensional radiographic images taken around a single axis of
rotation.
 positron emission tomography (PET)
 single-photon emission computed tomography (SPECT)
 Dual-energy CT scan .can dx even gout
 2d ,3d

15. Bone scanBone scan
nuclear medicine imaging technique of the
bone
Single phase
3 phase
PET
For tumor and inflammation

17. MRIMRI
strong magnetic fields, magnetic field
gradients, and radio waves to generate
images of the organs in the body
Axial sagittal
T1,T2,STER, FAT SEPREESION

20. Ultra soundUltra sound
Cyst ,mass
Doppler
FB
Operator dependant

21. ArthroscopyArthroscopy
Diagnostic
Therapeutic

22. BiopsyBiopsy
 1.FNA
 2.true cut
 3.incisional
4.excional

23. summarysummary
The message is how to chose best and
informative investigation
Invasive or not
Cost or not
Available or not
