First, let us define what is fracture reduction.

Fracture reduction is the term used to describe

how a bone is fixed or set after a fracture. The pieces of bone must be put in close proximity to
one another so that healing can occur. Fracture reduction is essential to ensure that the bone
heals properly and that permanent functional loss or deformity is avoided.

Let us recall what is a closed fracture. A closed fracture is also called a simple fracture. In
a closed fracture, the broken bone doesn't break your skin. The bone is broken, but the skin is
intact.

Casts and splints are orthopedic devices that are used to protect and support fractured or
injured bones and joints. They help to immobilize the injured limb to keep the bone in place
until it fully heals. Casts are often made from fiberglass or plaster. Splints are also called half-
casts and provide less support than casts.
Splints are often used for simple or stable fractures, sprains, tendon injuries, and other soft-
tissue injuries; casting is usually reserved for definitive and/or complex fracture management.

An open fracture, also called a compound fracture, is a fracture in which there is an open
wound or break in the skin near the site of the broken bone. Most often, this wound is caused
by a fragment of bone breaking through the skin at the moment of the injury.
An open fracture requires different treatment than a closed fracture, in which there is no open
wound. This is because, once the skin is broken, bacteria from dirt and other contaminants can
enter the wound and cause infection. For this reason, early treatment for an open fracture
focuses on preventing infection at the site of the injury. The wound, tissues, and bone must be
cleaned out in a surgical procedure as soon as possible. The fractured bone must also be
stabilized to allow the wound to heal.

Casts come in many shapes and sizes, but the two most common types of cast material used
are plaster and fiberglass. While casts can be uncomfortable and cumbersome, they are an
effective and efficient method to treat fractures.

Ap chest
WARNING: With possible spinal injury or severe trauma, do not attempt to move the patient. In
these situations, the patient will often be on a backboard. Obtain assistance from other medical
personnel when placing the IR beneath the board. Some ER stretchers or tables have a tray
under the patient in which the IR can be placed.
NOTE 1: Costophrenic angle cutoff is a problem with recumbent chest positions taken with a
shorter source image receptor distance (SID) because of the divergence of the x-ray beam.
Therefore, unless the patient is quite small, a crosswise IR placement is recommended.
NOTE 2: Focused grids generally are difficult to use for mobile chests because of the problems
of grid cutoff.

AP Oblique and Lateral Sternum

The sternum is nearly impossible to visualize radiographically on a straight AP/PA projection
because of superimposition of the thin, flat bone by the thoracic vertebrae. It is possible to
visualize the sternum, however, by superimposing it over the homogeneous heart shadow. This
requires a left posterior oblique (LPO) position or an equivalent mediolateral CR angle for a
supine patient. (This CR angle results in some undesirable part distortion but may be necessary
if the patient cannot be rotated into an oblique position.)

AP Ribs- Above or Below Diaphragm and Oblique

If patients are able to assume an erect position, this is often less painful than imaging the ribs in
the recumbent position, which places the weight of the body on the site of injury (see Chapter
10). Anterior or posterior oblique projections would be determined by the affected area. Severe
trauma requires adaptation for oblique position with a cross-angle CR, as shown in Fig. 15-48.
Above or below the diaphragm is determined by the region of injury. Remember the
importance of including an image of the chest to assess possible lung or thoracic injury resulting
from a rib fracture. Optimally, this chest projection would require an erect or lateral decubitus
position to detect air-fluid levels, which may not be possible with a trauma patient.

AP (PA) Oblique and Lateral- Fingers, Thumb, Hand and Wrist

NOTE: For maximum detail, use the smallest possible IR.

PA (AP) Lateral Forearm and Wrist

include both joints with original trauma images of forearm. Post reduction images may include
only the joint nearest fracture site, depending on department protocol.

PA (AP) Lateral (and optional Trauma Lateromedial- Coyle Method- Elbow

As with other trauma radiographic examinations, a minimum of two projections of the elbow—
an AP-PA and a lateral—should be obtained. For patients with multiple injuries, including
possible trauma to the thorax and/or spine, and for whom the elbow remains partially flexed
and the hand pronated, horizontal beam PA and vertical beam lateral projections may be
performed as demonstrated. If the trauma region includes the proximal humerus or shoulder,
the entire humerus, including both elbow and shoulder joints, should be examined as shown on
the following page, along with a transthoracic lateral.
AP and Lateral Humerus
Do not attempt to rotate the arm for initial AP and lateral projections if signs and symptoms of
fracture or dislocation are present. The AP should include both elbow and shoulder joints, but
two lateral images will be required if the initial examination is to demonstrate both the
proximal and distal humerus. Depending on department protocol, subsequent examinations
may require that only the joint nearest the injury be included
NOTE 1: This view also may be accomplished in the x-ray suite by placing the affected side
against the upright Bucky with the patient supine on a gurney. The beam then would be
centered through the thorax to the surgical neck of the injured arm.
NOTE 2: A 10° to 15° cephalad angle may be required if shoulder of interest cannot be lowered.
(Check grid alignment to prevent grid cutoff from cross-angled CR.)

AP and Lateral-Shoulder, Scapula, and Clavicle

NOTE: Some distortion will occur with this medial CR angle if it is needed to achieve a lateral
position of the scapula.
NOTE: If patient size requires use of a grid for the AP and AP axial projections of the clavicle,
align the grid lengthwise to prevent grid cutoff for the axial projection.

Based on this study, it can be concluded that acquiring PA Erect CXR for patients in cohort
wards with the x-ray beam penetrating through a glass panel is safe and effective, without any
compromise to the image quality. With the number of COVID-19 cases escalating globally, we
hope that our study can provide some insights to Radiographers and Radiological Technologists
in providing Mobile Chest Radiography services in a safe and efficient way in isolation facilities.
This study can also provide some insights to hospital administrators in designing ward set-up
that can be pandemic-friendly for new hospitals in future.