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Well, yeah, we'll start in about 10 minutes time. We'll wait for everyone to join. There's apparently about 5657 people who have registered. So it should be quite a few. If there's any issues, my phone is next to me. So you can whatsapp Me if there's like, I don't know if the screen cuts or anything. Yeah. Yeah, I, I'll be double checking, making sure it's running kind of thing. About 10 minutes before we end. We should, there's a feedback form, um, that's already built into the platform and we'll just send it and it'll up all the feedback from any everyone who's attended. Essentially. Amazing. I put my own in but I just, in case I can, I'll ignore my one because there's already one built in kind of thing. It's in the feedback part of the chat. Even you can send it if you want. But, um, it's just a standardized, I can't see how many people can. I see how many people there are. Well, yes, if you go on people you can see currently we have one viewer. Um, it's on the right and now we have two. So we do have a couple, but obviously it's still quite early on a lot of people living on. Um, but also, like, once we fill in the feedback form, they get certificates. So it's an incentive to it and they get the recording as well. So currently it's recording at the moment. So we, we are live kind of same. How did you find Kings uh as a medical school, by the way? Like, is it quite nice? I loved it. I actually really enjoyed it. I think it was great. I think there's very good balance between working hard and not working. Um very, like, well, very warm welcoming environment. I II would really recommend but I think they've changed it now. But yeah, II really, I really enjoyed it. What have they changed now? About, about games? Um I think they just become a bit more stricter and a bit more. I think the m sounds become a bit harder and a bit stricter. I'm not too sure, but that's the thing with like every medical school at this point, they've all been heading down more into the strict territory. Um Yeah. And it says a lot of my friends also go Kings and they say they're quite nice as well, kind of thing. Yeah. Yeah. And by the way for like radiology, like applications, have you been like getting like publications, like um posters and like all of that stuff? Yeah, I left it quite last minute but I only kind of got all my stuff sorted a few days ago. But, yeah. Yeah, getting there. Is it, like, quite easy to do an audit when you're an f, one kind of thing, or? Yeah. Yeah. It, it's very easy. Yeah, most trials have something and it's quite easy to join in. Yeah. Whoever's already joined. Hi, my name is. So, uh, we're having a chat about general life as medics. If anyone wants to join in, feel free. Um, can people, uh, on me and speed? See people should be able to, um, I don't know if anyone will respond though and chat or unmute. Mhm. And there's no response. So, I guess people are saying other things until it starts. Yeah. What are your best? What are your top tips for, like Aussies and radiology? Just in like general? I'd say top tips for Aussies would be, don't forget the basics, basics, like washing hands, introducing yourself, confirming the patient details, all that because they're easy marks that people tend to lose. Mark lose on by focusing on the more intellectual stuff. I'd say when you're revising, just revise with friends or like colleagues. So it's a lot easier to do than doing it by yourself. Um, and it most likely will get better than you think it has gone. When are your exams? Oh, mine are in February. So, not that far away. So, just been studying and revising basically. But the thing is they've made the original exam national now. So it's, it's a lot easier. It's just the OS that's quite difficult because it's all set by the universities so they can just throw anything they want in there, sort of, kind of thing. Um, yeah. How was your, like, Kings Oy? Was it, like, quite chill or was it very, like, difficult, kind of, gosh, it was two years ago now. Um, it was over two days. How many? Yeah, six stations on each day? It was ok. There was a lot of content we had to know and they could ask absolutely anything. Um So it was quite intense and then we had to be in isolation. But yeah, it was ok, I think because you guys had it during COVID, right? So, no, mine was last year. No, two years ago. Two years. So what do you mean by isolation kind of thing? Um So for example, if you're like, ay in the morning, you, you're not allowed to get your phone back until the afternoon people have gone into their ay, I see. I see. Yeah, we, we have the same thing but they call it sequestering for us, which is why I got a bit confused. Just different words for the same thing. Yeah, I see. Yeah. Our, I just have one day which is quite good. They will get done all at once. Um Yeah, someone says I'm on my phone and a phone and I don't have any option to mute or unmute? Ok. That's ok. I'll try to check the chart regularly anyways. I see. I