Transcript More upper extremity

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More upper extremity
IMAGE REVIEW & CRITQUE
Lecture # 3 – Part 1
Upper Extremity
RT 123 – WEEK 9
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Shield ?
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Anatomy &Positioning
Review
Upper Limb
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RE: LATERALS PG 80
PROJECTION VS POSITION
• CHEST / ABDOMEN / SKULL
• The lateral is referred to the POSTION –
which is the SIDE TOUCHING THE IR
• SO LEFT LATERAL (position ) in
referred to as a LATERAL PROJECTION
• LIMBS : Pos/Pro – side entered by IR
• MEDIOLATERAL OR LATERALMEDIAL
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LEFT LATERAL OF CHEST
LEFT LATERAL POSITION – LATERAL PROJECTION
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Lateromedial
mediolateral
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Lateromedial humerus
Taken “AP”
Mediolateral humerus
“Taken PA”
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Lateromedial
mediolateral
EPI’s ?
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Hand - lateralmedial
Hand Position?
Hand - mediolateral
Internal Rotation - (lesser tubercle in profile)
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Greater tubercle
Lesser tubercle
in profile in
external rotation
internal rotation
Proximal HUMERUS
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Anatomy Review
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Position – Best Seen?
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Position – Best Seen?
?
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Position – Best Seen?
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Position – Best Seen?
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Scaphoid most commonly fx of carpel bones
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15 º
5º
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? Taken
for?
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Flexed joint
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supracondylar fracture of the elbow
Name 3 postions to best
demonstrate this fx?
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supracondylar fracture of the elbow
If a child complains of elbow pain after a fall
and refuses to straighten his or her arm
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Will This Work?
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using shields
when collimator
head cannot be
rotated.
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Patient
positioning for
AP humerus
image when
fracture is located
close to shoulder.
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Taken “AP”
Mediolateral humerus
“Taken PA”
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Projection ? – For?
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Distal Humerus (poss fx)
Poor position distally better position
not good Rad Prot
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Epi’s are ┴ do not move arm if
fracture is suspected!
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classifications
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Ossification of carpals
• It is useful to have some
idea of the age at which
each of the carpal ossific
centres appears although
one would not expect you
to know them all by heart!
• Ossification is usually
visible by the end of the
first year in the capitate
and hamate . The
remainder of the carpals,
except for the pisiform,
have appeared by the
eighth year.
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Bone age?
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The capitate (1) and hamate (2) both are seen
as large circular bony structures.
A very faint smaller bony ossific centre is also
present just proximal to the hamate.
This is the first appearence of the triquetral
• The epiphyseal growth
plates have also started to
ossify on each of the
metacarpals. These are at
the proximal ends of these
bones.
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JOINT CLASSIFICATION
• GLIDING
• HINGE
• BALL & SOCKET
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SADDLE
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COMMON FRACTURES
pg 74
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fracture description
• The first consideration is the age of the
patient.
• Fractures in children require special
attention because a child's bones are still
growing and changing.
• An adult fracture is classified based on its
location, direction, alignment, articular
involvement (involving most of the joint
rather than the shaft), and whether it is
open or closed.
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The direction of the fracture is described as
• transverse (fracture line is straight across
the bone)
• spiral (fracture line spirals down the bone)
• oblique (slanted fracture line)
• comminuted (more than two fragments)
• segmental (several large fractures in the
same bone)
• open fracture means that bone fragments
have broken through the skin causing an
open wound
• closed fracture means that there is no
opening in the skin.
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Fracture Terminology Review
• Greenstick fractures – occurs when bone
is angulated beyond limit of bending
• Complete fractures - Transverse
fractures
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- Spiral / Oblique Comminuted /
Segmental
• Avulsions:
• Forcible tearing/separation of ligaments or
muscles from the bone
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COMMON FRACTURES
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PG 99
Avulsion – tearing away from bone
Boxer – base 4th or 5th metacarpal
Colle’s – distal radius/ulnar – posteriorly
Smith’s distal radius/ulnar – anteriorly
Greenstick – bending of bone (children)
Pathologic – fx of a diseased or weakened
bone
• + Galeazzi and Monteggia fractures
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Upper Extremity Avulsions
• Avulsion of muscles
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Greater tubercle
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Lesser tubercle/
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Medial epicondyle of humerus
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Lateral epicondyle of humerus
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Children
• Epiphyseal plate
fractures:
• 30% of children
fractures involve the
growth plate
(epiphyseal plate
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• Buckle (torus)
fractures – caused
by compression
failure of bones. It
occurs usually near
the metapysis where
porosity is greatest
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• The most difficult aspect of
reconstruction of fractures of the
distal humerus is the restoration
of normal anatomic relationships
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MORE IMAGE ANALYSIS
Practice TEST
“FILM CRITIQUE”
WHAT DO YOU KNOW?
