lower extrem toe-ankle2012
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Transcript lower extrem toe-ankle2012
Film Critique
1st year 5th class
Toes
Standard views
*AP
*Oblique (medioblique)
*Lateral (mediolateral/lateromedial)
Structures shown
AP projection of the phalanges of the foot
(*1st toe only has 2 phalanges the 2nd-5th
have 3 phalanges) ***We need from
distal phalanx to the distal end
metatarsal.
AP Right 1st Toe
Sesamoids
Check the film for:
No rotation of phalanges
Interphalangeal and
metatarsophalangeal joint spaces
open (no bent toes)
Toes should be separated from each
other so there is no soft tissue
overlap
Soft tissue and bony trabeculation
(this is to check for a good
technique)
AP left 1st toe
Rotation of toe
Soft tissue overlap
AP
Oblique Toes
Oblique left 1st toe
Structures shown
****
We do a medioblique:
An oblique projection of the phalanges
The Interphalangeal joints and 2nd -5th
metatarsophalangeal joints open
***Distal phalanx to the distal end of the metatarsal
Toes should be separated from each other
Both soft tissue and bony trabeculation should be seen
(techn)
Oblique left 2nd toe
LT
Cadaver bone
Lateral left 1st toe
Might need tape, straw or tongue depressor to separate toes
Lateral toes
Lateral left 2nd toe
lateromedial
Lateral left 3rd toe
Mediolateral
Do lateromedial (1st-3rd) and
mediolateral (3rd-5th) to get the toe
closest to the film
Structures shown: Lateral toe
A lateral projection of the phalanges: Phalanges in profile
(toenail should appear lateral)
The interphalangeal joints spaces open. The MTP joints will
be overlapped but may be seen in some patients.
***The distal phalanx to the distal ends of the
metatarsals
Phalanx, without superimposition of adjacent toes. When
superimposition cannot be avoided, the proximal phalanx
must be demonstrated.
Toes should be separated from each other
Soft tissue and bony trabeculation (techn)
Lateral left 2nd toe
Lateral left 1st toe
Tongue depressor
Lateral Left 2nd toe
Foot
Standard views
*AP
* AP Oblique (medioblique)
*Lateral (mediolateral)
AP Right Foot
Intermediate
Base of the 5th
Common area for a foot fracture base of 5th Jones fracture
AP Right foot
**In this view you
Will not see the
Calcaneus!!
Structures shown:
Dorsoplanter (AP) projection of the
tarsals anterior to the talus, the
metatarsals,and the phalanges
You will not see the whole calcaneus
on this view. Why?
Some people angle 10 degrees
toward the heel on this view
***You want all of the phalanges,
metatarsals and tarsals distal to the
talus on your image
Check film for:
Motion
Rotation: there will be overlap of second- fifth
metatarsal bases
Open joint space between medial and
intermediate cuneiform
No overlap of toes
Density- are the toes burned out
Oblique Right foot
Oblique Right Foot
medioblique
Structures shown:
AP medioblique projection of the
phalanges and metatarsals
Interspaces open between the cuboid
and calcaneus, the cuboid and the 4th
and 5th metatarsals, the cuboid and
the lateral cuneiform and the talus
and the navicular
Cuboid is in profile
Sinus tarsi, calcaneus, navicular,&
base of the fifth are seen
Oblique Left Foot
Calcaneus?
Check for:
Enough rotation when the 3rd – 5th
metatarsals bases are free from
superimposition
The lateral tarsals with less
superimposition than in the AP
Joint spaces open
Base of the fifth metarsal is seen
Density: are the toes seen and are
the tarsal seen
Tip of toes to calcaneus on the image
Lateral Right Foot
Lateral Right Foot
R
mediolateral
Structures shown:
Mediolateral projection of the entire
foot. ***You need distal ends of the
tib/fib, ankle joint, calcaneus to the
distal phalanges.
Bad lateral foot
Check for:
Tip of toes to calcaneus and distal
tib/fib on the image
Metatarsals nearly superimposed
Density to see toes, metatarsals and
tarsals
Good Positioning
Poor : heel not flat
Poor : knee elevated
Poor : foot not flat
NO!
CALCANEUS
Standard views
*AP axial (plantodorsal)
*Lateral (mediolateral)
Sustentaculum
tali
Trochlear
process
tuberosity
Structures shown:
An axial projection of the calcaneus
***from the tuberosity to the
sustentaculum tali and trochlear
process
AP Axial Right Calcaneus
Check for:
Calcaneus should be visualized to
include the talocalcaneal joint
No rotation of calcaneus (check the
first or fifth metatarsals)
Density to see joint without burn out
of tuberosity (two films if not using
DR or CR)
Rotation / foot flexion
Rotation : can see
4th & 5th metatarsals
Good
Too much flexion
Can’t see joint space
Structures shown:
Lateral projection of the ankle joint
and the calcaneus and adjacent
tarsals.
Lateral Left
calcaneus
Check for:
No rotation of the calcaneus
Density can you see soft tissue and
bone
Sinus tarsi seen
Ankle joint and adjacent tarsals
should be on the film
Ankle
Standard views
*AP
*OBL (mortise)
*Lateral (mediolateral)
AP
Right
Ankle
Structures shown
AP projection of the ankle joint,
***distal ends of tib/fib and the
proximal portion of the talus
Dorsal flex
AP Left ankle
Check for:
Talotibial joint space should be seen
Ankle joint should be centered
Moderate over lapping at the tibiofibular
articulation is normal
***Area from the distal tibia and fibula to
the talus should be included
Oblique Left Ankle
Structures shown:
Distal ends of the tib/fib with the
entire ankle mortise joint
demonstrated in profile.(all three
sides of the mortise joint should be
open.)
AP OBLIQUE ANKLE
The entire ankle mortise joint should be
demonstrated in profile. We oblique 15-20
degrees to open all three joints.
AP
Too
much
Oblique Right Ankle
is it open?
Don’t just dorsiflex the foot, roll
the leg
Check for:
Entire ankle mortise joint
No overlap of the anterior tubercle of
the tibia and the superolateral
portion of the talus with the fibula
Talofibular joint space in profile
Talus demonstrated with proper
density
Lateral Right
Ankle
Lateral ankle (mediolateral)
A true lateral image of the lower
third of the tib/fib, the ankle joint
and the tarsals including the base of
the 5th metatarsal
Lateral Right Ankle
Poor positioning
Dorsiflex the foot
Check for:
Ankle joint should be centered
Talotibial joint should be well
visualized
Fibula should be over the posterior
half of the tibia
Density of ankle should be sufficient
to see the outline of the distal
portion of the fibula
Fifth metatarsal should be seen to
check for a Jones fracture