How$to$read$fracture$X.

rays$$$

Leonard$Banza$
&$
Sven$Young$
 Objec=ves$of$the$lecture$

•  To$learn$how$to$read$X.rays$in$a$systema=c$way$

•  Describe$various$fracture$paEerns$
 Systema=c$order$to$follow$
preliminary$ques=ons$to$ask$
1)  Name$of$pa=ent$
2)  Date$$
3)  2$views:$lateral$and$AP$
4)  2$joints:$above$and$below$the$
fracture$
 Systema=c$order$to$follow$
5)  Name$the$bone$e.g$$=bia$
6)  Name$the$part$of$the$bone$

7)$$$$Type$of$fracture$
  $$simple$($transverse,$oblique,$spiral$)$
  $$wedge$
  $$comminuted,$segmental$etc.$
8)  Describe$the$deformity$(DAMS)$
  $displacement$
  $angula=on$
  $malrota=on$
  $shortening$
Following$above$order:$

1)  $Pa=ent’s$name$

2)  Date$$
3)$2$views:$AP$and$lateral$

•  2$views$at$right$
angles$$

•  Help$to$fully$
describe$#$in$both$
planes$

•  Easy$to$miss$#$on$
only$one$view$
AP LATERAL
4)$2$joints:$above$and$below$fracture$
5)$name$the$bone$&$6)$part$fractured$

Intra-articular fracture

Metaphyseal fracture

Diaphyseal fracture
 7)$Type$of$fracture$

a)  $$SIMPLE$fracture:$one$fracture$line$
  spiral$
  oblique$
  transverse$
b)  $$WEDGE$fracture:$buEerfly$segment$
c)  $$COMPLEX$fracture:$comminuted$$
Simple$spiral$fracture$
Simple oblique fracture
Simple$transverse$fracture$$
Wedge$fracture$

Wedge fracture: butterfly

fragment
Comminuted$#:$mul=ple$
fragments$

Comminuted fracture of the tibia

shaft / diaphysis
 Children’s$bone$is$different$$

•  Green$s=ck$
•  distrac=on$
•  plas=c$deforma=on$
 Children’s$bone$is$different$$

•  Buckle$
•  compression$
•  plas=c$deforma=on$

Gips 2 uker
Vossakurset 2011
What$is$the$fracture$paEern?$

transverse

wedge

comminuted
What$is$the$fracture$paEern?$

transverse
What is the fracture pattern?

transverse

wedge

comminuted
What is the fracture pattern?

wedge
 Describe$the$deformity$(DAMS)$
 $Displacement$

 $Angula=on$

 $Malrota=on$

 Shortening$
Displacement:$bone$ends$have$
moved$rela=ve$to$one$another$

Use distal fragment to

describe displacement
Displacement$

 Describe
displacement in both
planes

 Estimate %age of
contact

 lateral displacement
with 50% bone
apposition
displacement$
$$$Postero$lateral$displacement$
with$25%$bone$apposi=on$
angula=on:$bone$fragments$are$
angulated$rela=ve$to$each$other$

 $describe$angula=on$
with$$
 respect$to$=lt$of$distal$
fragment$
 Es=mate$angle$between$
fragments$
 Distal$fragment$
angulated$laterally$at$25$
degrees$
There$is$no$angula=on$in$this$fracture$

TRUE

FALSE

DON’T KNOW
There$is$no$angula=on$in$this$fracture$

FALSE
Malrota=on:$bone$fragments$have$
rotated$rela=ve$to$one$another$
Rota=on$$
 Very important to have
two joints in the X-ray.

 At hip it looks AP

 Knee it looks lateral

 Therefore rotated by 90
degrees!

 Without knee included it

would not be possible to tell!
shortening$

Describe shortening if any

Estimate the amount of

shortening
$summary:$systema=c$reading$of$X$rays$
1)  Name$of$pa=ent$
2)  Date$$
3)  2$views:$lateral$and$AP$
4)  2$joints;$above$and$below$the$fracture$
5)  Name$the$bone$e.g$$=bia$
6)  Name$the$part$of$the$bone$
 Systema=c$order$to$follow$

7)  Type$of$fracture$
  $$simple$
  $$wedge$
  $$comminuted$
8)  Describe$the$deformity$(DAMS)$
  $displacement$
  $angula=on$
  $malrota=on$
  $shortening$
 Rule$of$2’s$in$bone$X.rays$
•  2$views$or$more$eg$oblique$views$
•  2$joints$
•  2$sides$
•  2$=mes$
•  2$opinions$
Why$boys$need$parents$

Vossakurset 2010
 $THANKS$

•  $$$$$$$$$