see. So, yeah, we'll, we'll start in about a few minutes. Um We're just waiting for a few more people to join. Um, so about six at five will begin. Oh, by the way, do you wanna share your slide just to be ready? Is that, is that OK? Yeah. Um Yeah, so we perfect. perfect. So when people join, they know they're joining like the right thing basically. Yeah, that's the only thing. Yes. Mhm. Sorry. Ok. But um Yep. So we go on your other tips to fill the time. We've still got like a couple of minutes before we begin. Anything else? Mokes um I would say don't panic. Um focus on your at es because they will always come out. Um Honestly, as long as you have a good structure, that's all that matters most of the time. They're not really that focused on whether, you know, like what's like whether you get the diagnosis or the management plan, more of it is just whether or not you can, whether or not you're communicating well and being a nice person and I think the patient don't forget to ice. Ice is very important. Um What other or are there? Um. Mhm. Yeah, I would say best way that I revised was rising with friends and so we'd all make up scenarios and then revise together practice all our practice, all the clinical examinations together. Um, go to placement, you gotta be able to practice on the actual patients. Um, other than that, not too much. Really. Yeah. Thanks for the advice. I think we can probably start now, to be honest. I think six or five we've got enough people. Yeah. Ok. And can see the powerpoint, just put it in the chat. Um, hopefully I can see it so hopefully everyone else can't see the point. Please just let me know people can see it. Lovely. Ok. Hi everyone. My name's Solo. Um And today I'm gonna be teaching you about upper and lower limb radiology. So just a bit of background about myself. I'm currently a foundation year to doctor. Um I'm currently doing trauma in orthopedics. I graduated two years ago from Kings. I did my foundation year at Chelsea and Westminster and I'm doing my foundation year too at ing. So I'm staying around the Northwest London region interest wise. Um Not 100% sure what I want to do, but radiology is quite high up there as is from orthopedics. Hence the subject of my talk. Also, I run enjoy my respiratory rotation in F one. So keeping my options quite open still, but we'll see what happens. And if anyone at any point has any questions about anything to do with applying or wants any advice, I'm happy to leave my email and you can contact me at any point if you want to. Um But moving on to this talk. So today we're just gonna go over some, we're gonna go over the structure of how to uh inter x-rays, mainly looking at musculoskeletal. So, lower and upper limb x-rays, we're gonna discuss some clinical cases, review some X rays and then go over upper and lower limb pathology. Um Hope that makes sense. And if I'm not answering any questions in the chart and you have any questions, please just on me and ask them that's completely fine. Um So just firstly how to actually go through an X ray. So the first thing don't forget is always look at the patient details, check their name, the date of birth at the hospital and the hospital on them. That's the key thing. Um Yeah, and it's important that we're looking, we we make sure we know if we're looking at right or left next, there's bone alignment that we need to look at. We need to look at the cortex, soft tissue, joint spacing bone texture, bone texture. The location of the X ray is, is it your hip, knee foot ankle? Are there any involvement of any joints? So, bone alignment, when I talk about bone alignment, I mean that if you look, for example, here, you can see that this bone is completely misaligned. So therefore, it can indicate that there's clearly a fracture or a joint dislocation. So and then, so, so if you can see that here and here that there's clearly some sort of joint dislocation. So that's what I mean by bone alignment and then moving on to cortex. So when I say cortex, I mean, checking the outline of all the bones visible on the X ray. So you don't wanna just stop. When you see one abnormality, you wanna go through all the bones to make sure to see if you can see any sort of abnormality. So here we can see an abnormality. There's a break, there's plenty aba disruption in the cortical outline indicating that there is a fracture. I hope everyone can see this. And then if we look at the soft tissue, so sometimes looking at the soft tissue can provide us with some helpful in uh information. Sometimes we'll see some swelling but it might not be, but it might not, but a fracture might not be that obvious. So if you look at this image here, we can clearly see that there's quite a bit of swelling around the bone and that's the soft tissue swelling we can see, but there's a very, very small fracture here, but it's really not that visible. But because we can see some swelling, we clearly know that there's something going on. And therefore, if we couldn't see the fracture, then we would potentially