Specific pathology can learn during orthopedics appointment
Clavicle series
- indications
- suspicion of bony injury
- procedure
- 2 views of clavicle
- straight AP of the clavicle
- oblique AP of the clavicle (15 degrees)
- similar tests
- shoulder x-ray
- centred over the shoulder
- AP and oblique view to look for dislocation
- important pathology
Shoulder series
A shoulder series (or shoulder x-ray) is most frequently performed following trauma looking for evidence of fracture or dislocation.
- indications
- suspicion of bony injury
- concern for dislocation
- shoulder pain or restriction of movement
- procedure
- AP view of the shoulder
- front-on view of the shoulder girdle including the entire clavicle and scapula
- there are several potential seconds views
- Y-view: useful when looking for shoulder dislocation
- angled along the scapula blade
- axial: used in general trauma
- looking up through the shoulder
- Garth's view: often utilised when the should is unable to be abducted
- similar tests
- clavicle x-ray
- only used when the suspicion is of clavicle pathology
- important pathology
Humerus series
A humerus series (or humerus x-ray) is a set of two x-rays performed of the entire humerus. It is performed to look for evidence of injury (or pathology) affecting the humerus. It may be performed as a second test after a shoulder or elbow x-ray has demonstrated a humeral fracture.
- indications
- suspicion of bony injury
- assessment of a partially imaged fracture on shoulder/elbow series
- procedure
- include the entire bone including the shoulder and elbow joints
- AP and lateral views of the humerus
- views at 90 degrees to each other
- similar tests
- shoulder x-ray
- shoulder injury or suspicion of dislocation
- elbow x-ray
- elbow injury
- important pathology
Elbow series
Summary
- indications
- suspicion of bony injury
- suspicion of elbow (or radial head) dislocation
- elbow pain
- procedure
- AP and lateral views of the elbow
- a Coyle's view may be performed upon suspicion of a radial head fracture
- anatomy
- bones
- proximal radius including radial head and radial neck
- proximal ulna including olecranon and coronoid process
- distal humerus including humeral condyles
- joints
- radiocapitellar joint
- trochlear joint (humeroulnar joint)
- proximal radioulnar joint
- similar tests
- humerus series
- used specifically for humeral pathology
- forearm series
- only used for specific forearm injury
- important pathology
Forearm series
A forearm series (or forearm x-ray) is a much less common study to perform than its neighbouring elbow or wrist series. Forearm imaging may be performed in children because of difficulty to localise pain, or where there has been focal trauma to the forearm.
The forearm series should not be considered a two-for-one examination of the elbow and wrist. Separate investigations of the wrist and elbow will produce higher spatial resolution examination with less beam divergence issues.
- indications
- suspicion of a forearm injury
- i.e. not wrist and not an elbow injury
- completion imaging when further injuries are suspected
- isolated radial or ulnar fracture looking for further fracture or dislocation
- younger children who cannot discriminate site of injury well
- procedure
- AP and lateral views of the forearm
- in one view, the wrist will be AP and the elbow lateral
- in the other view, the wrist will be lateral and elbow, AP
- it is challenging to get perfect views, especially of the elbow
- similar series
- elbow series
- distal humerus to mid-forearm
- covers proximal radius and ulnar
- wrist series
- distal radius and ulna, carpals and proximal metacarpals
- important pathology
Wrist series
A wrist series (or wrist x-ray) may be performed for a multitude of reasons. However, they are most commonly used in the assessment of trauma, by clinical teams within the Emergency Department or Orthopaedic service.
- indications
- suspicion of bony injury
- the Amsterdam wrist rules can be used for decision support about who should get a wrist x-ray
- assessment radiopaque foreign body
- procedure
- AP and lateral views of the wrist
- includes distal radius and ulna and proximal-mid metacarpals
- similar series
- hand series
- radiocarpal joint to the tip of phalanges
- scaphoid series
- wrist series plus two additional scaphoid views
- important pathology
Scaphoid series
A scaphoid series (or scaphoid x-ray) may be performed for a multitude of reasons. However, they are most commonly used in the assessment of trauma, by clinical teams within the Emergency Department or Orthopaedic service.
- indications
- suspicion of bony injury of the scaphoid
- procedure
- AP and oblique views of the wrist
- axial view of the scaphoid (to free it from superimposition)
- two further dedicated views of the scaphoid
- similar series
- wrist series
- distal radius and ulna, carpals and proximal metacarpals
- hand series
- radiocarpal joint to the tips of the fingers
- important pathology
Hand series
A hand series (or hand x-ray) may be performed for a multitude of reasons. However, they are most commonly used in the assessment of trauma by clinical teams in the Emergency Department or Orthopaedic service.
- indications
- suspicion of bony injury
- assessment of radiopaque foreign body
- assessment of joint disease
- procedure
- AP and oblique views of the hand
- a lateral view is of little use unless answering specific questions
- extends from the radiocarpal joint to the tips of fingers
- similar series
- wrist series
- distal radius and ulna, carpals and proximal metacarpals
- scaphoid series
- wrist series plus two additional scaphoid views
- thumb series
- just for looking at the thumb
- both hands
- used in arthritis for joint assessment
- important pathology
Both hands series
Both hands series (or both hands x-ray) is an investigation almost exclusively performed in the rheumatology service to assess patients with arthritis. It is not used in trauma.