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Name the labeled anatomy #1
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Name the labeled anatomy #2
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www.rad.washington.edu
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POSITIONS?
#3
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Problem Pathology
position?
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Problem
Pathology ?
OSTEO ARTHRITIS
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Problem
Pathology
CRITIQUE
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CRITIQUE
What projection
position?
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Problem
Pathology ?
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• A 14-year old boy was
roughhousing with a
friend when he heard a
crack and felt a sharp
pain in his mid-humerus.
• What is the correct
terminology to use in
describing this fracture?
• Why did this otherwise
healthy young man break
his arm from minor
trauma?
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• comminuted fracture
• From?
• a pathologic fracture
through a pre-existing
bone lesion that had
weakened the
integrity of the bone
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Position? Pathology?
• This 22-year old man
has had a swollen
wrist for several
months. Take a look
at his radiograph and
answer the following
questions. Is this
lesion benign or
malignant? What is
the specific name for
this bone tumor?
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Position? Pathology?
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• This clinical picture is
classic for a fracture of
the radial head.
• When an adult falls on an
outstretched hand, the
force of the fall is
transmitted up the radius
and frequently will impact
or crack the radial head.
• In this lateral view there is
a subtle disruption in the
relationship between the
head and the shaft of the
radius.
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Problem
Pathology ?
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Name of fx
#13
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greenstick
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Type of fracture?
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# 15
• What do fat pads
suggest?
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• Anterior fat pad
displacement in the
lateral view suggests
effusion, but if the
posterior fat pad is
visible at all, an elbow
fracture is likely.
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#16
Position / problems ?
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Name of FX?
#17
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#18
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#19
High
resolution
digital
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#20
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• POSITION?
• CRITIQUES?
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• POSITION?
• CRITIQUES?
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• POSITION?
• CRITIQUES?
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• POSITION?
• CRITIQUES?
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• POSITION?
• CRITIQUES?
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• POSITION?
• CRITIQUES?
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• POSITION?
• CRITIQUES?
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• POSITION?
• CRITIQUES?
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• POSITION?
• CRITIQUES?
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• POSITION?
• CRITIQUES?
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How did you do?
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More Pathology Review
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• A 6 year old boy falling on his
outstretched left arm
• displaced
supracondylar
fracture of the left
humerus
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Ulnar nerve injury
“funny bone”
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Giant cell
turmor
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Monteggia Fractures
• fracture of proximal
radius
• dislocation of the
radial head
• Involvement forearm
& elbow joint
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Galeazzi Fracture
• Mechanism: Fall on outstretched hand
with elbow flexed
• Fracture of the radius with shortening
and dislocation of the distal ulna
• Dorsal angulation
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Galeazzi Fracture
• Galeazzi and
Monteggia fractures
are both fractures in
which there is a
fracture with
shortening of one of
the two bones of the
forearm with
dislocation of the
other bone
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Fat pad
sign
Radial
Head
fracture
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Radial head fractures
• are common injuries, occurring in about 20
percent of all acute elbow injuries.
• They are more frequent in women than in men
and occur most often between 30 and 40 years
of age.
• Approximately 10 percent of all elbow
dislocations involve a fracture of the radial head.
• As the humerus and ulna return to their normal
alignment, a piece of the radial head bone could
be chipped off (fractured).
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Subluxation of radial head
• This is the most common
traumatic injury of the elbow
in children.
• It is also known as "pulled
elbow" or "nursemaid's
elbow." The average age of
incidence is 2-4 years.
• As children get older, the
annular ligament gets
thicker and resists tearing,
making this injury less likely.
• Treatment entails reduction
by forcefully supinating the
forearm with the elbow
flexed 60 to 90 degrees.
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1. Radial Growth Plate
2. Colles Fracture