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X ray interpretation maot
- 1. X-RAY INTERPRETATION Amy B. Harris, MSN, RN, OCNS-C Children’s National Health System
- 2. UPPER EXTREMITY LOWER EXTREMITY SPINE SHOULDER FOOT AND ANKLE 100 100 100 100 100 200 200 200 200 200 300 300 300 300 300
- 3. ANKLE FOR 100 This fracture will require Open Reduction and Internal Fixation
- 4. WHAT IS A BIMALLEOLAR FRACTURE? Fracture of the Distal Tibia and Fibula
- 5. UPPER EXTREMITY LOWER EXTREMITY SPINE SHOULDER FOOT AND ANKLE 100 100 100 100 200 200 200 200 200 300 300 300 300 300
- 6. Patients with this type of injury may have neuro deficits SPINE FOR 100
- 7. WHAT IS A T-12 BURST FRACTURE Stable: Thoracic Lumbar Sacral Orthosis (TLSO); No B.L.T.; Advancing to P.T. to strengthen trunk flexor and extensor muscles Unstable: Surgical Fusion – with instrumentation, followed by P.T. to regain strength
- 8. UPPER EXTREMITY LOWER EXTREMITY SPINE SHOULDER FOOT AND ANKLE 100 100 100 200 200 200 200 200 300 300 300 300 300
- 9. SPINE FOR 200 This fracture may require Halo Immobilization
- 10. WHAT IS A JEFFERSON’S FRACTURE? • COMPRESSION AND OR BURST FRACTURE OF THE C1 VERTEBRAE • UNSTABLE FRACTURE of POSTERIOR ARCH AND ANTERIOR ARCH OF C1 MECHANISM: • DIRECT BLOW TO THE VERTEX OF THE HEAD (AXIAL COMPRESSION LOAD) • COULD BE FROM A FALL OR FROM AN OBJECT STRIKING THE VERTEX OF THE HEAD NEUROLOGIC INJURY IS RARE BUT CAN OCCUR IF THERE IS INVOLVEMENT OF C2 ODONTOID VIEW ABOVE – LM = LATERAL MASSES OF C1
- 11. UPPER EXTREMITY LOWER EXTREMITY SPINE SHOULDER FOOT AND ANKLE 100 100 100 200 200 200 200 300 300 300 300 300
- 12. UPPER EXTREMITY FOR 100 This particular view is used to identify this type of fracture
- 13. WHAT IS A SCAPHOID FRACTURE? BONUS QUESTION for 100 points: WHAT TYPE OF VIEW WAS SEEN IN THE PREVIOUS SLIDE?
- 14. SCAPHOID VIEW
- 15. SCAPHOID FRACTURE Surgical Fixation on the left – note Open Growth Plates 4 months post-op on the right
- 17. UPPER EXTREMITY LOWER EXTREMITY SPINE SHOULDER FOOT AND ANKLE 100 100 200 200 200 200 300 300 300 300 300
- 18. UPPER EXTREMITY FOR 200 THIS TYPE OF FRACTURE CAN BE GRADED – TYPE I, II, OR III
- 19. WHAT IS A SUPRACONDYLAR HUMERUS FRACTURE?
- 20. SUPRACONDYLAR HUMERUS FRACTURE Rare in Adults Often occurs in children from a fall onto an outstretched hand Considered suspicious in a child age 3 or under Requires 3 views of the distal humerus initially May require Closed Reduction and Percutaneous Pinning (CRPP) depending on the severity of the injury Anterior Sail SignPosterior Fat Pad Lateral view is indicated -
- 21. UPPER EXTREMITY LOWER EXTREMITY SPINE SHOULDER FOOT AND ANKLE 100 100 200 200 200 300 300 300 300 300
- 22. DAILY DOUBLE!!
