X-Ray RoundsX-Ray Rounds

Basics / Wrist

Mark Scott Nov. 1, 2007

Basics / Wrist

Mark Scott Nov. 1, 2007

Systematic ApproachSystematic Approach

Fracture Identification, Look for:• Mal-alignment• Discontinuity• Radio-lucency / radio-opacity• Fat pads

Fracture Identification, Look for:• Mal-alignment• Discontinuity• Radio-lucency / radio-opacity• Fat pads

Mal-AlignmentMal-Alignment

DiscontinuityDiscontinuity

RadiolucencyRadiolucency

Fat PadsFat Pads

Rule of 2’sRule of 2’s

• 2 views• 2 joints• 2 sides (esp. for children)• 2 times (before/after)

• 2 views• 2 joints• 2 sides (esp. for children)• 2 times (before/after)

Fracture DescriptionFracture Description

• Location (bone, level)• Pattern (type of #, open vs. closed)• Alignment (of distal segment)• Angulation• Rotation• Displacement• Salter classification

• Location (bone, level)• Pattern (type of #, open vs. closed)• Alignment (of distal segment)• Angulation• Rotation• Displacement• Salter classification

Transverse # of distal radius with 100 dorsal angulation?

Transverse # of distal radius with 100 dorsal angulation?

Colles FractureColles Fracture

Oblique # of distal radius immediately proximal to physis with 2mm of ulnar

displacement?

Oblique # of distal radius immediately proximal to physis with 2mm of ulnar

displacement?

Salter II #Salter II #

Salter-Harris ClassificationSalter-Harris Classification

S Separation (I)A Above (II)L Low (III)T Transverse (IV)R cRush (V)

S Separation (I)A Above (II)L Low (III)T Transverse (IV)R cRush (V)

Salter-Harris ClassificationSalter-Harris Classification

Salter IV Salter IV

Salter II Salter II

Salter III Salter III

Colles #, 100 dorsal angulation, ? impaction Colles #, 100 dorsal angulation, ? impaction

# Distal radius, dorsal disl. of scaphoid/lunate# Distal radius, dorsal disl. of scaphoid/lunate

FOOSH, pain with axial loading of 1st MCFOOSH, pain with axial loading of 1st MC

FOOSH, pain with axial loading of 1st MCFOOSH, pain with axial loading of 1st MC

52 M demonstrating gymnastics52 M demonstrating gymnastics

FOOSH 6 yo MFOOSH 6 yo M

ReferencesReferences1. McRae, R. Pocketbook of orthopaedics and fractures

[2nd ed.]. Churchill Livingstone Elsevier, 2006.2. Tintnelli, JE. Emergency medicine: a comprehensive

study guide [6th ed]. American College of Emergency Physicians / McGraw-Hill, New York, 2004. Pp. 1674-84.

3. Ritchie JV. Emergency Emerg Med Clin North Am - 01-NOV-1999; 17(4): 823-42

1. McRae, R. Pocketbook of orthopaedics and fractures [2nd ed.]. Churchill Livingstone Elsevier, 2006.

2. Tintnelli, JE. Emergency medicine: a comprehensive study guide [6th ed]. American College of Emergency Physicians / McGraw-Hill, New York, 2004. Pp. 1674-84.

3. Ritchie JV. Emergency Emerg Med Clin North Am - 01-NOV-1999; 17(4): 823-42