Difference between revisions of "X-ray of fractures"

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{{Authors
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{{Top
 
|author1=[[User:Mikael Häggström|Mikael Häggström]]
 
|author1=[[User:Mikael Häggström|Mikael Häggström]]
 
|author2=
 
|author2=
 
}}
 
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==Subgroups==
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Locations:
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*[[X-ray of hip fractures|X-ray of '''hip''' fractures]]
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*[[X-ray of calcaneal fractures|X-ray of '''calcaneal''' fractures]]
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*[[X-ray of thumb fractures|X-ray of '''thumb''' fractures]]
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*[[X-ray of scaphoid fractures|X-ray of '''scaphoid''' fractures]]
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*[[X-ray of distal radius fractures|X-ray of '''distal radius''' fractures]]
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*[[X-ray of ankle fractures|X-ray of '''ankle''' fractures]]
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*[[X-ray of foot fractures|X-ray of '''foot''' fractures]]
  
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==By location==
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Patient groups:
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*[[X-ray of hip fractures]]
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*[[X-ray of fractures in children|X-ray of fractures in '''children''']]
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==General evaluation==
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{{Fracture detection on X-ray}}
  
 
==Classification==
 
==Classification==
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On projectional radiography ("X-ray") in general, the main types of misalignment of a fracture are:<ref>{{cite web|url=https://www.radiologymasterclass.co.uk/tutorials/musculoskeletal/trauma/trauma_x-ray_page3|title=Introduction to Trauma X-ray|website=Radiology Masterclass|accessdate=2018-07-03}}</ref>
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On projectional radiography ("X-ray") in general, the main types of misalignment of a fracture are:
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*Displacement
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{{Fracture misalignment|align=center}}
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*Angulation
 
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*Distraction (making bone longer)
 
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*Impaction or shortening
 
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*Rotation
 
  
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===Growth plate fractures===
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==Report==
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Growth plate fractures are also called ''Salter-Harris'' fractures.
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{{Reporting}}
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====SALTER mnemonic for classification====
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===First images===
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[[File:SalterHarris.svg|thumb|300px|Salter-Harris fracture types]]
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If no signs of trauma are seen, it is generally appropriate to negate skeletal damage and dislocations, with the latter word also excluding joint dislocations.
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The mnemonic "SALTER" can be used to help remember the first five types.<ref name=Davis>{{cite book|title=Blueprints Radiology|url=https://books.google.com/books?id=coLSTFjlGqcC&pg=PA12&dq=salter+harris+classification+SALTR#PPA83,M1 |first=Ryan|last=Davis|accessdate=March 3, 2008|isbn=9781405104609|year=2006}}</ref><ref name="Gaillard">{{cite web|url=http://www.orthoconsult.com/salter-harris-fractures/|title=Salter-Harris Fractures|last=|first=|date=|publisher=OrthoConsult|dead-url=|accessdate=5 February 2017}}</ref><ref name=Tidey>{{cite web |title=Salter-Harris Fractures|url=http://members.fortunecity.com/radrep/id36.htm |first=Brian|last=Tidey|accessdate=March 3, 2008}}</ref>
 
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This mnemonic requires the reader to imagine the bones as long bones, with the epiphyses at the base.
 
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* I  – S = '''Slip (separated or straight across)'''. Fracture of the cartilage of the physis (growth plate)
 
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* II  – A = '''Above'''. The fracture lies above the physis, or '''A'''way from the joint.
 
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* III – L = '''Lower'''. The fracture is below the physis in the epiphysis.
 
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* IV  – TE = '''Through Everything'''. The fracture is through the metaphysis, physis, and epiphysis.
 
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* V  – R = '''Rammed (crushed)'''. The physis has been crushed.
 
  
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<gallery>
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In case of fracture:
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File:Salter Harris 1 demo(1).jpg|Salter–Harris I fracture of distal [[radius (bone)|radius]].
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*'''Location'''.  
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File:Salter Harris 2 demo.jpg|Salter–Harris II fracture of [[ring finger]] [[Proximal phalanges|proximal phalanx]].
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:*In particular, note any '''intra-articular''' extension (or suspicion thereof)
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File:Salter Harris 3 demo.jpg|Salter–Harris III fracture of [[Hallux|big toe]] proximal phalanx.
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*Any '''misalignment'''. Mild misalignment can often be described simply as such. On the other hand, if it is close to having an impact on orthopedic care, or generally for more severe misalignment, it is more appropriate to specify it in distance or angle. Because [[geometric magnification]] makes absolute distances less certain, they displacement should be compared to for example the thickness of the cortex or entire bone where feasible.
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File:Salter Harris 4 demo.jpg|Salter–Harris IV fracture of big toe proximal phalanx.
 
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</gallery>
 
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==Report==
 
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If no signs of trauma are seen, it is generally appropriate no negate skeletal damage and dislocations, with the latter word also excluding joint dislocations.
 
  
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Mild misalignment can often be described simply as such. On the other hand, if it is close to having an impact on orthopedic care, or generally for more severe misalignment, it is more appropriate to specify it in distance or angle. Because [[geometric magnification]] makes absolute distances less certain, they displacement should be compared to the thickness of the cortex or bone where feasible.
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===Follow-up===
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*Any misalignment, or negation of it.
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*Signs of healing
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[[File:Screw fracture of material used for ankle fracture.jpg|thumb|Screw fracture in osteosynthesis material.]]
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*In case of osteosynthesis material, look for absence or presence of:
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:*Change in position
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:*Lucent zones around screws
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:*Fracture of the material
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:*Screw tips penetrating into soft tissues, or protruding screw heads
  
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==References==
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{{Bottom}}
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{{reflist}}
 

Latest revision as of 17:59, 14 July 2019

Author: Mikael Häggström [notes 1]

Subgroups

Locations:

Patient groups:

General evaluation

edit
Even if there's an initial obvious fracture, evaluate:

  • Bone contours for disruptions
  • Bone areas for unusual lines that are either hypoattenuating (in case of separation) or hyperattenuating (in case of compression)

Classification

On projectional radiography ("X-ray") in general, the main types of misalignment of a fracture are:

Types of fracture misalignment:[1]
  • Displacement
  • Angulation
  • Distraction (making bone longer)
  • Impaction or shortening
  • Rotation


Report

See also: General notes on reporting

First images

If no signs of trauma are seen, it is generally appropriate to negate skeletal damage and dislocations, with the latter word also excluding joint dislocations.

In case of fracture:

  • Location.
  • In particular, note any intra-articular extension (or suspicion thereof)
  • Any misalignment. Mild misalignment can often be described simply as such. On the other hand, if it is close to having an impact on orthopedic care, or generally for more severe misalignment, it is more appropriate to specify it in distance or angle. Because geometric magnification makes absolute distances less certain, they displacement should be compared to for example the thickness of the cortex or entire bone where feasible.

Follow-up

  • Any misalignment, or negation of it.
  • Signs of healing
Screw fracture in osteosynthesis material.
  • In case of osteosynthesis material, look for absence or presence of:
  • Change in position
  • Lucent zones around screws
  • Fracture of the material
  • Screw tips penetrating into soft tissues, or protruding screw heads

Notes

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.

References

  1. ↑ . Introduction to Trauma X-ray. Radiology Masterclass. Retrieved on 2018-07-03.
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