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LANGUAGE OF FRACTURES Things you must describe (clinical and x-ray): ◦ Open vs Closed fracture ◦ Anatomic location of fracture.
Table of contents
Knee Imaging
Finally, assess the alignment of bones. As you look at the relationship of the bones to one another, does anything look out of place? In the case of an orthopedic injury, for example, you may noticed displacement associated with a fracture, or a dislocation here are some splinting tips if you note an abnormality. Misalignment can also be a result of chronic conditions such as degenerative bone disease. And now for the obvious — when interpreting an extremity X-ray, assessing the bones is a clear must.
As you review the films, pay special attention to the cortical outline of each bone and also look for abnormalities in bone density and texture. A breach in the cortical outline signals a fracture whereas changes in bone density may be a sign of a chronic problem like osteopenia or demineralization.
Wheeless' Textbook of Orthopaedics
Know how to recognize bony lesions, which may be benign or malignant. Remember, your patient may have more than one injury or radiographic abnormality. The entire film must be reviewed, even if you note an obvious fracture. While cartilage itself is not readily visible on an X-ray, radiographic imaging does allow for evaluation of joint spaces. Abnormally wide spaces, for example, could signal a ligament injury or distracted fracture. Narrow spaces may be a sign of degenerative processes and thinning cartilage, as in the case of osteoporosis.
You must also assess the growth plates in your imaging of pediatric patients. Injuries involving the growth plate are prone to complication and should be carefully treated and followed up closely.
Not sure if the joint spaces look correc t on your image? Do a side-by-side comparison. Image the unaffected side of the anatomy. Are the films symmetrical? As such, in clinical practice, the use of the term Colles fracture with an appropriate description of any associated injuries is sufficient in most instances. Plain films usually suffice, although if there is a concern of intra-articular extension, then CT may be beneficial.
The plain radiographic series often comprises an AP and a lateral view; however, it is not uncommon for an oblique view to be included. The fracture appears extra-articular and usually proximal to the radioulnar joint. Dorsal angulation of the distal fracture fragment is present to a variable degree as opposed to volar angulation of a Smith fracture. There is also usually impaction with resultant shortening of the radius. In addition to noting the presence of a fracture a number of features should be sought and commented upon:. The vast majority of Colles fractures can be treated with closed reduction and cast immobilization.
The cast extends from below the elbow to the metacarpal heads and holds the wrist somewhat flexed and in ulnar deviation 4 - for those of you familiar with Australian rules football; this position is reminiscent of the position adopted when holding a ball in preparation for a kick. This cast is known as a Colles cast 4. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys.
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FAQ Policy. About this book The second edition of this book concisely covers the most recent developments in orthopedics and trauma.
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