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Operative Imaging for Distal Radius Fracture Volar Plate Surgery
--- under construction---Introduction
Good theatre radiography requires a sound knowledge of the radiographic equipment (mobile image intensifier is commonly used) and the surgical procedure. Radiographers who are familiar with the surgical procedure will require less direction- they are able to anticipate what is required and the operating theatre experience is more likely to be a meaningful professional experience. This page considers the reduction and immobilisation of a distal radius fracture via a case-study.Anatomy
This 40 year old male presented to the Emergency Department following a motor vehicle accident. The patient was referrred for left wrist and hand radiography. There is a comminuted fracture of the distal radius. The lateral projection image demonstrates a large volar distal radius fragment.
The patient underwent surgical reductyion and fixation of the fracture with volar plate and screws.
The surgeon made an incision over the flexor radialus carpi (FRC) tendon. The FRC tendon is retracted to the ulnar side of the wrist. Self retaining retractors (cats paws) are positioned to keep the incision open. The pronator quadratus was disected away from the radius and the brachioradialis tendon was released from its distal insertion. The fracture line and distal fragments were exposed. The distal fragment positions were adjusted and two Kirschner wires were inserted.
Place provisional fixation using k-wires
- Holds fracture reduced
- Demonstrated where screws will be going
The position of the distal fragments was checked with the image intensifier. A left volar plate was selected and positioned to assess fit. Using the Polyaxial Drill Guides built into the plate, holes were drilled for the screws The drill bit position was assessed with the image intensifier. It is important that any discontinuity in the articular surface of the distal radius is minimised and the drill holes/screws are not intra-articular. Note that the first screw is placed in the oblong hole allowing the plate to be respotioned distally or proximally as required Inserting proximal locking screws. The final position of the volar plate and screws is shown. Final position, lateral projection.
- An overcouch technique should generally be used for small anatomy such as the wrist
- Laser assisted centring should be employed if available.
- Ask the surgeon where he/she would like the Image intensifier and screen positioned.
- Use the minimum dose setting which will provide an adequate image.
- The surgeon must be able to see the distal fragments clearly- it is important that the patient not be left with
- a large step in the radial articular surface.
- a large separation of fragments
- radial shortening
- Magnification (smaller field size) should be used if the anatomy is not sufficiently well demonstrated (the surgeon should not have to walk over to the image intensifier screen to see the image adequately). Equally, magnification should not be employed if not required because it increases patient radiation dose.
- It is prudent to use a higher dose mode (higher quality) for the final images (only) which are kept as a record of the final position
- You may note that the surgeon adjusts the PA and lateral wrist position to account for the palmar tilt (PA projection) and radial incination (lateral projection)- this will afford improved demonstration of the radiocarpal joint. (see discussion here)
Latest page update: made by M.J.Fuller
, Apr 24 2010, 7:05 AM EDT
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|gyoga||All digital x-ray equipments are giving wrong 2-D measurements.||1||Feb 16 2013, 11:04 PM EST by metal-fan-666|
Thread started: Feb 10 2013, 12:45 PM EST Watch
All digital x-ray equipments are giving wrong 2-D measurements irrespective of brands and no one interested to correct it.The digital medical X-ray image is superimposed image of multiple planes of our body. The plane away from the detector will have more magnification and plane near to the detector will have least magnification. Scanogram is a special type of X-ray used to measure the bone length. In orthopedic field the Scanograms are used to measure real size or length of the bone. An accurate and reproducible assessment of limb length is required for successful treatment. Nowadays Digital X rays are widely used and images on the films are either magnified or reduced. With the help of workstations and CPU the distance of the required images are measured and these measurements are inaccurate since they are measured at detector level and not at anatomical level. Work stations and CPU are not available as end users in all the places. In such conditions our simple techniques will help us to get the real size of images on the laser film.
Cancer Institute (WIA)
Chennai south India ph 91 9841748715
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