Trauma Films for Upper Body. LCDR. Naruebade Rungrattanawilai RTN M.D., LL.B. FRCOST, DMOC
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1 Trauma Films for Upper Body LCDR. Naruebade Rungrattanawilai RTN M.D., LL.B. FRCOST, DMOC
2 Objective A 42 year-old housekeeper with history of motorcycle accident. There was no external wound but she have pain on her left hip. She was unable to bear weight on her left leg. She cannot move left hip by herself but full passive rage of motion. Then you request film.
3 Objective What is pitfalls? Film : No Fx
4 Principle Light & Shadow Orthogonal - At least 2 views On joint above - One joint below Special view / Specific view
5
6 C-Spine When to remove cervical collar? Film C-spine in every case? Trauma series?
7 C-Spine When not to film C-spine : NEXUS criteria Normal level of consciousness No evidence of intoxication No Postr. cervical spine tenderness No other distracted pain No focal neurological deficit
8 C-Spine Alignment Antr. vertebral line Postr. vertebral line Spinolaminar line Postr. spinous line Soft tissue swelling*** C3 : 7mm C7 : 21mm
9 C-Spine C2 C5 T1
10 C-Spine Adequate film C1-T1 If not Swimmer view
11 C-Spine
12 Open mouth view C-Spine Upper C-spine injury (C1-C2 injury)
13 C-Spine C1 Ring Fx Jefferson s Fx
14
15 Clavicle & AC Joint -Failure- AC joint Clavicle Fx SC joint
16 AC Joint
17 AC Joint Type I-II : Non-op Type III : Controversy Type IV-VI : Sx
18 AC Joint Evaluate CC interspace compare to normal side Both clavicles in one long film
19 AC Joint
20 AC Joint Need Transaxillary view to R/O Type IV injury
21 Clavicle Mid shaft Fx : Non-op except Open Fx NV injury Assc. injury : Upper limb / Lower limb / Bilateral
22 Clavicle Skin tenting Sx
23 Clavicle
24 Clavicle Key structure : CC ligament Neer classification
25 Clavicle Both clavicles in one long film
26
27 Proximal Humerus
28 Proximal Humerus Surgical neck Fx 3-part Fx Surgical neck & GT
29 Shoulder Orthogonal view of shoulder AP view Transscapular view
30 Shoulder Transaxillary view
31 Shoulder Velpeau view
32 Shoulder Antr. Antr.
33 Shoulder Antr. shoulder dislocation Mechanism of injury Abduction external rotation
34 Shoulder
35
36 Humeral Shaft
37 Humeral Shaft Holstein Lewis
38 Humeral Shaft Repeat film after reduction and apply splint
39
40 Distal Humerus
41 Distal Humerus
42 Distal Humerus
43 Distal Humerus เร มเห น Ossificaiton center เม อ 2yr - C : Caitellum 4yr - R : Radial head 6yr - I : Internal epicondyle 8yr - T : Trochlea 10yr - O : Olecranon 12yr - E : External epicondyle CRITOE
44 Distal Humerus A - Teardrop B - Shaft-condyle angle C - Antr. humeral line D - Coronoid line
45 Distal Humerus Most common : Supracondylar Fx Tender on both lateral and medial elbow 2 nd most common : Lateral condyle Fx Tender on lateral elbow only Not tender on medial elbow
46 Distal Humerus Supracondylar Fx Gartland classification Type I : Antr. humeral line not pass middle capitellum Type II : Intact Postr. cortical hinge Type III : Complete Fx
47 Distal Humerus Lateral condyle Fx Milch Classification
48 Lateral condyle Fx Distal Humerus Milch classification Staging
49 Distal Humerus Pull Elbow = Radial head subluxation
50
51 Forearm
52 Forearm Galeazzi fracture Radial Fx with DRUJ injury
53 Forearm Monteggia fracture Ulnar Fx with Radial head dislocation
54 Forearm Night stick fracture Isolated ulnar shaft Fx
55
56 What to measure? Distal Radius
57 Distal Radius
58 Distal Radius Measure before and after reduction Radial height : 0.7cm Dorsal tilt : 23º Radial inclination : 16º Radial height : 1cm Volar tilt : 14º Radial inclination : 25º
59 Distal Radius Acceptable alignment : : Articular stepping < 2 5 : Radial height < 5mm compare to normal side 10 : Dorsal tilt < : Radial inclination < : Volar tilt < 20
60 Distal Radius Surgical risk prediction : La Fontaine 60 : Age > 60yrs เอา : Ulnar styloid Fx ดอร : Dorsal comminution เข า : Intraarticular Fx 20 : Initial dorsal tilt > 20
61 Distal Radius Fernandez classification Bending Shearing Compression Avulsion Combined
62 Distal Radius Colle s Fx Smith s Fx Reverse Colle s Fx Chauffeur s Fx Radial styloid Fx
63 Distal Radius Barton s Fx : Shearing Fx Volar Barton Dorsal Barton Volar Barton Dorsal Barton
64 Distal Radius Die Punch Fx Compression Fx on lunate fossa
65 Distal Radius Pediatric distal radius fracture Green stick Fx Incomplete Fx Torus Fx Cortical compression
66
67 Scaphoid Scaphoid view Mild extend wrist Ulnar deviation
68 Metacarpal Neck Shaft Base Boxer s Fx
69 Metacarpal Reduction technique Jahss s maneuver
70 Metacarpal Acceptable alignment Repeat film after reduction Bone Shaft Neck 2 nd MCB rd MCB th MCB th MCB 30 60
71 Jame s position Mild extend wrist Flex MCP 90 Full extend PIP & DIP Metacarpal
72 Metacarpal 1 st MCB Intraarticular Fx = Unstable Fx
73 Finger Reduction technique for proximal phalanx Fx Tension band effect
74 Finger
75 Finger
76 1 st digit Not 1 st finger Finger
77 Finger
78 No Fx but Ligament injury Finger
79 Finger DIP Fx-dislocation : Volar vs Dorsal
80 Finger PIP dislocation PIP Fx-dislocation
81 Finger Should not traction If necessary gentle traction
82 Quiz
83 Quiz 1 A 32 year-old gardener fall on left shoulder 2 hour before visiting doctor. At ER there was tenderness on left AC joint and film was showed as picture below What should you do after complete history taking and physical examination?
84 Quiz 1 What is your diagnosis and management?
85 Quiz 2 What s abnormal? What is the diagnosis? or, do you need other film?
86 Quiz 2 Open mouth view
87 Quiz 3 What will you report this film to your orthopedic staff?
88 Quiz 4 A 4 year old girl fall on outstretched hand and come to see you at ER. She complaint pain on her left elbow. Otherwise include distal neurovascular status were normal. What is your diagnosis?
89 Feel Free To Ask :) Thanks
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