Chest

 
     Subcutaneous Emphysema

Check for

• Soft tissue for Subcutaneous emphysema
• Bones for fractures
• Pleura
• Mediastinum
• Trachea
• Diaphragm

Broken Shenton's Line

Essential in polytrauma - check for

• Disruption of the ring
• Sacro-iliac joints
• Shenton's line
• Sacral fractures
• Ask for further views if indicated

Cervical spine

C1 to TI all seen

Check for

• C1 to T1 must be seen
• Alignment - trace out 4 lines
• Pre-vertebral soft-tissue shadow
• Atlanto-dens interval =3mm
• Open-mouth view for C1 &C2 fractures
• AP view for facet dislocations

Loss of vertebral height

Look for

• Loss of Vertebral body height
• Displacement of posterior body
• Angulation of spinous processes
• On AP films look for : Widening of inter-pedicular distance
• CT is best for upper thoracic spine

Fracture splinted

• Stabilise patient before X-ray
• Splint fracture before X-ray
• Don't forget soft-tissues
• The joint above & below the fracture must be seen
• Always insist on two views-AP & lateral

Angulation and deviation

Look for :

• Displacement
• Angulation
• Shortening
• Radial deviation
• Exclude intra-articular fracture

          Head of humerus

Check for

• Head of the humerus lies below the coracoid
• Inferior subluxation can be mistaken for dislocation
• If in doubt obtain a lateral or trans scapular view

Malleolar fractures

Look at

• Medial and /or lateral malleolus fractures
• Mortise (AP) view for talar shift
• Reduce dislocation before X-ray. Proximal fibula may be fractured
• Remember epiphyseal injuries in children

  S P Suresh