ESSENTIAL PROJECTIONS

• ROUTINE PROJECTIONS
• SPECIAL PROJECTIONS
 GENERAL PRINCIPLES FOR DETERMINING
POSITIONING ROUTINES

• MINIMUM OF TWO PROJECTIONS

– Superimpositions of anatomic structures
– Localization of lesions or foreign bodies
– Determination of alignment of fractures.
• Forearm
• Humerus
• Femur
• Hips
• Tibia-fibula
• Chest
• MINIMUM OF THREE PROJECTIONS
– Fingers
– Hand
– Wrist
– Elbow
– Ankle
– Foot
– Knee
 SKELETAL TRAUMA AND
FRACTURE TERMINOLOGY
• Dislocation
– It occurs when the bone is displaced from a joint,
or when the articular contact of bones that makes
up a joint is completely lost.
– Most common in shoulder, fingers, patella, and hip
• Subluxation
– Partial dislocation
– A nursemaid elbow (jerked elbow) which is a
traumatic partial dislocation od the radial head of
a child, caused by a hard pull on the hand and the
wrist of a child or adult.
• Sprain
– A forced wrenching or twisting of a joint results in
a partial rupture or tearing of the supporting
ligament without dislocation.
– May result in a severe damage associated blood
vessels, tendons, ligaments or nerves.
• Contusion
– Bruise type of injury with possible avulsion
fracture.
– An example is a hip pointer, a football injury
involving contusion of the bone at the iliac crest of
the pelvis.
• Fracture
– Break in a bone
Fracture Alignment Terminology
• Refers to the associative relationship between long
axes of the fracture fragments. A fracture is aligned if
the long axes of the bone is parallel to each other.
• Apposition
– Describes the manner in which the fragmented
ends of the bone make up each other.
– types of Apposition
• Anatomic apposition
• Lack of apposition
• Bayonet
 Types of Apposition

• Anatomic apposition
– Anatomic alignment of the ends of the fractured bone
fragments, wherein the ends of the fragments make end to
end contact.
• Lack of apposition (distraction)
– The ends of the fragments are aligned but pulled apart and
are not making contact with each other
• Bayonet Apposition
– A fracture wherein the fragments overlap and the shaft
makes contact, but not at the fracture ends.
• Angulation
– Describe the loss of alignment of the fracture,
apex is the direction of the angulation and is
opposite relation to the distal part of the fracture
fragments.
 Types or direction of Angulation

• Apex Angulation
– Describes the direction or the angle of the apex of
the fracture, such as medial or lateral apex, wherein
the point of the apex of the fracture is medially or
laterally.
• Varus deformity
– The distal part of the distal fragments angled
towards the midline of the body, results in the
lateral apex that points away from the midline
• Valgus deformity
– The opposite of varus, the distal parts of the distal
fragments are angled away from the midline, the
apex is pointed toward the midline.
 Types of Fractures

• Simple Fractures
– A fx in which the bone does not break through
the skin
• Compound (open) fx
– A fracture in which a portion of a bone protrudes
to the skin.
• Incomplete Fx
– Does not traverse through entire bone.
– The bone is not broken into two pieces.
– Two major incomplete fractures:
• Torus fx
– No complete break in the cortex.
• Greenstick (hickory or willow stick fx)
– Fracture is in one side only.
– The cortex of one side is broken.
• Complete fx
– The break is complete and includes the cross
section of the bone.
– The bone is broken into two pieces.
 Three major examples of complete fractures

• Transverse fracture
– Fracture is transverse at a near angle to the long axis
of the bone.
• Oblique fracture
– Fracture passes through the bone at an oblique
angle.
• Spiral fracture
– In this fracture, the bone has been twisted apart and
the fracture spirals around the long axis.
• Comminuted fracture
– The bone is splintered or crushed at the site of the
impact resulting into two or more fragments.
 Three types of comminuted fracture
• Segmental fracture
– A type of double fracture in which the fracture lines isolate
a distinct segment of the bone.
• Butterfly fracture
– A comminuted fracture with two fragments on each side of
a main, wedged-shaped separate fragment, has a
resemblance to a wings of a butterfly.
• Splintered fracture
– A comminuted fracture in which the bone is splintered into
thin, sharp fragments.
• Impacted fracture
– One fragment is firmly driven into the other, such
as the shaft of the bone being driven into the head
or end segment.
 Specific Named Fractures

• Barton’s fracture
– This is an intraarticular fracture of the posterior lip of the
distal radius.
• Baseball (mallet) fracture
– Fracture of the distal phalanx caused by striking the end of
the extended finger.
• Bennet’s fracture
– The longitudinal fracture, which occurs at the base of the
first metacarpal with the fracture line entering the
carpometacarpal joint
• Boxer’s fracture
– Commonly involves the distal fifth metacarpal
with an apex posterior angulation best
demonstrate on lateral view.
• Colle’s Fracture
– This fracture of the wrist in which the distal radius
is fractured with the distal fragment displaced
posteriorly
• Smith’s fracture
– Fracture of the wrist with the distal fragment of
the radius displaced anteriorly.
• Hangman’s fracture
– This fracture occurs on the pedicles of the C2 with
or without displacement of C2 and C3.
• Hutchinson’s fracture (chauffer’s)
– Intraarticular fracture of the radial styloid process
• Monteggia’s fracture
– Fx of the proximal half of ulna, along with
dislocation of the radial head.
• pott’s Fracture
– Complete fracture of the distal fibula with major
injury to the ankle joint.
 Additional Fracture Types
• Avulsion’s Fracture
– Fracture results fro severe stress to a tendon or
ligament in a joint region.
• Blow out fracture
– Direct blow to the orbit
• Chip fracture
– Fracture involves an isolated bone fragment
• Compression fracture
– Vertebral fracture caused by compression type injury.
• Contrecoup fracture
– Injury/fracture to the one side of the structure hat is caused by impact
on the opposite side.
• Depressed fracture (ping-pong fracture)
– Fracture of the skull, a fragment is depressed.
• Epiphyseal fracture
– Fracture through the epiphyseal plate
• Le Fort fracture
– Bilateral horizontal fracture of the maxillae that may be result in an
unstable detached fragment.
• Pathologic fracture
– Fractures are due to disease process within the bone
• Stellate fracture
– The fracture lines radiate from the central point of
injury with starlike pattern.
• Stress or fatigue fracture (march)
– Type of fracture is nontraumatic in origin. Caused by
repeat stress on a bone.
• Trimalleolar fracture
– Facture of the ankle joint involving the medial,
lateral, and posterior malleoli of the distal tibia.
• Tripod fracture
– Caused by blow of the cheek resulting in fracture of
zygoma in three places, the orbital process, maxillary
process and the arch.
• Tuft or burst fracture
– Comminuted fracture of the distal phalanx.