![]() ![]() a well-positioned oblique lumbar radiograph will demonstrate the scottie dog sign, showing the articular processes and facet joints. check department protocol before imaging, as focused imaging of the lower lumbar vertebrae may be required. Assessment requires a systematic approach. the entire lumbar spine should be visible from T12/L1 - L5/S1. The lateral view is often the most informative image. If the lateral view does not show the vertebrae down to T1 then a repeat view with the arms lowered or a ' Swimmer's view' may be required. In the context of trauma these images are all difficult to acquire because the patient may be in pain, confused, unconscious, or unable to cooperate due to the immobilisation devices. At that point, in keeping with the hospitals protocol, a radiology technologist carefully removed the neck collar and proceeded to obtain anteroposterior, open. The 3 standard views are - Lateral view - Anterior-Posterior (AP) view - and the Odontoid Peg view (or Open Mouth view). Imaging should not delay resuscitation.įurther imaging with CT or MRI (not discussed) is often appropriate in the context of a high risk injury, neurological deficit, limited clinical examination, or where there are unclear X-ray findings. This is because normal C-spine X-rays cannot exclude significant injury, and because a missed C-spine fracture can lead to death, or life long neurological deficit.Ĭlinico-radiological assessment of spinal injuries should be managed by experienced clinicians in accordance with local and national clinical guidelines. Bones - Cortical outline/Vertebral body heightĬlinical considerations are particularly important in the context of Cervical spine (C-spine) injury.anteroposterior projection of the cervical spine demonstrating the vertebral bodies and intervertebral spaces. Alignment - Anterior/Posterior/Spinolaminar Note: in the absence of CT 5 views of the C-spine should be performed: AP, lateral, obliques and odontoid 5.Look at all views available in a systematic manner.Clinical considerations are of particular importance when assessing appearances of C-spine X-rays.Normal C-spine X-rays do not exclude significant injury.Anatomy & Physiology, Connexions Web site. Lindsay Davidson, annotated by Mikael Häggström.Joint dislocation of the metacarpophalangeal joint. When assessing a fracture, apply a structured approach paying particular attention to the location, type and displacement of the fracture.There are several sub-types of fractures, each associated with different mechanisms of injury and patient factors.The ABCS approach provides a generic framework to assess most types of X-rays (alignment and joint space, bone texture, cortices and soft tissues).Always begin X-ray interpretation by carefully checking the details of the patient and radiograph.By applying a structured approach to musculoskeletal X-ray interpretation you reduce the risk of missing pathology.Rotation: usually difficult to appreciate on an x-ray.If translation is further away than the width of the bone, it is said to be ‘off-ended’. translation of 25% of the width of the bone). ![]() Described using the width of the bone as context (e.g. Translation: movement of the fractured bones away from each other.Angulation: changes in the axis of the bone, usually described as dorsal/palmar or varus/valgus or radial/ulnar.Is there displacement?ĭisplacement is described in terms of the distal fragment to the body (e.g. This is important to state because of the risk of infection with open fractures. If a fracture is associated with a puncture of the skin or open wound, this is classed as an open fracture. Black arrow demonstrates the fracture line while the white arrow marks the growth plate. Subchondral sclerosis (increased bone density) is often present along the joint lines in patients with osteoarthritis.Īn X-ray of the left ankle showing a Salter-Harris type 3 fracture of the medial malleolus. 1Ĭarefully look at the joint space to identify changes such as joint space narrowing due to cartilage loss, cartilage calcification (as in chondrocalcinosis) or new bone formation (e.g. Joint dislocation of the metacarpophalangeal joint of the 5th digit. The radiograph below demonstrates why it is important to have more than one view. When describing the displacement, the position of the fragment distal to the fracture site is always described. Alignment and joint spaceĬhanges in alignment suggest a fracture, subluxation (partial dislocation) or dislocation. If you spot one abnormality, do not lose focus until you have reviewed all areas of the image, otherwise, you might miss important pathology. The ABCS approach of X-ray interpretation involves assessing the following:ĭon’t forget to review all views, compare both sides and re‐examine any previous imaging. You might also be interested in our premium collection of 1,000+ ready-made OSCE Stations, including a range of radiology interpretation stations ✨ X-ray interpretation (ABCS approach)
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |