20150914 Staff Lecture Dep. of Emergency Medicine Jeju National University Hospital

1. Orthopedic Radiology
:Shoulder & Upper Extremity
2015-09-14 Staff Lecture
Dep. of Emergency Medicine
Sung Wook, Song

2. Reference
• Wiki Radiolgraphy http://www.wikiradiography.net/
• Schwartz D, Reisdorff E. Emergency Radiology. McGraw-Hill 2000.
• Orthopedic Radiology
• Knoop K, Stack L, Storrow A, Thurman RJ. The Atlas of Emergency
Medicine, Third Edition. McGraw Hill Professional; 2009.
2

3. Orthopedic Radiology: Basic
• Radiographic Dx. of a fracture
1. fracture line 의 확인
2. 주위 soft tissue 의 변화
3. skeletal contour 또는 alignment 의 변화
• Standard & Supplementary view
• Systematic Interpretation : ABC’s
3

4. 4

5. 5

6. SHOULDER
6

7. 7

8. 8

9. 9

10. 10
Shoulder AP

11. 11Shoulder True AP: Grashey method

12. 12

13. 13
Lt. Shoulder Inferosuperior (IS) axial view
Rt. Shoulder
IS axial view

14. CASE
14

15. 15
Deformity(+): Rt. shoulder
prominence of the acromion

16. 16humeral head: not in the glenoid fossa & anterior and inferior location

17. 17
internal rotation of the greater tuberosity ! a dip of ice cream
“ice cream cone sign”

18. 18Posterior Shoulder Dislocation: scapular Y view

19. 19Posterior Shoulder Dislocation: scapular Y view

20. 20
lightbulb sign

21. ELBOW
21

22. 22

23. 23

24. 24

25. 25

26. 26
Elbow AP - Adult

27. 27Elbow oblique - Adult

28. 28
Elbow Lat. - Adult

29. 29Elbow AP - Pediatric

30. 30
Elbow oblique - Pediatric

31. 31
Elbow Lat. - Pediatric

32. Ossification Center : Pediatric
32

33. 33
Ossification Centers
C R I T O E
1 3 5 7 9 11

34. Elbow Injuries by age
34

35. Radiologic evaluation: ABC’S
35

36. Alignment: 2 lines
36
1. Anterior humeral line (1-2)
2. Radiocapitellar line (3-4)

37. Alignment: AH & RC line
37

38. 소아: Radiocarpitellar line
38

39. Easily missed site : Adult
39

40. Easily missed site : Child
40

41. CASE
41

42. 42
fat pad sign(+)
! supracondylar fracture

43. 43

44. CASE
44

45. 45
swelling & pain in the forearm, palpable radial head in antecubital fossa
“Monteggia fracture”

46. 46
fracture of the proximal 1/3 of the ulna & combined D/L of the radial head
“Monteggia fracture”

47. 47
fracture of the distal 1/3 of the radius & combined D/L of the radioulnar joint
“Galeazzi fracture”

48. 48
Isolated fracture of the middle third of the ulna
“Nightstick fracture”

49. 49

50. 50
Galeazzi fracture dislocation
Monteggia fracture dislocation
Essex Lopresti lesion

51. WRIST & HAND
51

52. 52

53. 53
1st digit : thumb : 엄지
2nd digit: index finger : 검지
3rd digit: middle finger : 중지
4th digit: ring finger : 약지
5th digit: little finger : 새끼손가락

54. 54
floor : scaphoid bone ! common fx. site falling on outstretched hand(FOOSH)

55. 55

56. 56
S: 배모양의
L: 초승달
TQ: 삼각골
P: 완두콩모양
H: 갈고리모양
C: 얼굴모양
TD: 사다리꼴
TM: 큰 사다리꼴
CMCJ: carpometacarpal jt.
MCJ: midcarpal jt.
RCJ: radiocarpal jt.
DRUJ: distal R-U jt.

57. 57

58. 58

59. 59

60. 60

61. 61

62. 62

63. 63
tenderness over 5th MC base
or pisiform

64. 64
tenderness in “anatomic snuff box”

65. 65
tenderness over volar surface
of the carpals

66. 66

67. PA view: alignment
67
3 smooth arcs
abn.! carpal dislocation or Fx.

68. Scaphoid ring sign
68
scaphoid rotatory subluxation
intercarpal joint space: 2mm
특히 scapholunate joint space

69. lateral view: scapholunate angle
69

70. Dorsal / Volar
intercalated segmental instability
70

71. 71

72. CASE
72

73. 73
distal forearm displaced dorsally classic dinner-fork deformity
“Colles fracture”

74. 74
distal forearm displaced volar – reverse Colles
“Smith fracture”

75. 75
volar displacement of the distal radial fregment
“Smith fracture”

76. 76
4 type of distal radius fracture

77. CASE
77

78. 78
Perilunate dislocation

79. 79
Perilunate Dislocation
dorsal displacement of the carpal bones in relation to the lunate

80. 80
Scapholunate Dissociation
widened scapholunate joint space

81. 81
scaphoid fracture
middle third of scaphoid fracture

82. FINGER
82

83. 83

84. 84

85. 85

86. 86

87. 87

88. CASE
88

89. 89
Boutonnire deformity
4th digit : flexion of PIP & extension of DIP

90. 90
Swan-Neck Deformity
Index finger : hyperextension of PIP & flexion of DIP

91. 91
Mallet Finger
distal phalanx flexion & unable to extend it

92. 92
Mallet Finger
distal phalanx flexion & unable to extend it

93. 93

94. Boutonnire & Swan-neck deformity
• Boutonnire deformity
– injury to the central slip
• Swan-neck deformity
– contracture of intrinsic hand m
94

95. 95

96. 96
Mallet Finger: unopposed flexion of the DIP joint
(A) complete tear, (B) avulsion of a small chip fragment

97. 97
Jersey Finger
flexion if disrupted in the injured hand

98. Mallet & Jersey Finger
• Mallet finger: DIP " tearing the extensor mechanism
– sudden axial flow to the tip of the extended finger
• Jersey finger: DIP " avulsion of the flexor mechanism
– ring finger(m/c), FDP tears
98

99. 열공합시다.
99