consider getting another angle or um getting act scan instead. Then. So here you can see that this is fat here and then this is larger. And then the next thing to look at is joint spacing. So, loss of joint spacing, that's when it's narrowed due to cartilage loss or it can be widened due to a dislocation or dissociation. So, when there's loss of joint space, that's one of the key indicators of osteoarthritis, very common in exams always comes up. Um, and it's quite clear here that there is some loss of joint space in this one, none of the other thing. And then we have bone texture. So sometimes you've got these, sometimes you get um white lines, trabecula in the bone and these can be normal and then sometimes they can be associated with abnormalities or disease. So, unfortunately, I couldn't find an abnormal one, but it's important just to look at all the um white lines to make sure that they are all normal and it might seem difficult at first. But the more x-rays you look at, the more you're trying to figure out what's normal and what's abnormal. And then focusing on trauma and orthopedics, we wanna look at the type of fracture. So you've got closed fractures where open fractures where there's a break to the skin. You've got transverse fractures, you've got spiral fractures, you've got commun fractures which are uh which is where there's more than one piece of the bone. You've got impacted fractures which are like this, then you've got oblique fractures which are this way and then green stick fractures, which tend to happen more in Children. And then always, don't forget to men, don't forget to examine the joint above and the joint below. Ok. And then the next thing to look at is when, when we're looking at um li x-rays is that we should always get two views, two views always better than one. And we tend to get an anterior posterior view, which is this one. So you're looking at it kind of from the front, front to back. And then we also tend to get a lateral view, lateral view. For example, in this one, you can't really see a break if you're looking just at the AP view. However, when you get a lateral view, lateral view, you can clearly see that there's a break in the um in um the fibula. Yeah. And then you should always compare it with the other side. So if you've got a hi a x-ray of the pelvis, for example, you should compare the right hip with the left hip or if you've got an x-ray of I did something else. You should always compare it with the other side. If you have both of them, she'll always look at current images with previous images. If there's a previous X ray of the same thing. For example, if you've got a knee X ray showed osteo osteoarthritis from two years ago and a new one, you wanna compare the previous to the old one to see if there's been a change. And then the next thing is to look for the unexpected, sometimes you might not be looking for something but might accidentally come across a me a metastasis or uh or a lobe or something that you're not expecting. So, moving on from just the basics of how to inter M SK fractures. Let's move on to case one. So, Missus Rosa, an 85 year old female brought in by ambulance following a fall from standing an unwitnessed fall. There's no preceding symptoms, past medical history of hypertension and vestibular schwannoma. Regular meds, amLODIPine naproxen and lo lansoprazole. She lives on the second floor flat, no patch, hair mobilizers with a stick on examination. The right leg is shortened and externally rotated. There's no open wounds or skin breaks. There's no bruising or erythema around the right hip and the sensation is intact. What is everyone thinking? If you can answer in the chat? What you're thinking? It could be if you can. Yeah. Any ideas what's going on? She had the form, her right leg is shortened and externally rotated. Oh OK. This is her xray. Um Does anyone want to make any comments about her X ray before we talk about it? Do you want a message in the chat or unmute or can anyone see any abnormalities of the X ray? Yeah. OK. So everyone's thinking enough. Are you thinking right or left sided? And can you see this on the X ray. OK. So if you look at the slides, you can see if you look at the X ray, you can see that there is clearly compare the right and left together. You can see that there's a bit of disruption in the right side of the X ray. So on the right hip, so this is completely fine here, you can clearly see that there's a bit of a break. So this hip would be a fracture of the right hip. And we'd say it's a right intertrochanteric fracture. Ok. So this is a neck of femur fracture. So, these are very common, the current elderly osteoporotic patients, most of them you can see on an X ray. Um and if they are quite difficult, we can get act or MRI. But it's important to know that the most common clinical signs are if it's sh if the leg is shortened or externally rotated. So just a bit of detail about um the hip. So one of the key ways that um you'll get us in an oscopy is about shen's line. So this