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
If there has been movement of fracture pieces
No movement between bone fragments
When it seems like it is in-between displaced and nondisplaced
Spiral (If it is hard to tell if it a spiral or oblique, you can say, “long oblique”)
Wedge or “butterfly fragment”
Comminuted (many pieces)
Segmental (Multiple sections)
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)
Midshaft (or middle third)
Certain bones have unique locations besides the bone regions listed above
Proximal humerus, the humeral head
Greater and lesser tuberosity
DRUJ (Distal radioulnar joint)
DRUJ (Distal radioulnar joint)
Pertroch (Next to the intertrochanteric region)
Subtroch (below the lesser trochanter
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)
Lateral mal (distal third fibula fractures can still count as a “lateral mal”)
If there is joint involvement
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)
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”