pg teaching orthopedic X rays

1. ASYSTEMATICAPPROACHTO INTERPRETORTHOPEDIC X-RAYS
REVIEW OF INTERESTING X RAYS AND MRI FROM EXAM POINTOF
VIEW
Dr. Jitesh jain

2. MRI knee – coronal and sagittal sections
• Coronal section – front to back
• Patella
• Anterior horn of both menisci
• Body of both menisci and collaterals ligaments
• Intercondylar Notch with both cruciates ligaments
• Posterior horns

3. MRI knee
• Sagittal sections- from medial to lateral or lateral to medial
• Fibula
• Lateral Collateral ligament
• Body of lateral meniscus
• Horns of lateral meniscus
• Notch with ACL
• Notch with PCL
• Horns of medial meniscus
• Body of medial meniscus
• Medial collateral ligament

4. MRI knee- side identification
• Look for patella- anterior
• Look for fibula- lateral and posterior
• Look for BLACK in white or WHITE in black

5. ACL tear PCL tear
• MRI is highly specific for ACL tear but not for the PCL tear

6. Normal ACL

7. ACL tear

8. Sagittal section

9. Coronal section

13. ????

14. Mucoid degeneration of ACL

20. Cartilage

21. X RAYS
• Trauma
• Arthritis
• Oncology
• Miscellaneous

22. Missed fractures
Location
Percentage
Missed (%)
Missed/All
Fractures
Foot 7.6 18/238
Knee 6.3 14/224
Elbow 6.0 14/234
Hand 5.4 10/185
Wrist 4.1 25/606
Hip 3.9 20/512
Ankle 2.8 8/282
Shoulder 1.9 5/266
Tibia/Fibula 0.4 1/266
Total 3.7 115/3081

23. How to read an x ray

24. • All x-rays should have an adequate number of views.
• Minimum of 2 views—AP and lateral
• 3 views preferred
• Joint above and joint below
• All x-rays should have adequate penetration

25. Adequate penetration:
An under-penetrated film- diffusely opaque
(too white)
An over-penetrated film- diffusely lucent ( too
black)

26. Adequate penetration

27. Alignment

28. Cartilage and joint
space
joint spaces on x-rays
• Widening of joint spaces signifies
ligamentous injury and/or
fractures
• Narrowing of joint spaces
arthritis

29. Joint space widening

30. Fracture identification

31. Soft tissues: give important information

32. How to read x ray: View, side, age, sex,
positive findings, diagnosis
• This is a X ray Anteroposterior
view of the right hip joint of ……
yesrs old male/female showing
Joint space narrowing, sclerosis
of articular margins and erosions
of femoral head. Likely
diagnosis is TB right hip joint.

33. In case of trauma x ray tell the fracture
pattern, displacement, angulation and
rotation
This is an AP view of left
knee joint with femur of a
…..old…..M/F….showing
short oblique fracture of
mid shaft of the femur with
medial displacement an
atleast 3 cm shortening.

34. Fracture mimics
• Growth plates
• Apophysis
• Accessory bone
• Harris lines
• Normal variant

38. Harris growth lines

39. Fracture mimmic: Normal variant

40. What is abnormal?

42. Loss of half moon overlap sign

43. Paediatric Elbow X ray

46. Diagnosis? See the alignment

52. X ray changes in different type of arthritis
• OA
• RA
• AS
• Gout
• Pseudogout

53. OA
• Joint space narrowing
• Subchondral sclerosis
• Osteophytes
• Joint effusion and cysts

55. RA
• Earliest changes are seen in hands and feet
• Characteristic changes are erosion of margins
• Osteophytes are usually not seen until secondary OA sets
in.
• Cysts are larger than OA

57. Diagnosis is easy in advanced disease
due to typical deformities

58. Psoriatic arthropathy

59. Diagnosis is easy in advanced disease

60. Periosteal reaction not seen in RA but in
PA

62. First sign of AS

63. Ank spondylitis

66. Gout

67. Chronic tophaceous gout: Martel sign

69. Pseudogout

70. Orthopedic onology

72. location

96. Chondroblastoma

104. X ray features of some rare diseases
Osteopetrosis

105. Osteopetrosis: Bone within bone
appearance

106. Chonrodysplasia punctata
• Calcific stippling of epiphyses:

107. Osteopoikilosis: Multiple round opacities

108. Melorheostosis- Irregular cortical sclerosis
: Dripping candle wax appearance

109. Zebra strip sign following bisphosphonate
therapy in Osteogenesis imperfecta

110. • Thanks