Basic Radiographic Principles Part II Kristopher Avant, D.O. October 19 th, 2016 I have no disclosures relevant to the material presented in this discussion. Good Stuff!!! 1
Really? Really! Musculoskeletal Objectives Ø Components in Interpretation Ø Normal Findings Ø Abnormal Findings Ø Common Pathology Ø Zebras Musculoskeletal Ø Classification and Names = Overwhelming!!! Ø Basics Ø Open vs. Closed Ø Location Ø Proximal Shaft Distal Ø Which bone Ø Fracture Type Ø Avulsion - Spiral Oblique - Transverse - Comminuted Ø Alignment Open Distal Radius Fx that is Comminuted and Dorsally angulated 2
Upper Extremity Ø Hand Ø Metacarpal Ø Phalanx Fractures Ø Dislocations Ø Wrist Ø Volar Ø Dorsal Ø Distal Radius Ø Carpal Fracture / Dislocation Ø Special Names Ø Elbow Ø Supracondylar Ø Condyles Ø Olecranon Ø Radial Head Ø Fracture / Dislocation Ø Shoulder Ø Clavicle Ø Proximal Humerus Ø Fracture / Dislocations Upper Extremity Imaging of the Hand 3
History Ø First x-ray in 1895 Ø Wilhelm Roentgen (1845-1923) Ø Wife s hand Know the Bones Shadows? Sesamoid Bones 4
Basic Views Basic Views Posteroanterior (PA) view Basic Views Lateral View 5
Basic Views One view is no view! Basic Views Where s the fracture? Ø Cortical breaks Ø Radiolucent lines Fracture Concepts 6
Special Views Standard Pronated oblique view Special Views Supinated oblique view Special Views Supinated oblique view Arthritis & Fracture 7
Joints Arthritis presents with: Ø Joint space narrowing Ø Sclerosis Ø Cysts Ø Osteophytes Joints Bone Density 8
Tuft Fracture 9
PIP Fx/Dislocations Metacarpal Fractures Boxer s Fracture 10
Carpal Fracture / Dislocations Ø Scaphoid Fractures Ø Perilunate dislocations Scaphoid Fracture Ø Can be occult! Ø Proximal Ø Middle Ø Distal Metacarpals capitate Lunate Radius Galulas Lines 11
Perilunate Dislocation Ø ~40% missed in ER Ø Can be devastating when missed Perilunate Dislocation Metacarpals Capitate Lunate Radius Galulas Lines 12
Most Common Missed Fracture? Diagnosis Distal Radius Fracture Ø Colles Ø Smith s Ø Barton s Ø Volar Ø Dorsal Ø Chauffeur Ø Galleazi 13
Distal Radius Bad vs. Not So Bad Colles Fracture Ø Distal Radius Fracture Ø Dorsal angulation 14
Smith s Fracture Ø Distal Radius Fracture Ø Volar angulation Barton s Fracture Ø Distal Radius fracture Ø Volar or Dorsal lip Chauffeur s Fracture Ø Radial styloid fracture 15
Galleazi Fracture Ø Radius Fracture Ø DRUJ dislocation Forearm Fractures Various Flavors! 16
Elbow Fx/Dislocations Distal Humerus Fractures Ø Supracondylar Ø Medial & Lateral Condyle Ø Capitellum Supracondylar 17
Medial & Lateral Condyle Capitellum Fracture Olecranon Fractures 18
Radial Head Fractures Radial Head Fractures Redneck Power!! 19
Shoulder! Proximal Humerus Axillary View 20
Clavicles Acromioclavicular Separation Upper Extremity Review 21
Lower Extremity Ø Pelvis & Hip Ø Hip Fractures Ø Rami Fractures Ø Knee Ø Supracondylar Ø Patella Ø Tibial Plateau Ø Tibial Spine Lower Extremity Ø Ankle Ø Malleolar Fractures Ø Maisonneuve Ø Foot Ø Lisfranc Injury 22
Hip Fractures Types of Fractures Femoral Neck Fx 23
Intertrochanteric Fx Pubic Rami Fractures Distal Femur 24
Distal Femur Patella Fractures Bipartite Patella 25
Tibial Plateau Schatzker Classification Tibial Spine 26
Malleolar Fractures Bimalleolar / Trimalleolar Fracture Blisters 27
Maisonneuve Fracture Ø Spiral fracture of the proximal fibula with a tear of the syndesmosis Ø Associated fracture of the medial malleolus or rupture of the deltoid ligament Lisfranc Injury Ø Ligament that runs between medial cuneiform and 2nd metatarsal Pediatric MSK Imaging Ø Salter-Harris Classification Ø Growth plates / Ossification centers look weird!! Ø Immobilize if painful Ø Compare with contralateral side if necessary 28
Salter-Harris Salter-Harris Pediatric Proximal Humerus 29
Pediatric Elbow Alignment Ø Fat Pads Ø Anterior Humeral Line Ø Radiocapitellar Line Advanced Imaging Ø Ultrasound Ø Bone Scan Ø CT Scan Ø MRI 30
Bone Scan Ø Technetium-labeled bone scintigraphy Ø High sensitivity, low specificity Ø Increased uptake indicates increased blood flow (immediate) and bone turnover (delayed phase) Ø Useful for detecting: Ø Osteomyelitis Ø CRPS CT Scan Ø Quick 3D view possible Ø Useful for detecting: Ø Suspected fractures not easily seen on X-ray Ø Assess union Ø Evaluate cortical integrity with bony tumors Ø Study fracture pattern and plan surgical approach Ø Expensive, Timely MRI Scan Ø Useful for detecting: Ø Soft Tissue Anatomy (mass/swelling) Ø Ligament injuries May use arthrography Ø Vascularity (Kienböck s, Scaphoid Non-union) 31
Other Modalities Removing a Ring 32
33
34