X-ray signs of damage to bones and joints

Radiation examination of the skeleton is performed according to the prescription of the doctor in charge. It is indicated for all injuries of the musculoskeletal system. The basis of the study is the radiography of the bone (joint) in two mutually perpendicular projections. The images should be taken with an image of the entire bone with adjacent joints or a joint with adjacent bones. All victims are subject to examination in the X-ray room, in which consciousness is preserved and there are no life-threatening signs of damage to internal organs and vessels. The remaining victims according to clinical indications can be examined in the ward or dressing room with the help of a mobile X-ray machine. Refusal of radiography with damage to bones and joints is a medical error.

It is recommended to take pictures after the traumatologist makes local anesthesia, which facilitates the patient's condition and fixes the limb during shooting. In those cases when X-ray diffraction in two projections fails to accurately determine the presence and nature of the lesion, additional images are taken: X-ray patterns in oblique projections, sighting images, linear tomograms. According to special indications, sonography, CT and MRI are performed.

The main radiographic signs of the fracture of tubular and flat bones are generally known - this is the fracture line (slit) and the displacement of fragments.

A line, or a crack, a fracture is a light strip with uneven and often jagged edges. A classic example of such a line is a crack in one of the bones of the cranial vault. The fracture line looms more clearly in the cortical layer of the bone, then crosses it in a different direction. If it does not reach the opposite edge of the bone, then talk about an incomplete fracture. In these cases, there is no significant displacement of the fragments. With a complete fracture, the displacement of the fragments is observed as a rule. It is caused by both the injury itself and the traction of the muscles.

The nature of the displacement of the fragments is determined from the photographs in two mutually perpendicular projections. Distinguish the displacement along the length (longitudinal, which can occur with desire, wedging or divergence of fragments), along the width (lateral), along the axis (angular) and along the periphery, i.e. With the rotation of one of the fragments around its longitudinal axis. The magnitude of the longitudinal or lateral displacement is indicated in centimeters, and the angular and the peripheral are in degrees.

According to the radiographs, it is necessary to make sure that the fracture line passes through the articular surface of the bone; is not a fracture intraarticular. In addition, it is necessary to pay attention to the state of bone tissue around the fracture of the fracture, in order to exclude a pathological fracture, i.e. Damage that has occurred in the already affected bone (in particular, in the field of tumor development). In childhood, occasionally there is an epiphysis - a traumatic separation of the epiphysis of the bone from the metaphysis. The fracture line passes along the germ cartilage, but is usually slightly bent to the metaphysis, from which a small bone fragment breaks. In children, incomplete and subperiosteal fractures of tubular bones are relatively common. With them, the fracture line is not always visible and the main symptom is the angular flexure of the outer contour of the cortical layer. In order to catch this sign, it is necessary to carefully consider the contour of the bone all along.

Fractures of gunshot origin have a number of features. In the bones of the arch of the skull, pelvis and other flat bones they are predominantly perforated and are accompanied by numerous radial cracks. Similar lesions are observed in metaphyses and epiphyses. In the diaphysis more often there are comminuted fractures with multiple fragments and cracks. Gunshot injuries are often accompanied by the penetration of foreign bodies into bones and soft tissues. Metallic foreign bodies are detected by X-ray patterns, while foreign bodies that are non-contrast to X-rays are detected by sonography.

Thus, in the vast majority of cases, conventional X-ray images allow us to establish the nature of bone damage. However, there are situations when displacement of fragments is absent, and the fracture line can be seen indistinctly or it can not be distinguished from normal anatomical formations, for example, fractures of individual bones of the arch and the base of the skull, facial skull, arches and vertebrae processes, damage to large joints. In these cases, you must additionally apply a linear or computerized tomography. A reliable auxiliary diagnostic method is the radionuclide study - osteoscintigraphy. Scintigrams make it possible to establish a fracture, since in the area of damage RFP accumulates in a larger number than in the surrounding bone. In general, a typical scheme of radiation examination of a person injured in an acute trauma of the limb is given below. After a conservative or operative repair of the fracture, control x-rays are taken in two mutually perpendicular projections. They make it possible to evaluate the efficiency of alignment and the correct location of the pins and plates in metallic osteosynthesis.

When conservative treatment of the fracture with the help of fixative bandages (for example, gypsum), repeated x-rays are performed after each bandage change. In addition, repeated pictures are produced if there is a suspicion of a fracture complication.

With gunshot injuries, a serious complication is a gas infection. Radiograms determine the increase in the volume of soft tissues and loss of clarity of the outlines of individual muscle groups in the fracture region. A specific feature is the appearance of gas bubbles and the separation of muscle fibers by gas accumulations. The gas absorbs X-ray radiation weaker than surrounding tissues, therefore it causes clearly visible enlightenments.

Subsequently, radiographs are made to assess the condition of bone callus between fragments of the head of the humerus.

In the first decade after the injury, the fracture gap is seen particularly clearly due to resorption of damaged bone beams at the ends of the fragments. During this period, the fragments are connected by a connective tissue corn. In the second decade, it turns into an osteoid. The latter is similar in structure to bone, but does not contain lime and does not stand out in the pictures. At this time, the radiologist still catches the fracture line and also notes the oncoming bone restructuring - osteoporosis. In the third decade, a doctor can feel a dense corn that fixes the fragments, but on X-rays this callus is still not displayed. Complete calcification of the callus occurs in 2-5 months, and its functional restructuring lasts a very long time.

In the surgical treatment of fractures, the surgeon determines the necessary time for performing control shots. It is necessary to check the development of the bone callus, the position of the metal fixing devices, to exclude complications (necrosis or inflammation of the bone, etc.).

To violations of healing fractures is the delayed formation of bone callus, but it does not need to be confused with non-non-fracture and the formation of a false joint. The absence of a callus is not a proof of the development of a false joint. It is evidenced by the infection of the medullary canal at the ends of the fragments and the formation of a closing bone plate along their margin.

X-ray diagnostics of dislocations is relatively simple: in the pictures, there is a lack of a head in the articular cavity - a complete discrepancy between the articular ends of the bones. It is especially important to trace whether dislocation is accompanied by detachment of bone fragments from the joint ends. Bone fragments can interfere with the normal correction of the dislocation. In order to recognize the subluxation, it is necessary to carefully consider the relationship between the articular head and the articular cavity. Subluxation is indicated by a partial discrepancy between the articular surfaces, as well as the wedge-shaped shape of the x-ray joint gap.