- 23. LOWER EXTREMITY FOR 100 DAILY DOUBLE! If this fracture occurs in an elderly individual it is considered a fragility fracture
- 24. HIP FRACTURE - INITIAL ASSESSMENT AND MANAGEMENT Assess Neurovascular Status Obtain Full Past Medical and Surgical History Assess for History of DVT/PE X-Rays Buck’s Traction Begin Mechanical DVT Prophylaxis Protect Skin Turn and evaluate skin Pain Management Intravenous Fluids I.V. Antibiotic dose Pre-op ?NPO – immediate surgical prep
- 25. HIP FRACTURES Obtain history re occurrence of other fragility fractures Nutritional Assessment Labs DEXA Scan Follow up with PCP FOCUS on prevention!
- 27. WHAT IS AN INTERTROCHANTERIC FRACTURE?
- 29. FEMORAL NECK FRACTURE TREATED WITH HEMIARTHROPLASTY
- 30. UPPER EXTREMITY LOWER EXTREMITY SPINE SHOULDER FOOT AND ANKLE 100 200 200 200 300 300 300 300 300
- 31. SHOULDER FOR 100 This injury will require pre-operative planning to determine the course of treatment
- 32. WHAT IS AN ANTERIOR FRACTURE DISLOCATION? This is a Type I Anterior Fracture Dislocation – Radiographically distinguished by engagement of the humeral head on the anterior glenoid on the AP view. An Axial view would also be necessary
- 33. UPPER EXTREMITY LOWER EXTREMITY SPINE SHOULDER FOOT AND ANKLE 100 200 200 200 300 300 300 300 300
- 34. SHOULDER FOR 200 AP and Axillary Lateral views will be necessary for full assessment of this injury
- 35. WHAT IS A SALTER HARRIS II FRACTURE OF THE PROXIMAL HUMERUS?
- 36. PROXIMAL HUMERUS FXS Birth injuries 0-5 yo Salter I 5-11 yo metaphyseal 11 to maturity – Salter II Others rare (III, IV)
- 37. UPPER EXTREMITY LOWER EXTREMITY SPINE SHOULDER FOOT AND ANKLE 200 200 300 300 300 300 300
- 38. ANKLE FOR 200 This injury requires AP, lateral and mortise views for full assessment
- 39. WHAT IS A TRIMALLEOLAR FRACTURE? Fracture of the lateral malleolus (distal FIBULA) and the medial and posterior malleoli of the TIBIA Treatment - ORIF
- 41. TRIMALLEOLAR FRACTURE Important to always x-ray the joint above and below the fracture BONUS QUESTION for 100 points: What type of fracture may be found if the knee was also x-rayed with a severe ankle injury?
- 42. MAISONNEUVE FRACTURE The Maisonneuve fracture is a spiral fracture of the proximal third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane. There is an associated fracture of the medial malleolus or rupture of the deep deltoid ligament. This type of injury can be difficult to detect. The fracture is named after the surgeon Jules Germain François Maisonneuve.
- 43. UPPER EXTREMITY LOWER EXTREMITY SPINE SHOULDER FOOT AND ANKLE 200 300 300 300 300 300
- 44. LOWER EXTREMITY FOR 200 A CT scan may be ordered to further define the extent of this fracture
- 45. WHAT IS A TIBIAL PLATEAU FRACTURE?
- 46. TIBIAL PLATEAU FRACTURE TWO DIFFERENT PATIENTS
- 47. TIBIAL PLATEAU FRACTURE • Common injury which affects the articular surface of the proximal tibia • Ranges from minimally displaced lateral depression fractures to severe bicondylar fractures • May be associated with meniscal tears, ligament tears, knee dislocations, compartment syndrome, or vascular injuries
- 48. FIXATION OF TIBIAL PLATEAU FRACTURE
- 49. UPPER EXTREMITY LOWER EXTREMITY SPINE SHOULDER FOOT AND ANKLE 300 300 300 300 300
- 50. UPPER EXTREMITY FOR 300 THE BADO CLASSIFICATION SYSTEM SUBDIVIDES THIS INJURY INTO FOUR TYPES.
