Transcript Fractures hand to elbow

An initial Evaluation of a Radiographic film
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Discovery and History of x-rays
Image Perception
Radiographic densities
How to read a Radiograph (AABCS)
Describe a fracture and terminology
Mechanism of Injury
Lines and measurements
Image perception
• Searching for familiar identifiable patterns or a
combinations of patterns.
• The success or failure of this process depends
on a number of factors:
– Knowledge, Understanding and Experience.
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Anatomy and physiology
Abnormal and normal appearances .
Spatial awareness
Attenuating properties of structures
Image artefacts
Optical illusions
Mach Band Effect
The Machband describes an effect where
the human mind subconsciously
increases the contrast between two
surfaces with different densities.
Radiographic Densities
Different density material will attenuate
different amounts of x-ray beam.
Pb
82
BaSO4
56
Bone
Muscle
Fat
Air
8
20
X-ray film
How to read a Radiograph ?
Good Film Viewing
Concentration on the part of the observer is crucial.
Physical discomfort due to poor ventilation
Excessive temp, Humidity
Anxieties, domestic and personal distractions
Poor health, workload can all effect diagnostic accuracy.
High priority is given to optimise image quality
How ever little thought is given to optimal image
viewing conditions
Film Viewing Box / Monitor
Ambient lighting
No distractions
Biscuits and coffee
Why
important
Why is
doitwe
need
to
have TWO
to examine
all the
views.
views ?
Some Useful Terms
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Abnormality
Asymmetry
Bilateral
Defect
Deformity
Degeneration
Demineralisation
Depressed
Deviated
•Diastasis
•Discontinuity
•Displacement
•Disruption
•Erosion
•Extends through
•Impaction
•Irregularity
•Intact
•Malalignment
•Mild, Moderate
Gross
•Opacity
•Radiolucent
•Rotation
•Unilateral
Degree of Severity
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Minor
Mild
Low grade
Marginal
Partial
Extremely
Considerable
Pronounced
Marked
Severe
Gross
Excessive
Progression/time related
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Acute
Chronic
Recent
Healed
Longstanding
Active
Aggressive
Developing
Deterioration
Improvement
Direction of the Fracture Line
Types of Fractures
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Buckle/Green Stick
Comminuted
Avulsion
Pathological
Stress
Impacted
Initial Evaluation of a Radiographic
Film---------• Name, Date,
Anatomical markers,
projections
• Overall size and shape
of the bones
– Consistent with age ,
sex, uniformity
• Thickness of cortex
– thick at mid-shaft, Is it
visible all the way round.
• Density of the bone
– Increased or decreased
Bones
• Step or break in the Cortex
• Distortion of Trabecular pattern
• Distortion of bone shape
Cartilage and Joint space:
• Intra-articular involvement
• Look for Joint Space narrowing or
widening
Soft Tissue Swelling
Film has edges
Measurements and Lines
There are certain normal anatomical
relationships that can be measured
or assessed for alignment. These
can be of great benefit when trying
to spot fractures.
the ankle…..
B
A
20 - 40°
C
Boehler’s Angle
Summary
• Start with an overall observation of your
radiograph, pt. details, correct hand ?
• Think of the MOI, adult, child
• Pitfalls- accessory ossicles
• Consider soft tissue- occult fractures
• Once you spot a fracture, carry on to
examine rest of the radiograph
• Describe what you see
• Use measurements and line to help you