Asist. Marko Macura, MD
Orthopaedic trauma surgeon
 systematic
 fracture
x-ray interpretation
nomeclature

A
◦ Adequacy, Alignment

B
◦ Bones

C
◦ Cartilage

S
◦ Soft Tissues

ABCs approach applies to every x-ray image!
 Adequate
views:
• Min. 2 views—AP & lateral
(except maybe children)
• 3 views even better (oblique view)
• Sometimes more (i.e. Brodin’s)- CT is better
 Sufficient
exposure!- visibility, image
resolution, technical adequacy
 Alignment:
 Normal
anatomic relation of bone axes
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
 Narrow
joint spaces mean thin cartilage due to
degeneration- osteoarthrosis
 Evaluate
 May
soft tissue swelling
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
 Better
terminology describing fractures.
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
 Full
force is the cause
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!
 Full
descr.: comminuted fx of trochanteric
region of the right femur
 Description
of fragment position
• alignment
• angulation
• dislocation
• Bayonet aposition
• distraction
• dislocation, luxation
 Alignment
 Angulation
of long axes of fragments
is every nonaantomic alignment
 Described
as degrees of angulation of distal
fragment related to proximal fragment.
 Draw
long-axes of fragments
 Aposition/contact:
magnitude of fragment
contact
 Shift/: ½ shift ia also ½ 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 ½ shift. Fx of base of
ulnar styloid- minimally shifted
 Shift
most 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, spiralshort/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
 Don’t
forget: describe open/closed, NV status
 Short
oblique fx of right tibia at junction of
prox and mid third with ½ lateral shift, no
angulation
 Fx of fibula at the same level with bayonet
aposition
 Open/closed, NV status