is formed by the medial edge of the femoral neck and the inferior edge of the superior pubic ray line. So usually we look at this line. If that slide is, is disrupted, it will indicate a fracture. But sometimes this line can be normal and there's still a fracture. But it's a good way to easily look if something is normal or abnormal by looking at shen's line. And then if you look from this and also, so this is the later view. So you've got the shaft, the greater and lesser the neck of the femur and the head. So an intracapsular fracture are those that include the femoral head on the capsule and then an extra capsular fracture. There is that uh between the greater and lesser and below the and below including the intertrochanteric line and below this one. So here, for example, is an, so here you can see an X ray of a hip. So um so if you look at the one that's not got any sort of annotation, we can clearly, if we trace Trenton's lyme, there is a cleared disruption in the um in the lung and therefore, that reflects in that there is clearly something going wrong. Then we look at more detail. And if we look at more detail, we can see that there's a bit of overlap here with the bone and that this is clearly shortened and that's indicating that there is a fracture and now this fracture is currently a fracture here and that's within the femoral neck. And therefore, this is telling us that it is an intracapsular fracture of the femur of the hip right here. So there's line is lost and there's also a big bone overlap here indicating that there is a fracture. And then again here. So if you look here, we can clearly see So this is the same x-ray but just a different view clearly see that there is a break here which we couldn't see in the previous X ray and then there's also this fracture here. So that's why it's very important to get two separate views. Ok. I hope that makes sense so far. So with intracapsular fractures, we look at something called the garden classification. So this is mainly a system used to assess how severe the edema fractures are. So the grade three, grade four are the ones that are most more severe and have greater issues. And that's because the that's because the there's a lot of blood supply around surrounding the hip joint. And therefore, if they're completely displaced, there's a chance that it can lead to avascular necrosis. So they have to be looked at in a lot more detail. As you can see, grade five, grade four has total has is total displacement. Whereas grade one and grade two, they're not really displaced. So these may or may not need fixing. These two will 100% need fixing. Yeah. So you can just see here another example of a grade for intracapsular fracture. Again, Shen's line is completely um is completely disrupted and you can clearly see the displacement because this is supposed to be underneath the femoral head and then we've got extracapsular fractures. So these are those that occur not within the neck, not within the capsule itself, but just outside So between the greater and lesser tantus and below. So here we can clearly see again that there is a fracture here. So and again, here another example. So you've got your greater trach and your lesser trachaner and then you've got your fracture below it here. So that's an extracapsular fracture. OK. That makes sense. So you have any questions about hip x-rays? OK? That's fine. So, moving on to case number two. So this is a 32 year old male, an Uber driver. So these are all cases that I've kind of seen, I've changed them a bit, but these are all real cases that have come through that come through eating. So a 32 year old male, an Uber driver was cycling and was hit by a car at a low speed. Otherwise he's fit and well, no significant past medical history, not on any regular medications on examination. He's got significant pain in the knee. Can't wait there. He's got reduced range of movement and significant swelling around the knee. This is his, this is his X ray. Does anyone have any comments or ideas of what could be going on even if it's wrong? Take a gas? Ok. Ok. So one c so if we, if we draw a line around the cortical edge, the beer completely fine. And then what about here? There's clearly a disruption here. If everyone can see that everywhere else is completely fine. So there's a disruption here and that's known as a tibial plateau fracture. Same if we cut this. But if we cut this horizontally, I'll get um an image like this. So tibial tuberosity, the medial and lateral condyle and then the intercondylar t cubicles. So a tibial platy fracture, these osk type questions will be that I'll be a typical patient who's been hit by a bumper of the car because they tend to hit at the, at the end of the tibial plateau. Um So most tend to result from the impact from um these bumpers. Um The most common mechanism of injury involves either falling from a significant height or getting hit by a bumper. Um It's quite common in younger patients, soft tissue injuries can occur and the fracture to the lateral