Interpretation of Musculoskeletal X- rays

Jatinder S. Luthra

Skeletal condition

• Fractures• Osteomyelitis• Structural anomalies• Degenerative joint conditions

Rule of Two

• Two views - AP and Lateral• Two joints – joint above and below

• Two occasions – repeat x- rays• Two limbs – Compare

• Patient details • Date of exam.• Side – Rt./Lt. – Marker• Exposure• Whole area covered – Joint above and below• Two views• Abnormalities

• Bone • Joint • Soft tissue

RegularityCortex intactFractures – location, pattern, deformity.Density

Joint congruencyFracture extends into jointDamage/ degenreration

Break in integrityAirForeign bodySwelling

Description of fracture

Bone and joint alignment

Joint space

Bone Texture

Soft Tissue Anomaly

Bone Anatomy

Joint Anatomy

Cortical outline

Two views

Compare normal

Look for unexpected

Artefacts

Transverse fracture

Oblique

Spiral

Sagittal

Compare with old X- rays

Multidirectional

Comminuted

Butterfly Fragment

Segmental

Shortening

Angulation and Rotation

Distraction and impaction

Pathological fracture - Osteoporosis

Pathological fracture – Multiple myeloma

MOTH EATEN APPEARANCE

Pathological fracture – Benign lesion

GEOGRAPHICAL MARGIN

Avulsion Farcture

Stress Fracture

Periprosthetic fracture

Fracture Mimics

Fracture Mimics

Fracture Mimics

Fracture Mimics- Vascular markings

Fracture Mimics

Foreign Body

Needle

Needle

Clavicle

Acromioclavicular Joint

Shoulder - Normal

Shoulder – Anterior Dislocation

Shoulder – Posterior Dislocation

BULB SIGN

Scapula - Normal

Scapula - Fracture

Humerus Fracture

Elbow - Normal (10 year old)

Elbow - Normal (Lateral)

Elbow - Subtle Fracture

Elbow – Supracondylar fracture

Elbow - Dislocation

Wrist – Colle’s Fracture

Wrist – Smith’s Fracture

Wrist – Comminuted Fracture

Monteggia Fracture

Greenstick Fracture

Torus Fracture

Wrist - Normal

Scaphoid Fracture

Trapezium Fracture

Wrist normal view

Scapholunate dissociation

Wrist dislocation

Cervical spine – Lateral view

Cervical spine – Lateral view

Cervical spine – Lateral view

Cervical spine – AP view

Cervical spine – Open mouth view

Cervical spine – Open mouth view ( Rotated view)

Cervical spine – Swimmer’sview

C1 Fracture

C2 – Odontoid Fracture

C2 – Odontoid Fracture

C2 – Hangman Fracture

C2 - Teardrop fracture

C2 - Teardrop fracture

Cervical Spine – Facet dislocation (Lateral view)

Cervical Spine – Facet dislocation (AP view)

Cervical spine – prevertebral space

Cervical spine – spinous fracture

Thoracic spine - Normal

Thoracic spine - Normal

Thoracic spine - Normal

Lumbar spine – Normal view

Lumbar spine – Normal view

Lumbar spine – Normal view

Lumbar spine – Normal view

Lumbar spine – Three Coloumn

Lumbar spine – Three Coloumn

Lumbar spine – Compression Fracture

Lumbar spine – Compression Fracture

Lumbar spine – Burst Fracture

Lumbar spine – Burst Fracture

Lumbar spine – Chance’s Fracture

Lumbar spine – Chance’s Fracture

Osteoporotic fracture

Osteoporotic fracture

Fracture transverse fracture

Spinous process fracture

Pelvis X-ray - Normal

Pelvis X-ray – Pubic ramus fracture

Pelvis X-ray – Acetabular fracture

Pelvis X-ray - Diastasis

Pelvis X-ray – ASIS avulsion

Sacrum- Normal

Sacral Fracture

Hip - Normal

Hip - Normal

Hip - Normal

Hip – Intracapsular fracture

Hip – Intertrochanter fracture

Hip – Subtrochanter fracture

Hip - Dislocation

Femur fracture

Pathological fracture

Knee - Normal

Knee - Normal

Knee - Normal

Fracture Tibial plateau

Fracture Tibial plateau

Patella Fracture

Patella Dislocation

Fabella

Bipartite Patella

Tibia and fibula fracture

Tibial Stress fracture

Toddler’s fracture

Ankle - Normal

Ankle - Normal

Ankle - Normal

Lateral malleolus fracture

Bimalleolar Fracture

Bimalleolar Fracture

Osteochondral fracture

Calcaneal fracture

Foot - Normal

Lisfranc Farcture

Fracture 5th metatarsal

Osteosarcoma

Aneurysmal bone cyst

Osteochondroma

Osteopetrosis

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