- 51. WHAT IS A MONTEGGIA FRACTURE? Definition: fracture of the proximal ulna with associated dislocation of the radial head Accounts for less than 5 % of all forearm fractures More common in children Adult injuries are typically high energy, fall from heights or MVA
- 53. 1. HUMERAL SHAFT 5. CAPITELLUM 9. RADIAL 2. OLECRANON FOSSA 6. RADIAL HEAD TUBEROSITY 3. LATERAL EPICONDYLE 7. TROCHLEA 10. ULNAR SHAFT 4. MEDIAL EPICONDYLE 8. CONOID TUBERCLE
- 55. UPPER EXTREMITY LOWER EXTREMITY SPINE SHOULDER FOOT AND ANKLE 300 300 300 300
- 56. SPINE FOR 300 THESE IMAGES WERE OBTAINED FOLLOWING INITIAL PLAIN X-RAYS OF THIS INJURY IN THE TRAUMA BAY
- 57. WHAT IS A SPINAL CORD INJURY?
- 59. UPPER EXTREMITY LOWER EXTREMITY SPINE SHOULDER FOOT AND ANKLE 300 300 300
- 60. FOOT AND ANKLE FOR 300 THIS TYPE OF FRACTURE MAY RESULT IN A NON-UNION
- 61. WHAT IS A JONES FRACTURE?
- 62. UPPER EXTREMITY LOWER EXTREMITY SPINE SHOULDER FOOT AND ANKLE 300 300
- 63. SHOULDER FOR 300 This injury may occur due to a fall onto the involved shoulder
- 64. WHAT IS AN AC JOINT SEPARATION? Mechanism of Injury • Direct Blow Classifications • 1st Degree - Stretching with No Separation • 2nd Degree - Clavicle/Scapula Attachments Intact • 3rd Degree - Complete Separation AC Joint and Attachments Clinical Presentation • Pain / Swelling • Deformity in Higher Degrees • Decrease Range of Motion
- 66. AC JOINT SEPARATION Conservative Treatment • 1st & 2nd Degree AC Joint Separations P-RICE-MM Surgical Intervention • 3rd Degree and Higher Fixation Ligament Reconstruction Resection of Distal Clavicle
- 67. UPPER EXTREMITY LOWER EXTREMITY SPINE SHOULDER FOOT AND ANKLE 300
- 68. FOOT AND ANKLE FOR 300 INITIAL X-RAYS ON THE LEFT MAY NOT SHOW THE PRESENCE OF THIS FRACTURE DEPICTED ON THE RIGHT
- 69. WHAT IS A STRESS FRACTURE OF THE SECOND METATARSAL?
- 70. STRESS FRACTURE TREATMENT / PREVENTION Eat a healthy diet: A balanced diet rich in calcium and Vitamin D will help build bone strength. Use proper equipment. Old or worn running shoes may lose their ability to absorb shock and can lead to injury. In general, athletic shoes should have a softer insole, and a stiffer outer sole. Start new activity slowly. Gradually increase your time, speed, and distance. In most cases, a 10 percent increase per week is appropriate.
- 71. Cross train. Vary your activities to help avoid overstressing one area of your body. For example, alternate a high-impact sport like running with lower- impact sports like swimming or cycling. Add strength training to your workout. One of the best ways to prevent early muscle fatigue and the loss of bone density that comes with aging is to incorporate strength training. Strength-training exercises use resistance methods like free weights, resistance bands, or your own body weight to build muscles and strength. Stop your activity if pain or swelling returns. Rest for a few days. If the pain continues, see your doctor. Stress Fracture Treatment / Prevention (continued)
- 72. CONGRATULATIONS TO ALL OF OUR PARTICIPATING TEAM MEMBERS!!
- 73. REFERENCES Sarward, John F., Essentials of Musculoskeletal Care, 4th Edition, 2010 National Association of Orthopaedic Nurses www.orthonurse.org Orthopaedic Nurses Certification Board www.oncb.org American Academy of Orthopaedic Surgeons www.aaos.org www.eorif.com