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More upper extremity
IMAGE REVIEW & CRITQUELecture # 3 – Part 1 Upper ExtremityRT 123 – WEEK 9
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Shield ?
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Anatomy &Positioning Review
Upper Limb
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7 RE: LATERALS PG 80
PROJECTION VS POSITION• CHEST / ABDOMEN / SKULL
• The lateral is referred to the POSTION – which is the SIDE TOUCHING THE IR
• SO LEFT LATERAL (position ) in referred to as a LATERAL PROJECTION
• LIMBS : Pos/Pro – side entered by IR
• MEDIOLATERAL OR LATERALMEDIAL
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8 LEFT LATERAL OF CHEST
LEFT LATERAL POSITION – LATERAL PROJECTION
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Lateromedial mediolateral
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10 Lateromedial humerus Mediolateral humerus Taken “AP” “Taken PA”
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Lateromedial mediolateral
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12EPI’s ? Hand Position?Hand - lateralmedial Hand - mediolateral
Internal Rotation - (lesser tubercle in profile)
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13 Greater tubercle Lesser tuberclein profile in
external rotation internal rotation
Proximal HUMERUS
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Anatomy Review
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15 Position – Best Seen?
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?Position – Best Seen?
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17 Position – Best Seen?
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18 Position – Best Seen?
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19 Scaphoid most commonly fx of carpel bones
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15 º 5 º
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? Taken for?
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Flexed joint
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25supracondylar fracture of the elbow
Name 3 postions to best demonstrate this fx?
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26supracondylar fracture of the elbow
If a child complains of elbow pain after a fall
and refuses to straighten his or her arm
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Will This Work?
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using shields when collimator head cannot be rotated.
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30Patient positioning for AP humerus image when fracture is located close to shoulder.
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31 Lateromedial humerus Mediolateral humerus Taken “AP” “Taken PA”
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Projection ? – For?
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33Distal Humerus (poss fx)
Poor position distally - better position not good Rad Prot
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Epi’s are ┴ do not move arm if fracture is suspected!
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classifications
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Ossification of carpals
• It is useful to have some idea of the age at which each of the carpal ossific centres appears although one would not expect you to know them all by heart!
• Ossification is usually visible by the end of the first year in the capitate and hamate . The remainder of the carpals, except for the pisiform, have appeared by the eighth year.
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Bone age?• The capitate (1) and hamate (2) both are seen
as large circular bony structures. • A very faint smaller bony ossific centre is also
present just proximal to the hamate.• This is the first appearence of the triquetral
• The epiphyseal growth plates have also started to ossify on each of the metacarpals. These are at the proximal ends of these bones.
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38 JOINT CLASSIFICATION• GLIDING
• BALL & SOCKET
• HINGE
•
• SADDLE
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39 COMMON FRACTURES pg 74
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40 fracture description• The first consideration is the age of the
patient.• Fractures in children require special
attention because a child's bones are still growing and changing.
• An adult fracture is classified based on its location, direction, alignment, articular involvement (involving most of the joint rather than the shaft), and whether it is open or closed.
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41 The direction of the fracture is described as
• transverse (fracture line is straight across the bone)
• spiral (fracture line spirals down the bone) • oblique (slanted fracture line)• comminuted (more than two fragments) • segmental (several large fractures in the
same bone)• open fracture means that bone fragments
have broken through the skin causing an open wound
• closed fracture means that there is no opening in the skin.
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Fracture Terminology Review
• Greenstick fractures – occurs when bone is angulated beyond limit of bending
• Complete fractures - Transverse fractures
• - Spiral / Oblique Comminuted / Segmental
• Avulsions: • Forcible tearing/separation of ligaments or
muscles from the bone
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COMMON FRACTURES PG 99
• Avulsion – tearing away from bone• Boxer – base 4th or 5th metacarpal• Colle’s – distal radius/ulnar – posteriorly• Smith’s distal radius/ulnar – anteriorly• Greenstick – bending of bone (children)• Pathologic – fx of a diseased or weakened
bone• + Galeazzi and Monteggia fractures
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Upper Extremity Avulsions
• Avulsion of muscles
• Greater tubercle
• Lesser tubercle/
• Medial epicondyle of humerus
• Lateral epicondyle of humerus
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Children
• Epiphyseal plate fractures:
• 30% of children fractures involve the growth plate (epiphyseal plate
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• Buckle (torus) fractures – caused by compression failure of bones. It occurs usually near the metapysis where porosity is greatest
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49 • The most difficult aspect of reconstruction of fractures of the distal humerus is the restoration of normal anatomic relationships
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MORE IMAGE ANALYSISPractice TEST
“FILM CRITIQUE”
WHAT DO YOU KNOW?
