Osce Xray Summary.docx

Basic details

Basic Details of the X-Ray The first step, when presented any X-Ray, is to verify the simple details about the X-Ray:



Who is it, what is it, when was it taken?

You need to start by making sure you have the right patient and the correct date. Next you need to identify you what bone you are viewing and the type/angle of the X-Ray (e.g. lateral or AP).

“This is a lateral view X-Ray of Mr. X’s left forearm, taken on the 2/5/2011”



Is the X-Ray adequate?

Is there good exposure and can you see the joint above and below the bone of interest? “The X-Ray has acceptable exposure and the elbow and wrist joints are visible”

Main findings

The main findings need to outline what you see with the fracture. This will include the location, morphology, number of fragments/part and if it is displaced. More specifically:



What is the Location of the Fracture? o

Which bone?

o

Where in the Bone? (diaphysis, metaphysis, intra-articular (in the joint)

“The main finding is a fracture in the metaphysis of the radial bone”



What is the Morphology of the Fracture? o

The will usually describe the mechanism of injury (e.g., direct, wedge, oblique, spiral)

o

Number of parts (e.g. simple, comminuted (lots of parts), multifragmented; or say 2,3,4 or more parts

“This appears to be simple oblique fracture at the junction of the middle and lateral third of the radius”



Is the Fracture Displaced? o

Shortening = (in centimetres)

o

Translation = (how much in percentage has it lateralised from the original bone position)

o

Angulations = the degree the distal fragment piece has moved from the direction the proximal bone in pointing NOTE: comment as radial or ulnar and/or, frontal or dorsal)

o

Rotation = look at the lower joint and report in degrees the amount of rotation of the distal fragment)

“There is 50 percent radial translation of the fracture without significant shortening. The distal fragment is dorsally angulated 20 degrees with no obvious rotation”

Special types of fractures

Does the Fracture Resemble and Special Type of Fracture

1. Greenstick fracture 2. Colle’s fracture 3. Smith’s fracture

Other types

Comment on any other soft tissue swelling or lytic lesions, change in density of bone or other radiological changes such as signs of osteoarthritis or joint malformations

“There is no other abnormality noted.”

Summary

Summary example:

“This is a X-Ray of Mr. X’s left forearm taken on the 2/5/10. The X-Ray has acceptable exposure and the elbow and wrist joints are visible. The main finding is a fracture in the metaphysis of the radial bone. This appears to be simple oblique fracture at the junction of the middle and lateral third of the radius. There is 50 percent radial translation of the fracture without significant shortening. The distal fragment is dorsally angulated 20 degrees with no obvious rotation. There is no other abnormality noted.”