From the Guidelines
To accurately describe a fractured bone on X-ray, a systematic approach is necessary, focusing on key characteristics such as the exact bone involved, fracture location, pattern, completeness, displacement, angulation, rotation, and shortening, as well as whether the fracture is open or closed and any associated injuries 13. When evaluating a fractured bone on X-ray, it is crucial to consider the specific views necessary for an accurate diagnosis. For instance, in suspected distal radius fractures, a 3-view examination of the wrist, including a posteroanterior (PA), a lateral, and a 45 semipronated oblique view, is typically recommended 1. Additionally, for phalangeal injuries, an internally rotated oblique projection, in addition to the standard externally rotated oblique, can increase diagnostic yield 1.
Key characteristics to report include:
- The exact bone involved and the specific location of the fracture (proximal, middle, or distal third)
- The fracture pattern, which can be described as transverse, oblique, spiral, comminuted, or segmental
- Whether the fracture is complete or incomplete
- Displacement, measured in millimeters, and angulation, specified by direction and degree
- Any rotation of the distal fragment and shortening of the bone
- Whether the fracture is open or closed
- Any associated soft tissue injuries, joint involvement, or vascular compromise
It is also important to note that radiographs are used to detect fracture fragments, especially in cases of suspected finger tendon injuries, where large fragments may require open reduction and internal fixation 1. Furthermore, in osseous “mallet” injuries, involvement of more than one-third of the articular surface usually requires operative fixation, and palmar displacement of the distal phalanx or an interfragmentary gap of >3 mm is also an indication for surgery 1. A comprehensive and systematic description of the fracture on X-ray is essential for guiding appropriate treatment and monitoring healing progress.
From the Research
Radiographic Description of a Fractured Bone on X-ray
The radiographic description of a fractured bone on X-ray is not explicitly defined in the provided studies. However, the studies discuss the challenges and limitations of assessing fracture healing and the importance of radiographic evaluation in orthopedic trauma surgery.
Radiographic Evaluation of Fracture Healing
- Radiographic criteria for defining fracture healing are not well established, and there is a lack of consensus on the most appropriate measures 2.
- Plain radiography remains the most common approach for healing assessment, but radiographic criteria do not correlate well with fracture strength and stiffness 2.
- Research has focused on developing standardized scoring systems and identifying specific radiologic signs to evaluate fracture union 3.
Fracture Patterns and Mapping
- Fracture patterns and maps are developed to provide visual tools for surgeons and bioengineers to plan and design fracture fixation plates and implants 4.
- Fracture maps can be created using 3D printed bone models or by tracing fracture lines from a fractured bone to a healthy bone template on a computer 4.
- Heat maps can provide visual representations of critical regions of fractures propagating through the bone and identify weaker zones in the bone structure 4.
Imaging Techniques for Fracture Evaluation
- Multi-body image registration can be used for reduction planning and guidance in orthopedic trauma surgery, providing accurate restoration of natural morphology 5.
- The "joint above and below" radiograph approach may not be necessary for all lower-extremity long bone fractures in children, and clinical suspicion and physical examination findings should guide selection of radiographs 6.