- indications
- assessment of patients with arthritis
- procedure
- x-ray of both hands side by side
- similar series
- hand series
- distal humerus to mid-forearm
- covers proximal radius and ulna
- important pathology
- rheumatoid arthritis
- osteoarthritis
Thumb series
A thumb series (or thumb x-ray) is usually performed in the Emergency Department or Orthopaedic service following thumb trauma with suspected fracture or dislocation.
- indications
- suspicion of bony injury
- suspicion of dislocation
- procedure
- AP and lateral views of the thumb
- only includes the thumb and its articular with trapezium
- similar series
- hand series
- radiocarpal joint to tip of phalanges
- wrist series
- distal radius and ulna, carpals and proximal metacarpals
- important pathology
- base of thumb fracture
- scaphoid fracture
Pelvis x-ray
A pelvis x-ray, also known as a pelvis series or pelvis radiograph, is a single x-ray of the pelvis to include the iliac crests and pubic symphysis. It allows assessment of general pelvic pathology, the sacrum, some of the lower lumbar vertebra and the proximal femora.
- indications
- pelvic trauma
- suspicion of pelvic injury
- assessment of hip pain (consider hip series)
- procedure
- AP radiograph, usually supine
- includes the iliac crests, pubic symphysis and both proximal femora
- similar tests
- hip x-ray
- pelvic series + lateral/oblique view of the hip
- inlet and outlet view
- utilised for investigating narrowing or widening of the pelvic rim.
- can be used to assess anterior-posterior displacement of pubic rami fractures
- Judet views
- specialised views of the acetabular columns
- important pathology
Hip x-ray
A hip x-ray, also known as a hip series or hip radiograph, is a pelvis x-ray with an additional lateral view of the specified hip. It is used for the assessment of unilateral hip pathology, most commonly to diagnose a hip fracture or dislocation.
- indications
- hip trauma
- trauma with leg length discrepancy
- assessment of unilateral hip pain
- follow up in unilateral hip pathology
- procedure
- AP radiograph, of the pelvis
- second view of the hip
- shoot through lateral with the good leg flexed
- oblique view
- similar tests
- pelvis x-ray
- just the pelvis x-ray
- used for general pelvis assessment, e.g. trauma
- important pathology
Femur x-ray
A femur x-ray, also known as femur series or femur radiograph, is a set of two x-rays performed of the entire femur. It is performed to look for evidence of injury (or pathology) affecting the femur. It may be performed as a second test after a hip or knee x-ray has demonstrated a femoral fracture.
- indications
- suspicion of bony injury
- assessment of a partially imaged fracture on hip or knee x-ray
- procedure
- includes the entire bone including the hip and knee joints
- AP and lateral views of the femur
- views at 90 degrees to each other
- similar tests
- hip x-ray
- pelvis x-ray and lateral/oblique view of the hip
- performed specifically looking for hip fracture/injury
- knee x-ray
- performed specifically looking for knee injury
- important pathology
Knee x-ray
- indications
- knee trauma with suspicion of bony injury
- procedure
- AP and lateral views of the knee
- lateral view should be performed with a horizontal beam to demonstrate fluid levels (if present)
- similar tests
- femur x-ray
- specific test looking for isolated femoral injury
- tib/fib x-ray
- specific test looking for tibial or fibular injury
- may be used following direct trauma to the leg
- indications
- leg trauma with suspicion of bony injury
- procedure
- AP and lateral views of the leg
- from knee to ankle, including both joints
- similar tests
- knee x-ray
- specific test looking for knee injury
- ankle x-ray
- specific test looking for ankle injury
Tib/fib x-ray
Summary
Ankle x-ray
Summary
- indications
- ankle trauma with suspicion of bony injury
- procedure
- AP and lateral views of the ankle
- AP view performed at a slight angle to open up the mortise
- similar tests
- tib/fib x-ray
- specific test looking for isolated tibia/fibula injury
- foot x-ray
- x-ray of the foot only, not including the ankle
Foot x-ray
A foot x-ray, also known as foot series or foot radiograph, is a set of two x-rays of the foot. It is performed to look for evidence of injury (or pathology) affecting the foot, often after trauma.
- indications
- foot trauma with suspicion of bony injury
- foreign body examination
- procedure
- DP and oblique views of the foot
- not performed weight bearing in trauma
- DP (dorsoplantar)
- lateral views are of little value in trauma
- similar tests
- ankle x-ray
- x-rays of the ankle only
- calcaneus x-ray
- 2 view x-ray of the calcaneus
- used specifically when a calcaneal injury is suspected
Calcaneus x-ray
A calcaneus x-ray, also known as calcaneus series or calcaneus radiograph, is a set of two x-rays of the calcaneus. It is performed to look for evidence of injury (or pathology) affecting the leg, often after trauma.
- indications
- ankle trauma where the suspicion is of calcaneus injury
- jump/fall from height
- focal tenderness
- procedure
- lateral and axial views of the calcaneus
- axial view is an oblique view in the midline
- similar tests
- ankle x-ray
- specific test looking for ankle injury
- foot x-ray
- specific test looking for foot injury
Specific pathology, diagnosis and treatment learn in orthopaedics!
conditions
- upper limb
- lower limb
- pelvic fractures
- proximal femoral fractures
- distal fibula fracture
- 5th metatarsal fracture
- spine
- major trauma
- joint pain/arthritis
- osteoarthritis
- rheumatoid arthritis
- gout
- septic arthritis
- upper limb
- lower limb
- hip trauma
- lower limb injury
- foot and ankle injury
- joint pain/arthritis
presentations