The Unofficial Guide to Radiology

100 Practice Orthopaedic X-Rays with Full Colour Annotations and Full X-Ray Reports

Christopher Gee, Alexander Young, Zeshan Qureshi, Mark Rodrigues

• Publisher: Unofficial Guide to Medicine
• Year: 2020
• ISBN:
  9781910399217
• Edition: 1
• Topic: Medicine
• Subtopic: Radiology, Radiotherapy & Nuclear Medicine

"The Unofficial Guide to Radiology: 100 Practice Orthopaedic X Rays" is the sequel to the Unofficial Guide to Radiology, which has sold 1500 copies in just eight months. This book teaches systematic analysis of Orthopaedic X Rays. The layout is designed to make the book as relevant to clinical practice as possible; the X-rays are presented in the context of a real life scenario. The reader is asked to interpret the X-ray before turning over the page to reveal a model report accompanied by a fully colour annotated version of the X-ray. Uniquely, all cases provide realistic high quality X Ray images, are annotated in full colour, and are fully reported, following international radiology reporting guidelines. This means the X Rays are explained comprehensively, but with clear annotation so that a complete beginner can follow the thinking of the expert. This book has relevance beyond examinations, for post graduate further education and as a day-to-day reference for professionals.

HAND AND WRIST

CASE 1

A 37-year-old right hand dominant female office worker fell at a Christmas party, landing on her outstretched right hand. She is brought into the ED. There is no significant past medical history. On examination, there is no obvious swelling or deformity but tenderness is elicited on palpation of the anatomical snuffbox and with pulling of the thumb. Distal pulses are present and sensory and motor function is preserved. The injury is closed.

Scaphoid series X-rays of the right scaphoid are requested to assess for a fracture.

REPORT – SCAPHOID WAIST FRACTURE

TECHNICAL INFORMATION

Patient ID: Anonymous.

Area: Right scaphoid.

Projection: AP and oblique.

Technical Adequacy:

-Adequate coverage but additional views (lateral and angled AP) are required to complete the scaphoid series.

-Adequate exposure.

-The patient is not rotated.

FRACTURE DETAILS

There is a fracture involving the mid-portion (waist) of the scaphoid.

The fracture is transverse, comminuted and extra-articular.

There is minimal displacement and comminution.

There is no angulation.

There is no rotation.

There is no shortening.

JOINTS

There is no subluxation or dislocation.

There are no loose bodies.

There is no effusion or lipohaemarthrosis.

There are no arthritic changes.

SOFT TISSUES

There is no soft tissue swelling.

There is no surgical emphysema.

BACKGROUND BONE

The background bone is normal.

BONE LESIONS

There is no bone lesion present.

SUMMARY AND DIFFERENTIAL

These X-rays demonstrate a minimally displaced scaphoid waist fracture.

INVESTIGATIONS AND MANAGEMENT

Appropriate analgesia should be provided.

The other views from the scaphoid series should be reviewed to assess for alignment of the carpal bones, in particular, the scapholunate and capitolunate angles. A below elbow back slab should be applied and referral made to fracture clinic. Whilst it is likely that this would be managed non-operatively, operative management may be considered depending on the results of the full scaphoid X-ray series.

CASE 2

A 35-year-old right hand dominant lady fell over whilst skiing. She reports landing awkwardly on her left thumb. She presents to the ED. There is no significant past medical history. On examination, the patient has a swollen and tender left thumb. She is unable to move the thumb at the carpo-metacarpal joint due to pain. Distal pulses are present and sensory and motor function is preserved. The injury is closed.

AP and lateral X-rays of the left thumb are requested to assess for a fracture.

REPORT – BENNETT’S FRACTURE

TECHNICAL INFORMATION

Patient ID: Anonymous.

Area: Left thumb.

Projection: AP and lateral.

Technical Adequacy:

-Adequate coverage.

-Adequate exposure.

-The patient is not rotated.

FRACTURE DETAILS

There is a fracture involving the proximal aspect of the first metacarpal.

The fracture is...