X线摄片体位(手部)幻灯片.ppt
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Radiographic Positioning for Orthopedics
The Finger
* Routine: PA, Oblique, Lateral
* Includes all of phalanges and MCP
* CR perpendicular to PIP of finger
- PIP= proximal interphalangeal joint
- DIP= distal interphalangeal joint
Volar Plate Fracture
Dislocation
The Thumb an Overview
Thumb Injuries
* Intra-articularfractures includes
- Bonnet's fx: oblique fx of the metacarpal base.
- Rolando's fx: comminuted fx variant of Bennet's fx.
? These often requires a "K" wire to stabilize
* Extra- articular fractures includes
- Salter II fx: transverse pediatric fx involving epiphyseal plate
- Salter III fx: similar to Bennet's with medial epiphyseal remains attached to trapezium
- These types are often closed reduced
- Transverse fx of metacarpal base
Bennet's Fracture
Rolando's fracture
Extra-Articular Fracture
Thumb Injuries Continued...
* Partial and complete tears of ligaments and tendons
- Usually apparent during diagnostic examinations by doctors
- Radiographs may show joint incongruity or avulsion fx's
* Dislocations
- Easily seen during examinations
- Closed reduction is usually done
- Radiographs should be done on all dislocations to eliminate the presences of an avulsion fx such as:
? Volar plate fx
? Joint space widening
? Presences of trapped sigmoids or fragments in the joint space
Routine Thumb Positions
* This position allows the demonstration of the thumb in two or three positions, depending on the hospital routine.
* Patients positions: The standard routine includes the oblique,lateral, and AP (also called hyperpronation thumb) postions.
- The phalanges, MCP and CMC joints should be demonstrated in all joints should be projected open.
* CR: perpendicular to the MCP joint
Mallet Thumb and Gamekeepers Thumb
* Mallet thumb: flexion deformity due to force flexion of thumb.
- Extensor mechanism is damaged
- Also called dropped thumb
* Gamekeepers thumb: Ulnar collateral ligament injury.
- Associated with sports such as skiing, hockey
- Due to excessive radial stress
- Varus and valgus stress views will demonstrate radiographically.
Game Keepers Thumb
Special Imaging of the Thumb
Burmans Thumb Position
* This position allows the demonstration of the first CMC joint free of superimposition. Early detection of arthritis at the joint may also be possible.
* Patients position
- The thumb is in the lateral position
- The fingers are extended and held by the opposite hand
* CR: 45 degrees cephalad, toward long axis of the forearm, through the CMC joint.
Burmans Thumb
Roberts Hyperpronation Thumb
* Demonstrates the trapeziometacarpal articulation free of superimposition.
* Patient position
- The thumb is hyperpronated the same as the routine AP position
- The hand is dorsiflexed
* CR: 15 degrees toward the base of the first metacarpal
Geeda-Billings Thumb
* Demonstrates the base of the thumb in the lateral position free of superimposition.
* Valuable for the Bennet's and Rolando's fx's
* Patient position:
- Thumb is in the routine lateral position
* CR: 10 degrees cephalad along the long axis of the thumb.
Eaton Thumb Stress Position
* Demonstrates the trapeziometacarpal joint under stress to determine any ligament damage or loss of integrity
* Patient position:
- Both hands are pronated on the cassette
- The lateral aspects of the thumbs are placed together
- The patient pushes the thumbs together with as much force as possible
* CR: perpendicular to include the bases of both thumbs
Modified Eaton Thumb Position
* This position also demonstrates the first CMC joint, but allows the patient to apply more axial force to better demonstrate any problems with the joint
* Patient position:
- Both hands are pronated on the cassette
- The tips of the thumbs are placed together
- Force is applied by the patient axially
* CR: perpendicular to include both first CMC joints
Abduction Stress Position
* Demonstrates ligament injury or subluxation of the first MCP joint
* Patient position:
- Both hands are placed in the lateral position on the cassette
- The tips of the index fingers are placed on the ends of the thumbs
- Abduction stress is applied
- Success depends on the amount of stress applied by the patient
* CR: perpendicular to the film
Adduction Stress Thumb
* Demonstrates ligament injury on lateral aspect of 1st MCP
* Hands in lateral position
* Index fingers placed around finger tips
* Stress applied
The Hand Overview
Hand Anatomy
Fractures and Dislocations
* All phalanges and metacarpals are subject to fx's and dislocations
* Distal phalanges and thumb are most common sites of injury
* Metacarpals are second most common with the fifth metacarpal as most frequent among metacarpals.
- mid-shaft fx of the fifth metacarpal is called "Boxer's fx"
Boxer's Fracture
Pathologic Changes in The Hand
* Boutonniere deformity: Rheumatoid arthritis
* Swan Neck deformity: Rheumatoid arthritis
* Other boney changes: dependent on type of arthritis or pathologic condition
* Special positions are needed in some cases: Norgaard, Brewerton, Bora
Flexion/Extension Injuries of the Phalanges
* Volar plate fx:avulsion fx of the base of middle phalanx due to hyperextension
* Mallet finger: forced flexion of an extended DIPjoint resulting in a rupture or avulsion of the extensor tendon
* Trigger finger: same mechanics as Mallet finger but occurring at PIP joint
Routine Hand Positions
* PA, oblique, fan lateral
* Lateral variant:
- Flexion lateral: for anterior/posterior fragment displacement
- Extension lateral: for soft tissue injury
Routine Hand Positions
* Standard at IU includes PA, oblique, (claw or with step sponge), and "fan" lateral
* Patient positioning should include all the bones and joints of the hand with as many joints projected open as possible.
