Diagnosis and principles of treatment of Fractures

Diagnosis and principles of treatment of Fractures

Diagnosis and principles of treatment of Fractures

X-Ray Interpretation in Trauma 


 

 

Chest
 
(SUBCUTANEOUS EMPHYSEMA)
Check 

  • Soft tissue for Subcutaneous emphysema
  • Bones for fractures
  • Pleura
  • Mediastinum
  • Trachea
  • Diaphragm
Pelvis
 
(BROKEN SHENTON’S LINE)
Essential in polytrauma. Check 

  • Disruption of the ring
  • Sacro-iliac joints
  • Shenton’s line
  • Sacral fractures
  • Ask for further views if indicated
Cervical spine
 
(C1 TO TI  SEEN)
Check

  • C1 to T1 must be seen
  • Alignment – trace out 4 lines
  • Pre-vertebral soft-tissue shadow
  • Atlanto-dens interval =3mm
  • Open-mouth view for C1 &C2 fractures
  • AP view for facet dislocations
Thoracic & lumbar spine
(LOSS OF VERTEBRAL HEIGHT)
Look for 

  • Loss of Vertebral body height
  • Displacement of posterior body
  • Angulation of spinous processes
  • On AP films look for : Widening of inter-pedicular distance
  • CT is best for upper thoracic spine
Long bone fractures
 
 (FRACTURE SPLINTED)
  • Stabilise patient before X-ray
  • Splint fracture before X-ray
  • Don’t forget soft-tissues
  • The joint above & below the fracture must be seen
  • Always insist on two views-AP & lateral
Colles’ fracture
 
( ANGULATION & DEVIATION)
Look for 

  • Displacement
  • Angulation
  • Shortening
  • Radial deviation
  • Exclude intra-articular fracture
Shoulder dislocation (anterior)
 
(HEAD OF HUMERUS)
Check  

  • Head of the humerus lies below the coracoid
  • Inferior subluxation can be mistaken for dislocation
  • If in doubt obtain a lateral or trans scapular view
Ankle fractures
 
(MALLEOLAR FRACTURES)
Look at 

  • Medial and /or lateral malleolus fractures
  • Mortise (AP) view for talar shift
  • Reduce dislocation before X-rayProximal fibula may be fractured
  • Remember epiphyseal injuries in children

 

 


S.P.Suresh FRCS (Gen), FRCS (Orth).
Consultant Orthopaedic Surgeon
Email :[email protected]

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