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Orthopaedic Clinic Radiography
Radiographers who are employed in larger hospials will see patients who are referred from outpatient consulting clinics. Usually, a large number of these patients will be referred from orthopaedic clinic for radiography of fractures diagnosed in the Emergency Department (and elsewhere). This tends to be repetitive work and the objectives of re-imaging these fractures and dislocations may not always be clear. This page considers all aspects of orthopaedic clinic radiography.
This 10 year old boy presented to the Emergency Department following a fall from his pushbike. He was examined and found to have a swollen and painful right shoulder. He was referred for right shoulder radiography.
This is an AP shoulder image with the patient's arm in internal rotation. The radiography is compromised to suit the patient's condition. There is a proximal humerus fracture (? Salter-Harris II)
The patient was treated with a collar-and-cuff and referred to orthopaedic clinic for follow-up assessment of the injury. With the patient now in a less distressed state, the radiographer was able to achieve a true AP shoulder with external rotation of the humerus. The distal fragment is now demonstrated with significant displacement. Note that the humeral position is not comparable with the original position as demonstrated in the Emergency Department imaging. It is worth considering the need to provide radiographic demonstration of these fractures in true AP and lateral positions in the Emergency Department so that follow up imaging will be comparable. It is conceivable that if the two positions of the humerus are at 90 degrees (orthogonal), there may be no change in the actual position/displacement of the fracture i.e. apparent displacement is positional rather than actual.
Latest page update: made by M.J.Fuller
, Dec 27 2010, 7:38 PM EST
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Keyword tags: neck of humerus fracture NOH fracture orthopaedic clinic radiography proximal humerus fracture
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|messajo||Rotation w/ fx?||1||Jan 6 2013, 8:56 PM EST by metal-fan-666|
Thread started: Dec 24 2012, 2:13 PM EST Watch
This raises a few questions for me - the first one is: when the patient returns for follow-up images in a clinical setting, should you replicate the postioning of the initial ED images? If so, should they be in addition to the traditional positions, or in place of? My second question is: if you know the patient has a substantial fracture, such as the one above, is it reccomended that you try to have them externally rotate, rather than doing an AP neutral and a transthoracic or trauma Lateral? This seems to me that you would endanger displacing the fracture, and put the patient through unnecessary pain?
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