نسخ من How to read x ray of the skeleton 2008 2009
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Transcript of نسخ من How to read x ray of the skeleton 2008 2009
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By :DR
HASSAN ALQARNI
Supervised by
DR. munawar
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How to comment on Skeleton -X rays
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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
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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
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How we describe fractures on X ray ?
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By the direction of the fracture line
Longitudinal oblique Transverse spiral
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By the number of fracture fragments
Two fragments –Simple More than two
fragments-Comminuted
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By the relationship of the fracture to the atmosphere Closed Open or compound Best evaluated clinically
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By the relationship of one fracture fragment to another Displacement Angulation Shortening Rotation
Most fractures display more than one of these abnormalities
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By convention, abnormalities of position describe the relationship of the distal fragment relative to the proximal fragment
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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)
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Angulation The abnormal angle
that the distal fragment makes with the proximal
In this case the distal fragment is angulated medially
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Shortening Overlapping of the
ends of the fracture fragments
Shortening is usually described by the number of centimeters of overlap
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Rotation Almost always
involves long bones (humerus and femur)
Knee joint is in AP position (points forward) but ankle points lateral, in this case
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Colle’s fracture Fracture of the distal
radius with dorsal angulation
Caused by a fall on the out stretched hand
Common Fracture Eponyms
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Smith’s fracture fracture of the distal
radius with anterior displacement and palmar angulation
Caused by a fall on a flexed hand
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Examples of easily missed fractures
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scaphoid fractureBuckle fracture
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Supracondylar fracture of the humerus
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Posterior dislocation of the shoulder
Humeral head looks like “light bulb”
Usually need lanother view like axillary or Y view
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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
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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
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-Fractured ribs marked
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Monteggia_Fracture
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_left Clavicle fracture
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X-ray showing the distal portion of a fractured tibia and intramedular nail.
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An old fracture with nonunion of the fracture fragments.
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