X-ray reading in trauma cases is very important to diagnose analyze and plan the treatment options. It should be systematic and with certain rules.
First Rule: ABCD
A: Adequate Views
B: Bones
C: Cartilages (Joint spaces)
S: Soft tissues
To identify the Adequate Views in X-ray reading
Rule of TWO
- 2 views
- 2 Joint: One joint above one joint below
- 2 Abnormalities: Look for another injury
- 2 Limbs: Contralateral limb for comparison
- 2 Occasion: Compare with the previous X-ray
- 2 Evaluation: Repeat X-ray on follow-up
- 2 Review: In doubtful review with another person
Examine the entire length of bone
Fracture description through X-ray
- Anatomical Location of bone
- Fracture pattern
- Relationship with a fracture fragment
Anatomical Location
- Side of Bone (R/L)
- Identify Involved bone
- Location
- Proximal, diaphyseal, distal
- Intraarticular/ Extraarticular
- Head, neck, and base
Fracture Pattern
- Transverse
- Oblique
- Spiral
- Communited
- Segmental
- Impacted fractures/ depressed
- Avulsion
Alignment
Relationship of longitudinal axis from another
Distal in relation to proximal
Angulations
- Valgus/ Varus
- Anterior/ Posterior
- Rotation
Apposition
Amount of end-to-end contact of the fracture fragments
Bayonet Apposition
Overlapping of fracture fragment in the longitudinal axis
Distraction
Displacement in the longitudinal axis of the bone
Displaced
Medially- Laterally
Anteriorly- Posteriorly
Dislocation/ Subluxation
More on X-ray reading we can get on following link of AO.
See also: Radiograph of Bone Tumor
