Basic Orthopedic

Radiology for 4th year

Medical student

Pat Laupattarakasem, MD
department of Orthopedics
Faculty of Medicine Khon Kaen University
Objectives
Normal adult and children bone-joint
radiology
Basic ortho-radiologic terminology
How to describe anatomic radiological
terms of fracture and dislocation
How to describe radiologic bone
pathologies
The radiographic image
(RI)
RI is produced by the attenuation of X-
rays as they pass through intervening
tissues before striking film or sensitized
plate.
The resulting beam of X-ray is
attenuated by the patient’s soft tissues
and bones which make their shadows.
Effect of attenuation
most less
more attenuation
attenuation attenuation

Partial
Impenetrable penetrable
impenetrable
Metal-cortical
cancellous-Bone cartilage,
bone

White Gray Dark or black

 most attenuate

less attenuate

Air

Air

More attenuate
 calcify meniscus

articular cartilage

meniscus
Effect of attenuation
Radio-Anatomy
 Diaphysis

Distal epiphysis (cartilage)

condyle of humerus

metaphysis

center of ossification
of capitellum

epiphysis of Radial head

metaphysis

Diaphysis
Diaphysis

Metaphysis

capitellum
radius

Epiphysis

ulna
 supracondylar area

condylar area

olecranal
fossa
medial epicondyle

lateral
epicondyle

olecranol process
lateral condyle

radial head

radial neck proximal

radial tubercle
ulnar
 diaphysis
diaphysis

patella metaphysis

metaphysis lateral
patella condyle

lateral medial
condyle Fabela
condyle

Fibula

Fibula
tibial
tibial spine tibial spine
tubercle
 Distal

Head or condyle

Neck

shaft

base

proximal
Film forearm in pronation
and supination
Systematic checklist

Patient and image data

Soft tissues shadow
Cortical outline
Bone and joint alignment
Bone texture
Joint spacing
 Soft tissue shadow
Disappeared of Fat line

Fat line

air shadow
Abnormal soft tissue calcification in
Achilles tendon
 Soft tissue

Soft tissues:Skin, sub-

cutaneous fat or fat line.

Muscle planes are often

visible

Look for variations in

contour of the extremities,
swelling, mass or wasting
and density (calcification)
Bone and joint alignment
 Joint

lateral
medial condyle
condyle

narrowing
joint space

subchondral
bone sclerosis
How to describe fracture and
dislocation

Use proximal part of bone or axial bones

as a reference
describe how distal part displaces from
the proximal or axial bone
use anatomical term describe direction of
displacement or dislocation
describe types or patterns of fractures
 complete
incomplete complete non- complete
complete
displaced
displaced
fracture displaced displaced
angulation angulation and
fracture rotational
fracture fracture
fracture
overriding

Shortening

distraction
 proximal
bone

anterior angulation
lateral angulation

lateral medial anterior posterior

side side side side

posterior
medial
displacement
displacement

distaldisplaced transverse fracture at mid shaft of Rt humerus

Film humerus:
bone
there are anterolateral angulation and posterior-medial displacement.
 Dorsolateral
dislocation of PIP joint
ulnar or medial direction of long finger
dorsal or palmar direction

radial or lateral direction

 Orthopedic trauma

Two views

Joint above and below

Two sides

Two occasions
Film Rt hip AP/Frog leg
These are the right knee joint AP and Lateral views. Including distal femur and
proximal tibia.
How to describe an X-ray findings

the part : Right or left or both

humerus/es
The view: Anteroposterior (AP) or
lateral (Lat)
The field of visualization
Example:This is the X-ray film of Rt.
humerus, AP view, included the humeral
head, shaft and both condyles.
การอ่าน X-ray
อ่านที่ละ view AP หรื อ lateral
กระดูกอะไร บนสุดถึงล่างสุดเห็นกระดูกอะไร
อ่านจากนอกเข้ าใน skin, subcutaneous fat,
muscle, periosteum, cortex-medullary canal
type of fracture, site, displacement,
angulation, rotation, shortening
Upper extremity
 Lateral view AP view

posterior lateral a
a
angulation angulation

shortening

posterolateral
angulation and shortening
Posterolateral displacement of Supracondylar
fracture of Rt distal humerus
 anterior
angulation

lateral view
Lower extremity
Shenton’s curve
Axial skeletal
Orthopedic Treatments
Orthopedic Treatments
Orthopedic Treatments
Orthopedic Treatments
Complications in Orthopedic
Complications in Orthopedic
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