Format
Say the views you are seeing and the laterality, if you are unsure of the view just say 1 or 2-view of a left or right “blank”.
Look for open physes to say, “skeletally mature or immature individual”.
Starting out this a good practice, when you are a resident it may not be necessary at your program
Describe the fracture in the most straightforward way possible
Don’t get bogged down in the details (common mistake)
Say it with confidence (even if you are not).
If you’ve examined them, is it open or closed?
You can’t always tell if a fracture is open or closed from the x-rays, always use orthogonal views (xrays that are 90 degrees from each other such as an AP and lateral). On your exam, keep an eye out for small “poke holes” in skin. Bleeding from bone is often constant slow venous type bleeding.
“AP xray of left tib/fib, in a skeletally mature individual with an open comminuted midshaft tibia fracture and a segmental midshaft fibula fracture”
You technically can’t tell if this is open from the xray, but there looks like there are dressings over the fractures site. Keep an eye out for jagged and displaced edges.
Describe The Pattern
Displaced
If there has been movement of fracture pieces
Nondisplaced
No movement between bone fragments
Minimally displaced
When it seems like it is in-between displaced and nondisplaced
Transverse
Spiral (If it is hard to tell if it a spiral or oblique, you can say, “long oblique”)
Oblique
Wedge or “butterfly fragment”
Comminuted (many pieces)
Segmental (Multiple sections)
Angulation/translation
The proximal portion is always anatomically correct
Translation is rarely used as a descriptor in fracture conference (displaced is more often used)
Angulation is often only used for for long bone shaft fractures or distal radius fractures
Describe The Location
Bone Region followed by the bone name/bone location
Proximal (most proximal portion, humeral head for example)
Proximal third
Midshaft (or middle third)
Distal third
Distal
Certain bones have unique locations besides the bone regions listed above
Humerus
Proximal humerus, the humeral head
Greater and lesser tuberosity
Surgical neck
Humeral shaft
Supracondylar
Condyles
Radius
Radial head
Radial neck
Radial shaft
Distal radius
Radial Styloid
DRUJ (Distal radioulnar joint)
Ulna
Olecranon
Coronoid
Shaft
Styloid
DRUJ (Distal radioulnar joint)
Femur
Femoral head
Neck
Pertroch (Next to the intertrochanteric region)
Intertroch (intertrochanteric)
Subtroch (below the lesser trochanter
Shaft
Femoral condyles
Tibia
Tibial plateau, the tibia that contributes to the articular surface of the knee
Pilon fractures, the distal tibial metaphysis often involves the plafond (distal tibial articular surface)
Medial malleolus
Posterior malleolus
Fibula
Fibular head
Neck
Shaft
Lateral mal (distal third fibula fractures can still count as a “lateral mal”)
Unique Scenarios
If there is joint involvement
Dislocated
Describe the direction of the dislocation, the proximal fragment/bone in fractures and dislocations are always considered anatomically correct
Anterior,posterior, lateral, medial
If near the hand/wrist, volar and dorsal is the equivalent of anterior/posterior
“AP of left ankle in skeletally mature individual showing a tri-mal (fractures of all three malleoli of the ankle) ankle fracture dislocation”
The posterior malleolus is easier to see on the lateral view
If there are only two malleoli fractured, it is a “bi-mal” ankle fracture
If the lateral mal is fractured, but there is no medial mal fracture it is a bi-mal equivalent (deltoid ligament is not intact, and it “acts” like a true bi-mal
Subluxed (not quite dislocated, the joint is shifted out of position)
Periprosthetic fracture
use any time there is a prosthesis and fracture in the same bone that you are describing
“Lateral and AP of a skeletally mature individual showing an oblique distal periprosthetic femur fracture”
References:
Orthobullets.com
https://www.rch.org.au/fracture-education/evaluation/Evaluation_/