Asist.

Marko Macura, MD
Orthopaedic trauma surgeon
 systematic x-ray interpretation

fracture nomeclature
 A
Adequacy, Alignment
B
Bones
C
Cartilage
S
Soft Tissues
ABCs approach applies to every x-ray image!
 Adequate views:
Min. 2 viewsAP & lateral
(except maybe children)
3 views even better (oblique view)
Sometimes more (i.e. Brodins)- CT is better

Sufficientexposure!- visibility, image

resolution, technical adequacy
 Alignment: anatomic relation of bone axes

Normal images have normal axes relations

Fractures and dislocations can alter normal

axes relations
 Examine bones- look for fractures, cracks

Examine the whole bone- holistic approach :)

Fractures are sometimes barely visible!

 Cartilage is not visible on x-ray; Evaluate joint
spaces

Abnormaly wide joint spaces may speak for

ligament injuriy or impression fracture

Narrowjoint spaces mean thin cartilage due to

degeneration- osteoarthrosis
 Evaluate soft tissue swelling

May speak for an occult fracture

 A
evaluate adequacy: adequate views and image quality
evaluate alignment- long axes of bones
B
Examine bones (whole)- look for cracks and deformities
C
Examinie cartilage- joint space- width, assymetry,...
S
Evaluate soft tissues: swelling, joint effusion (relate image
to clinical exam)
 Lateral elbow view.

Swelling anterior to the

joint

Swelling posterior to
the joint
Suspect hairline
fracture- not clearly
visible on x-ray
 (A) alignment
(B)bones- fracures 2.,3. & 4. metacarpals
Frxs of diaphyses 2.-4th. metacarpals.
Cave!: jewelery (ring)- should always be
removed (oedema-constriction)
 Medical terminology describing fractures.

Better
communication with orthopaedic and
trauma surgeons.
 Fracture description

Open/closed fracture
Anatomic location
Fracture line shape
Interfragmentary position
Neurovascular status
 Describe to the surgeon open/closed fx
Closed fx
Simple, noncomplicated fx
No skin wounds at or near fracture site
Open fx
Complicated fracture (fractura complicata)
Skin wound- bony fragment may protrude
Open fxs are often comminuted & dislocated
 Surgical emergency
Immediate surgical treatment required
Stop the bleeding
treatment
IV antibiotics
Tetanus vaccine
Treat pain
Surgical debridement (excision, irrigation) & fx
reduction
 Describe anatomic fracture location
Left/right side
Which bone?
Location within the bone:
Proximal/middle/distal part
Bone is divided into 1/3 or epi-, meta-, diaphysys
Propagation of fx into a joint?
 Closed fracture of left distal femur

Remember fracture localization!

 Besides
location describe possible joint
propagation of fracture!
 Fracure line shape is important- biomechanics

Different shapes possible

 A transverse fx
B short oblique fx
C long oblique fx- may have spiral shape
D comminuted fx (more than 2 fragments)

IMPACTED fracture- two fragments are

wedged into each-other- stable structure
 Transverse fxs are perpendicular to the long
bone axis

Full description: closed short

oblique/transverse fx of the diaphysys of the
left humerus
 Spiral
fxs are created by twisting movement
through the long bone axis

Rotational force is the cause

Full descript: long spiral fx of the distal fibula

 Comminuted (multifragment) fxs have more
than 2 fragments

Sotimes difficult evaluation on native X-rays-

use CT!

Fulldescr.: comminuted fx of trochanteric

region of the right femur
 Description of fragment position
alignment
angulation
dislocation
Bayonet aposition
distraction
dislocation, luxation
 Alignment of long axes of fragments

Angulation is every nonaantomic alignment

Describedas degrees of angulation of distal

fragment related to proximal fragment.

Draw long-axes of fragments

 Aposition/contact: magnitude of fragment
contact
Shift/: shift ia also contact
Bayonet deformity: fragment overlap
Distraction/distance: distance between
fragments in long axes
Luxation (dislocation): disruption of anatomic
joint surface relations
 Closed fx od diaphysis of left tibia?
What about fragments?- partial contact (2/3)
Or 1/3 shifted
Shift/contact describe the same situtation

Final description: closed, short oblique fx of middle

1/3 of left tibia with lateral 1/3 shift
 There are 2 fxs
Closed fx of distal radius with shift. Fx of base of
ulnar styloid- minimally shifted

Shiftmost obvious on lateral view- more views are

helpful.
Possible intraarticular expansion
Jewelery!
 Joint surfaces are not in anatomic relationship

Described regarding position of distal bone in

relation to proximal one

Anterior dislocation of the knee

 At the end of fx description

Evaluated clinically, not on X-rays

 Describe:
Open/closed
Anatomic location (distal, middle, proximal third) &
intra-articular location
fracture lines(transverse, short-,long obliques, spiral-
short/long, comminuted=shattered)
Interfragmentary relation (angulation, shift/contact,
dislocation/luxation, etc.)
Neurovascular status
 Long oblique fx, probably prox. phalanx of
finger shortened for 2mm, no angulation

Dont forget: describe open/closed, NV status

 Short oblique fx of right tibia at junction of
prox and mid third with lateral shift, no
angulation
Fx of fibula at the same level with bayonet
aposition
Open/closed, NV status