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X-ray interpretation (main)
From WikEM
Contents
Background
It is important to have a method of reading xrays and communicating these findings with colleagues or consultants
Method
Demographics
- Patient name and age
- Orientation and location of images
- ex. AP and lateral of the right wrist
- Skeletal maturity
Assessment of bones
Follow the cortex and look for discontinuities
- Fractures
- Location
- Epiphysis, diaphysis, metaphysis
- Midshaft, proximal 3rd, mid-3rd, distal 3rd
- Joint involvement
- Orientation
- Transverse, oblique, sagittal
- Comminution
- Comminuted - small fragments
- Segmental - small section of bone boarded by fractures distally and proximally
- Butterfly fragment - large triangular segment
- Displacement
- Percentage of disruption
- ex. 50% displacement if bones are half overlapping or 200% displacement if the bones are separated by the distance of one bone-width
- Describe displacement of distal fragment relative to proximal
- Angulation
- Describe angulation as the direction the apex is pointing relative to anatomical long axis of the bone
- Shortening
- Rotational deformity
- Location
- Lesions
- Lytic/blastic lesion
- Important if assessing a pathological fracture
Assessment of Joints
- Position and alignment
- Fracture involving the joint
- Obvious degeneration or FB
Assessment of Soft Tissue
- Gas
- Can be present in open fractures or with soft tissue infections
- Fat pads
- ex. Sail sign
- Foreign body
Spinal Imaging
- By standard convention, spine films have slightly different terminology
- Anterolisthesis - A description of the inferior edge of a superior vertebrae in relationship to the superior edge of the inferior vertebrae
- Anterolisthesis of C5 on C6 (C5 is more anterior than C6)
- Retrolisthesis - A description of the inferior edge of a superior vertebrae in relationship to the superior edge of the inferior vertebrae
- Retrolisthesis of C6 on C7 (C5 is more anterior than C6)