* CR: perpendicular to the cassette, at the third MCP joint
Special Images of the Hand
Radiographic Positioning for Orthopedics
The Finger
* Routine: PA, Oblique, Lateral
* Includes all of phalanges and MCP
* CR perpendicular to PIP of finger
- PIP= proximal interphalangeal joint
- DIP= distal interphalangeal joint
Volar Plate Fracture
Dislocation
The Thumb an Overview
Thumb Injuries
* Intra-articularfractures includes
- Bonnet's fx: oblique fx of the metacarpal base.
- Rolando's fx: comminuted fx variant of Bennet's fx.
? These often requires a "K" wire to stabilize
* Extra- articular fractures includes
- Salter II fx: transverse pediatric fx involving epiphyseal plate
- Salter III fx: similar to Bennet's with medial epiphyseal remains attached to trapezium
- These types are often closed reduced
- Transverse fx of metacarpal base
Bennet's Fracture
Rolando's fracture
Extra-Articular Fracture
Thumb Injuries Continued...
* Partial and complete tears of ligaments and tendons
- Usually apparent during diagnostic examinations by doctors
- Radiographs may show joint incongruity or avulsion fx's
* Dislocations
- Easily seen during examinations
- Closed reduction is usually done
- Radiographs should be done on all dislocations to eliminate the presences of an avulsion fx such as:
? Volar plate fx
? Joint space widening
? Presences of trapped sigmoids or fragments in the joint space
Routine Thumb Positions
* This position allows the demonstration of the thumb in two or three positions, depending on the hospital routine.
* Patients positions: The standard routine includes the oblique,lateral, and AP (also called hyperpronation thumb) postions.
- The phalanges, MCP and CMC joints should be demonstrated in all joints should be projected open.
* CR: perpendicular to the MCP joint
Mallet Thumb and Gamekeepers Thumb
* Mallet thumb: flexion deformity due to force flexion of thumb.
- Extensor mechanism is damaged
- Also called dropped thumb
* Gamekeepers thumb: Ulnar collateral ligament injury.
- Associated with sports such as skiing, hockey
- Due to excessive radial stress
- Varus and valgus stress views will demonstrate radiographically.
Game Keepers Thumb
Special Imaging of the Thumb
Burmans Thumb Position
* This position allows the demonstration of the first CMC joint free of superimposition. Early detection of arthritis at the joint may also be possible.
* Patients position
- The thumb is in the lateral position
- The fingers are extended and held by the opposite hand
* CR: 45 degrees cephalad, toward long axis of the forearm, through the CMC joint.
Burmans Thumb
Roberts Hyperpronation Thumb
* Demonstrates the trapeziometacarpal articulation free of superimposition.
* Patient position
- The thumb is hyperpronated the same as the routine AP position
- The hand is dorsiflexed
* CR: 15 degrees toward the base of the first metacarpal
Geeda-Billings Thumb
* Demonstrates the base of the thumb in the lateral position free of superimposition.
* Valuable for the Bennet's and Rolando's fx's
* Patient position:
- Thumb is in the routine lateral position
* CR: 10 degrees cephalad along the long axis of the thumb.
Eaton Thumb Stress Position
* Demonstrates the trapeziometacarpal joint under stress to determine any ligament damage or loss of integrity
* Patient position:
- Both hands are pronated on the cassette
- The lateral aspects of the thumbs are placed together
- The patient pushes the thumbs together with as much force as possible
* CR: perpendicular to include the bases of both thumbs
Modified Eaton Thumb Position
* This position also demonstrates the first CMC joint, but allows the patient to apply more axial force to better demonstrate any problems with the joint
* Patient position:
- Both hands are pronated on the cassette
- The tips of the thumbs are placed together
- Force is applied by the patient axially
* CR: perpendicular to include both first CMC joints
Abduction Stress Position
* Demonstrates ligament injury or subluxation of the first MCP joint
* Patient position:
- Both hands are placed in the lateral position on the cassette
- The tips of the index fingers are placed on the ends of the thumbs
- Abduction stress is applied
- Success depends on the amount of stress applied by the patient
* CR: perpendicular to the film
Adduction Stress Thumb
* Demonstrates ligament injury on lateral aspect of 1st MCP
* Hands in lateral position
* Index fingers placed around finger tips
* Stress applied
The Hand Overview
Hand Anatomy
Fractures and Dislocations
* All phalanges and metacarpals are subject to fx's and dislocations
* Distal phalanges and thumb are most common sites of injury
* Metacarpals are second most common with the fifth metacarpal as most frequent among metacarpals.
- mid-shaft fx of the fifth metacarpal is called "Boxer's fx"
Boxer's Fracture
Pathologic Changes in The Hand
* Boutonniere deformity: Rheumatoid arthritis
* Swan Neck deformity: Rheumatoid arthritis
* Other boney changes: dependent on type of arthritis or pathologic condition
* Special positions are needed in some cases: Norgaard, Brewerton, Bora
Flexion/Extension Injuries of the Phalanges
* Volar plate fx:avulsion fx of the base of middle phalanx due to hyperextension
* Mallet finger: forced flexion of an extended DIPjoint resulting in a rupture or avulsion of the extensor tendon
* Trigger finger: same mechanics as Mallet finger but occurring at PIP joint
Routine Hand Positions
* PA, oblique, fan lateral
* Lateral variant:
- Flexion lateral: for anterior/posterior fragment displacement
- Extension lateral: for soft tissue injury
Routine Hand Positions
* Standard at IU includes PA, oblique, (claw or with step sponge), and "fan" lateral
* Patient positioning should include all the bones and joints of the hand with as many joints projected open as possible.
* CR: perpendicular to the cassette, at the third MCP joint
Special Images of the Hand
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