1. Interpretation of Musculoskeletal
X- rays
Jatinder S. Luthra

2. Skeletal condition
• Fractures
• Osteomyelitis
• Structural anomalies
• Degenerative joint conditions

3. Rule of Two
• Two views - AP and Lateral
• Two joints – joint above and below
• Two occasions – repeat x- rays
• Two limbs – Compare

4. • Patient details
• Date of exam.
• Side – Rt./Lt. – Marker
• Exposure
• Whole area covered – Joint above and below
• Two views
• Abnormalities

5. • Bone Regularity
Break in intact
Cortex
• Joint integrity –
Fractures
Joint congruency
Air
• Soft tissue location, pattern, joint
Fracture body
Foreign extends into
deformity.
Damage/ degenreration
Swelling
Density

7. Description of fracture

16. Bone and joint alignment

17. Joint space

18. Bone Texture

19. Soft Tissue Anomaly

20. Bone Anatomy

21. Joint Anatomy

22. Cortical outline

23. Two views

24. Compare normal

25. Look for unexpected

26. Artefacts

27. Transverse fracture

28. Oblique

29. Spiral

30. Sagittal

31. Compare with old X- rays

32. Multidirectional

33. Comminuted

34. Butterfly Fragment

35. Segmental

36. Shortening

37. Angulation and Rotation

38. Distraction and impaction

39. Pathological fracture - Osteoporosis

40. Pathological fracture – Multiple
myeloma
MOTH EATEN
APPEARANCE

41. Pathological fracture – Benign lesion
GEOGRAPHICAL
MARGIN

42. Avulsion Farcture

43. Stress Fracture

44. Periprosthetic fracture

45. Fracture Mimics

46. Fracture Mimics

47. Fracture Mimics

48. Fracture Mimics- Vascular markings

49. Fracture Mimics

50. Foreign Body

51. Needle

52. Needle

53. Clavicle

54. Acromioclavicular Joint

55. Shoulder - Normal

56. Shoulder – Anterior Dislocation

57. Shoulder – Posterior Dislocation
BULB SIGN

58. Scapula - Normal

59. Scapula - Fracture

60. Humerus Fracture

61. Elbow - Normal (10 year old)

62. Elbow - Normal (Lateral)

63. Elbow - Subtle Fracture

64. Elbow – Supracondylar fracture

65. Elbow - Dislocation

66. Wrist – Colle’s Fracture

67. Wrist – Smith’s Fracture

68. Wrist – Comminuted Fracture

69. Monteggia Fracture

70. Greenstick Fracture

71. Torus Fracture

72. Wrist - Normal

73. Scaphoid Fracture

74. Trapezium Fracture

75. Wrist normal view

76. Scapholunate dissociation

77. Wrist dislocation

78. Cervical spine – Lateral view

79. Cervical spine – Lateral view

80. Cervical spine – Lateral view

81. Cervical spine – AP view

82. Cervical spine – Open mouth view

83. Cervical spine – Open mouth view
( Rotated view)

84. Cervical spine – Swimmer’sview

85. C1 Fracture

86. C2 – Odontoid Fracture

87. C2 – Odontoid Fracture

88. C2 – Hangman Fracture

89. C2 - Teardrop fracture

90. C2 - Teardrop fracture

91. Cervical Spine – Facet dislocation
(Lateral view)

92. Cervical Spine – Facet dislocation
(AP view)

93. Cervical spine – prevertebral space

94. Cervical spine – spinous fracture

95. Thoracic spine - Normal

96. Thoracic spine - Normal

97. Thoracic spine - Normal

98. Lumbar spine – Normal view

99. Lumbar spine – Normal view

100. Lumbar spine – Normal view

101. Lumbar spine – Normal view

102. Lumbar spine – Three Coloumn

103. Lumbar spine – Three Coloumn

104. Lumbar spine – Compression Fracture

105. Lumbar spine – Compression Fracture

106. Lumbar spine – Burst Fracture

107. Lumbar spine – Burst Fracture

108. Lumbar spine – Chance’s Fracture

109. Lumbar spine – Chance’s Fracture

110. Osteoporotic fracture

111. Osteoporotic fracture

112. Fracture transverse fracture

113. Spinous process fracture

114. Pelvis X-ray - Normal

115. Pelvis X-ray – Pubic ramus fracture

116. Pelvis X-ray – Acetabular fracture

117. Pelvis X-ray - Diastasis

118. Pelvis X-ray – ASIS avulsion

119. Sacrum- Normal

120. Sacral Fracture

121. Hip - Normal

122. Hip - Normal

123. Hip - Normal

124. Hip – Intracapsular fracture

125. Hip – Intertrochanter fracture

126. Hip – Subtrochanter fracture

127. Hip - Dislocation

128. Femur fracture

129. Pathological fracture

130. Knee - Normal

131. Knee - Normal

132. Knee - Normal

133. Fracture Tibial plateau

134. Fracture Tibial plateau

135. Patella Fracture

136. Patella Dislocation

137. Fabella

138. Bipartite Patella

139. Tibia and fibula fracture

140. Tibial Stress fracture

141. Toddler’s fracture

142. Ankle - Normal

143. Ankle - Normal

144. Ankle - Normal

145. Lateral malleolus fracture

146. Bimalleolar Fracture

147. Bimalleolar Fracture

148. Osteochondral fracture

149. Calcaneal fracture

150. Foot - Normal

151. Lisfranc Farcture

152. Fracture 5th metatarsal

153. Osteosarcoma

154. Aneurysmal bone cyst

155. Osteochondroma

156. Osteopetrosis

157. THANK YOU