Navicular Bone
Normal [Courtesy of Dr. N. Jaffer]
Cuboid Bone
Normal [Courtesy of Dr. N. Jaffer]
Fracture Associated Sign
Soft Tissue (left image)
Normal knee
Knee Fat Fluid Level (right image)
This is indicative of a fracture, as compared to the accompanying normal image.
Bony Metastases
Metastases to right femur from non-small cell lung cancer. [Courtesy of Dr. N. Jaffer]
Osteoarthritis
Osteoarthritis Knee (left image)
Asymmetrical joint space narrowing, subchondral sclerosis and osteophyte formation on lateral femoral condyle.
Severe Osteoarthritis (right image)
Specific features include joint space narrowing and subchondral sclerosis.
Cervical Degeneration
C4-5, C5-6 severe degeneration. Narrowed disc space and collapse of vertebral body.
Ankylosing Spondylitis – Sacroiliitis
Earliest sign of AS is indistinctness of the sacroiliac joint. Subchondral bony erosions, subchondral sclerosis, and bony proliferation may eventually lead to bony fusion. In the later stage, the sacroiliac joint may not be visible or may present only as a thin dense line. Bamboo spine, also prominent here, is an AS feature caused by syndesmophytes formation.
Infectious
Osteomyelitis of the Femur
Fracture Types
A. Transverse
B. Oblique
C. Butterfly
D. Segmental
E. Spiral
F. Comminuted
G. Avulsion
H. Impacted
Description
Generally you should image the limbs bilaterally (unaffected and affected), image joints immediately proximal and distal to the affected joint, take AP and lateral views (and special views depending on the joint, i.e. skyline for knee or transcapular for shoulder) and then image before and after the reduction.
Site: Identify which bone, region of bone (proximal, distal, metaphyseal, etc.), intra- or extra-articular. Look for radiolucent (dark on x-ray) lines, discontinuities in the contour of the cortex.
Type: Transverse, oblique, spiral, comminuted.
Displacement: Undisplaced or displaced (angulated, translated, rotated, shortened, impaction).
Soft Tissue involvement: Calcification, gas, foreign bodies, open vs. closed. You may see features if fracture is not obvious, such as soft tissue swelling, changes in fat stripes, joint effusions and fat fluid levels caused by the displacement of periarticular fat by joint fluid.
Joints: Are the articular surfaces in apposition? Radiolucent lines? Arthritis features?
A negative x-ray does not exclude a fracture (especially in scaphoid, radial head or metatarsal head). Diagnosis is often clinical and not confirmed until 7-10 days later when enough bone resorption has occurred.