X-Ray Interpretation

- Name and Date of birth. Essential and should never be overlooked!

- Film details – When was it taken, which site of the body and which side of the patient. Radiographs should be marked with an ‘L’ or a ‘R’ so you don’t always have to rely on your anatomical knowledge!

- Projections – which views were taken? Anterior-Posterior, lateral (see examples)

- Imagine following the edge of the bone with a pen to help identify the fracture!

- Location – is the fracture located proximal or distal? This refers to the position of the structure in relation to its origin. In the example above this involves the distal radius.

- Does it involve growth plate in paediatric cases? This is important as involvement can inhibit bone growth in children. For these we use the Salter Harris Classification (memorised with SALTR)

- Fracture type

- Complete e.g. transverse, oblique, spiral, comminuted, avulsion

- Incomplete e.g. bowing, fissure, torus (buckle), Greenstick (buckle)

- Always check for joint involvement. Some fractures may be associated with joint dislocation. Fractures may also directly involve a joint, we refer to this as an intra-articular fracture.

- Is it a Dislocation or Subluxation (partial dislocation)?

- Be aware of fluid in the Joint (effusion) this may be due to trauma or may even be inflammation due to infection, arthritis or malignancy.

- Refers to the deformity of the distal part of a fracture in relation to the proximal part.

- Displacement

- Shortening

- Angulation

- Rotated

- Decreased - Osteopenia, lytic lesions (multiple myeloma)

- Increased - Osteosclerosis (hypoparathyroidism, osteoblastic mets)

Notice the Hypo-density of this individual’s distal radius and ulnar

- Signs of Arthritis –

Osteoarthritis - LOSS - Loss of joint space, osteophytes, subchondral cysts, subchondral sclerosis

Rheumatoid Arthritis - LOSE - Loss of joint space, Osteopenia, Swellings, Erosions.

- Air in soft tissues. This suggests a compound fracture, meaning there is an open wound allowing air to transfer into the fracture site.

- Be aware of Foreign bodies from previous surgery (e.g. hip replacement) or trauma (e.g shrapnel in road traffic accident).

For paediatric fractures it is important to consider involvement of the growth plate as damage can inhibit bone growth in children.

For these we use the Salter Harris Classification (memorised with SALTR)

I – Straight through (across growth plate)

II – Above – across growth plate then through metaphysis (most common)

III – Lower – across growth plate then down through epiphysis

IV – Transverse – through metaphysis, growth plate and epiphysis

V – Ruined – direct compression of growth plate (worse damage)