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NATIONAL SURGICAL TEACHING SOCIETY FY Survival Guide Radiology week - Orthopaedics 28th September 2023Mr Sanjeev Sharma BSc(Hons) MBChB(Hons) MSc(Dist) MRCS(Ed) Plastic Surgery CT1 • University of Birmingham and King’s College London graduate • Foundation Years in North Central Thames • Core Surgical Training in East Midlands • T&O & Plastic Surgery Theme • NSTS Regional Lead 2021-2022 • NSTS Education Officer 2023-2024KEY LEARNING OBJECTIVES ▯ Learn about the role radiology plays in the orthopaedic MDT ▯ Understand the indicator radiographs and pathology associated with common orthopaedic conditions ▯ Become familiar with radiographic techniques and how to interpret CT scans and MRI images ▯ Develop an understanding of appropriate management of radiologic findings in trauma and orthopaedic cases ▯ Identify the potential risks and complications of radiologic examinations in an orthopaedic setting XR Others CT Investigations US MRIHow to Interpret X-Rays • Confirm patient details (name, DOB, hospital number) • Confirm film details • Date and time • Area of body • Adequacy of views (need 2 views, usually AP and lateral) • Bone • Shape, density, fracture • Soft tissue • Swelling, foreign body, effusion, laceration • Joint • Joint space, shape, erosionsTypes of FracturesDescribing Fractures • Where is the fracture? • Which bone • Proximal, middle or distal • Intra- or extra-articular • What type of fracture? • Fracture pattern • Open or closed • Is there displacement? • Described in terms of distal fragment to the bodyCase 1 90-year-old ♀ Fall at home mobilising to bathroom o/e - right leg shortened and externally rotatedPoll – what is the diagnosis based on the clinical information?NOF Classification • Intra-capsular (proximal to intertrochanteric line) • Subcapital • Transcervical • Basicervical • Extra-capsular • Intertrochanteric • SubtrochantericGarden ClassificationPoll – what type of fracture is this?Shenton’s LinesCase 2 • 18-year-old ♂ • FOOSH off electric scooter • Pain in right wristPoll – what is the eponymous name for this fracture?Types of Distal Radius Fractures • Colles’ – dorsally displaced, extra-articular • Smiths’ – volarly displaced, extra-articular • Barton’s – intra-articular • Chauffer’s – radial styloid fracture • Die-punch – depressed fracture of lunate fossa of articular surface of distal radiusPoll – what is the eponymous name for this fracture?Poll – what is the eponymous name for this fracture?Poll – given the mechanism of injury what other fracture would you be considering?Case 3 • 13-year-old ♀ gymnast • Sudden onset pain in left shoulder • o/e – extreme pain, refusing to allow examinationPoll – what is the diagnosis?Poll – she has 4 dislocations, what further investigation would consider?Case 4 • 17-year-old ♂ • Tackled from the side whilst playing football • Pain in left ankle • Unable to weight bearWeber Ankle Fracture ClassificationPoll – what is the Weber classification?Case 5 • 50-year-old ♀ • Pain in lower back for 3 days • Acute worsening today • Pain down back of both legs • Episode of urinary incontinencePoll - What vertebral level is the compression ?How to Manage • Surgical emergency • Requires urgent surgical decompression • NBM • Admission • Regular neurological observations (ASIA chart) • IV fluids • Bloods inc. G&S • Mark and consent patient • Inform seniorKEY LEARNING OBJECTIVES ▯ Learn about the role radiology plays in the orthopaedic MDT ▯ Understand the indicator radiographs and pathology associated with common orthopaedic conditions ▯ Become familiar with radiographic techniques and how to interpret CT scans and MRI images ▯ Develop an understanding of appropriate management of radiologic findings in trauma and orthopaedic cases ▯ Identify the potential risks and complications of radiologic examinations in an orthopaedic setting THANK YOU! ● Stay tuned for “How to make the most of your F1 surgical job” – Tuesday 3rd October ● Follow the link to NSTS website for further learning resources