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Name the labeled anatomy #1
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54 Name the labeled anatomy #2
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56 www.rad.washington.edu
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57 POSITIONS? #3
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59 Problem Pathology position?
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60 Problem Pathology ?
OSTEO ARTHRITIS
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Problem Pathology CRITIQUE
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62 CRITIQUEWhat projection
position?7 ?
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63 Problem Pathology ?
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• A 14-year old boy was roughhousing with a friend when he heard a crack and felt a sharp pain in his mid-humerus.
• What is the correct terminology to use in describing this fracture?
• Why did this otherwise healthy young man break his arm from minor trauma?
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• comminuted fracture
• From?• a pathologic fracture
through a pre-existing bone lesion that had weakened the integrity of the bone
9 9
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66 Position? Pathology?
• This 22-year old man has had a swollen wrist for several months. Take a look at his radiograph and answer the following questions. Is this lesion benign or malignant? What is the specific name for this bone tumor?
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Position? Pathology? 11
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11 • This clinical picture is classic for a fracture of the radial head.
• When an adult falls on an outstretched hand, the force of the fall is transmitted up the radius and frequently will impact or crack the radial head.
• In this lateral view there is a subtle disruption in the relationship between the head and the shaft of the radius.
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69 Problem Pathology ?
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Name of fx #13
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greenstick
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72Type of fracture? 14
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# 15
• What do fat pads
suggest?
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• Anterior fat pad displacement in the lateral view suggests effusion, but if the posterior fat pad is visible at all, an elbow fracture is likely.
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#16
Position / problems ?
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#17Name of FX?
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#18
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78#19
Highresolution
digital
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#20
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100
• POSITION?
• CRITIQUES?
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101
• POSITION?
• CRITIQUES?
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102
• POSITION?
• CRITIQUES?
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103
• POSITION?
• CRITIQUES?
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• POSITION?
• CRITIQUES?
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105• POSITION?• CRITIQUES?
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106
• POSITION?
• CRITIQUES?
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107
• POSITION?
• CRITIQUES?
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108
• POSITION?
• CRITIQUES?
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• POSITION?
• CRITIQUES?
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How did you do?
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More Pathology Review
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• A 6 year old boy - falling on his outstretched left arm
• displaced supracondylar fracture of the left humerus
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94 Ulnar nerve injury“funny bone”
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95 Giant cell turmor
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96 Monteggia Fractures
• fracture of proximal radius
• dislocation of the radial head
• Involvement forearm& elbow joint
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98 Galeazzi Fracture
• Mechanism: Fall on outstretched hand with elbow flexed
• Fracture of the radius with shortening and dislocation of the distal ulna
• Dorsal angulation
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Galeazzi Fracture
• Galeazzi and Monteggia fractures are both fractures in which there is a fracture with shortening of one of the two bones of the forearm with dislocation of the other bone
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100 Fat pad sign
Radial
Head
fracture
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Radial head fractures
• are common injuries, occurring in about 20 percent of all acute elbow injuries.
• They are more frequent in women than in men and occur most often between 30 and 40 years of age.
• Approximately 10 percent of all elbow dislocations involve a fracture of the radial head.
• As the humerus and ulna return to their normal alignment, a piece of the radial head bone could be chipped off (fractured).
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102 Subluxation of radial head
• This is the most common traumatic injury of the elbow in children.
• It is also known as "pulled elbow" or "nursemaid's elbow." The average age of incidence is 2-4 years.
• As children get older, the annular ligament gets thicker and resists tearing, making this injury less likely.
• Treatment entails reduction by forcefully supinating the forearm with the elbow flexed 60 to 90 degrees.