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Same time or is it just my screen? Um, I don't know. Usually I can, like, pop out when I'm doing mine to see the chat at the same time. Can you not? Oh, wait, just click chat. Can you see in the top right next to the time? Uh, yeah, I don't know if you just wanna, um, mm, sorry. So, yeah, you can't just, can you share, like, just your internet screen by any chance? All right. Let me see if I, I'm not, I don't know how to do it on teams. Ok. Let me try that again. Yeah. Like if you click share it comes up with like, just share. Oh, I don't know what you've done there. I have no idea. Oh, gosh. Um, for me it's like if I click share it's like screen or window comes up as an option and when you click window it tells you like which specific window you want to share. Ok. Oh, ok. That's worked. That's one of our friends fell on Tuesday and broke her elbow. She had to have surgery. Oh, no. Oh, that's horrible. No, I can't see the chat now. Don't worry. I'll be here and I can look at the chart so I can like stop you. Has a question. OK. Perfect. Cause I've tried to make it interactive. So if people want to shout out or write things in the chat, but I can't see the chat. So don't worry, I'll, I'll keep an eye. OK. All right. Go ahead. OK. Hi, I'm Katie. I'm one of the f one doctors. So my presentations on fractures and bone disease, we'll just get going on it. OK. Did, did that change? Yeah. Yeah. Yeah. OK. Um So we'll go quickly through X ray interpretation. We'll do lower limb fractures and injuries, some upper limb fractures and injuries, osteomalacia, osteomyelitis, osteoporosis, and then a quick little quiz at the end. So with X ray interpretation, as with any X ray, you want to go through the patient details first, you want their name, their date of birth, the hospital number, you want the details of the X ray. So the date the area that was imaged. Um How many views you've got? Is it an adequate X ray? And then if you've got any previous imaging for comparison, that's always helpful. And I go through the abcs approach for MSK X rays. So with a, you start with alignment and looking at the joint space. Um so you look first for any obvious fractures. Um When I say obvious, you'll know what you're looking for. Um at this point, you also wanna mention if there's subluxation. So that's partial dislocation of the joint and then dislocations and any narrowing of joint space. So this x-ray is a left anterior hip dislocation. So with B you are looking at the bones, you want to see if there are any changes in density. So that's any disruption of the trabeculae, which are the white lines that kind of run through the bones. So you can have lytic and sclerotic lesions. So, lytic lesions are the darker kind of moth eaten bits of bone. Um So that's the left X ray. You can also have sclerotic which is the brighter, more white, more dense bits of bone. And you can have combination of the two but and sclerotic lesions. So first c you wanna look at the cortices, so you trace the cortex of each bone. So this you'll pick up on more subtle fractures, any signs of infection, um any tumors and periosteal reactions which is kind of new growth around the periosteum. Um So this is an X ray of a normal bone and a quite severe Osteomyelitis on the right and s is soft tissue. So you're looking for any swelling. So you might see effusion or lipohemarthrosis, which is what's in these x rays. So that's usually from a tibial plateau fracture and you get like a distinct line in the fluid which is the blood and the lipid kind of separating out. So you can also look for any gas which shows more likely an open wound or an infection. You can also get foreign bodies and any discontinuity of the soft tissue which shows wound. Um So femoral fractures, you can have quite a few different types. We usually classify them as intracapsular or extracapsular. So, with intracapsular, um it's generally neck of femur fractures that are more common. Um So if you look on the side, that's sort of the blue area in the picture, you can also have extracapsular fractures which are intertrochanteric, um which will be kind of in the, the yellow bit and subtrochanteric, which is the pink bit. You can also have femoral shaft fractures which are further down. Um So does anyone know how with a femoral fracture how the leg would usually present? I'm looking at the chart just waiting. Ok. You can shout it out if you guys want or just type it in the chat. So do you mean not? Yes, short, short and externally rotated, short and out. Yes, exactly. So short and abducted externally rotated is generally how they'll present. So neck of femur fractures, they're probably the most common ones that you have to know about. Um generally they damage the joint capsule and that disrupts the blood supply from the femoral circumflex arteries. So this is why they're quite at high risk of avascular necrosis. So we use the Garden classification for hip fractures. So garden stage one, if you look in the picture, it's undisplaced. So it's more impacted. Garden two is undisplaced but it is a complete fracture. Garden three is a complete fracture but it's not completely displaced. And then Garden four is a complete fracture and it's completely displaced. So we treat them according to this classification. So there's a little r that you can do. So 12, you do a screw. So it's generally a dynamic hip screw, but you can also do cannulated hip screws and three and four on the floor. So it's a hip replacement. When would you do a hemi versus a total hip replacement? Does anyone know we've got people saying age mobility, hemi frail based on frailty and baseline hemi for poor mobility, frail patients age. Yeah, that's exactly it. So generally you treat it based on age baseline mobility and if they've got any comorbidities. So older patients that are more frail and don't do as much mobilizing will get a hemy versus younger patients or people that are still quite mobile, they'll get a total hip replacement. So with the other kinds of femoral fractures. So generally we treat intertrochanteric with hip screws, subtrochanteric, get an IM nail and femoral shaft fractures. You can either have an IM nail or really depending on the surgeon's preference. You can do an or if so that will be plates and screws. So these X rays show all the different types. The first one is a dynamic hip screw. The second one is an im nail and the third one is an orif. So, one of the other important things to learn about for your exams is ankle fractures. So the ankle has three components, the tibia, the fibula and the talus. So the tibia and the fibula are joined by a syndesmosis which is like a really fibrous connective tissue. Um And so with ankle fractures, you can fracture the medial, the lateral or the posterior baliolus. And so you can have a singular fracture, a bimalleolar or trimalleolar, which means either two of the components or all three of the components.