plateau are more common than fractures to the medial plateau if that makes sense. Ok. So can everyone see, can everyone make up this fracture here? Yes, ma'am. So we use something called the shaker classification for this. So it's got six types. So the first one is just a classic, just one fracture from um just one fracture. The second almost has a bit coming off. So it becomes slightly more commu commuted. And then if you go all the way down to the sixth one where there's multiple fractures and um multiple fractures a lot more severe, very, very difficult for us to fix. So this is a tibial plateau fracture, very common in the past five days I've seen about three. So yeah, interesting to know. And then if you look here in more detail, it's very difficult to make up the fracture on this image. But if anyone wants to, if anyone can make it out, if you just go along the femur is fine, whereas there is clearly some disruption here which indicates that there is something going on. But a lot of time in orthopedics when we're not sure what's going on, we get a CT scan. So this CT scan is a different patient. But um as you can see, you can see the fracture a bit more clearly on the CT scan, which is here and then here whilst we can't really, whilst if it's, if we're finding it difficult, if you look here, we can clearly see that there's quite a lot of swelling of the knee above and below. And therefore this indicates that there is clearly something going wrong. So even if we're not sure we know that there's some swelling, we can see that if it's not the tibial plateau, there is something that needs to be investigated. However, here, you can actually see a fracture here. It's very small one right here, if that makes sense. OK. Does anyone have any questions? Yeah, catch up contact will, will be updated. Yeah. OK. But yeah, so that's tibial plateau fractures. They're also very common after, after north, they're probably the second most, most common things that come up in acies and exams from lower limbs. Third, most common is what we're moving on to next case. Number three. So this is a 56 year old female who presents to urgent care after falling down. The last four steps, twisted the left ankle and L as she landed got significant bruising around her ankle and is unable to wait there past medical history, discitis and underactive thyroid. So on examination, her left foot, foot is clinically swollen, bruised, tender to touch, but neurovascularly she's intact. Otherwise she's feeling well. Can you wanna look at this X ray and tell me what's going on whether or not you can see a fracture or from the history. What do you think is going on any guesses? Yeah, ankle fracture. Well, don't anyone know what type of ankle fracture or how we, how we look into ankle fractures? Ok. So yeah, clearly here we can see that there's an ankle fracture well done. And again, the way we look at it is if we, if we draw a line, we can see that there's clearly a disruption and therefore this indicates that there is a fracture and there is also some soft tissue swelling here if we have a look. Ok. So just a bit of anatomy before we go into it. So the synovial joint, so the distal tibia and the fibia articulate with each other, the distal tibiofibular joint and we call this the syndesmosis. So right here an ankle is made up of the tibia, the fibia and the taylors. And then there's three ligaments, the medial collateral ligament, the lateral collateral ligament and the interosseous ligament. So when we're discussing a fracture, it's very important to know where the fracture is. So this is our syndesmosis here. So there's three ways to classify this. We use something called the Weber classification. So type A is when the fracture is below the syndesmosis. Type B is at the level of the syndesmosis and type C is at the level of the syn above the syndesmosis. And these tend to be the most unstable and require surgical fixation. So if everyone can in the chart put down, which uh what they think this is whether A B or C. OK. So someone at C, anyone else wanna give any input? So A is below the level of the syndesmosis B is at the level of the syndesmosis and C is above the syndesmosis. So what does does it, is this above below or at the level? So this one's a bit of a tricky one actually. So this is technically the level of the syndesmosis here. So it's theoretically this is actually a Weber a fracture. However, because it is quite close to the syndesmosis, you can't, it can potentially be a Weber B fracture. So it's something like this. It's very dependent on the clinical picture of the person whether or not you would manage this conservatively or whether you would operate this one. What do people think A B or C? So this one here is at the level of the syndesmosis. And therefore, we would say that this is definitely a we bee fracture. And what's interesting is that you can clearly see the fracture here and that's actually become a bit oblique because it's gone this way. So that's an oblique oblique fracture and you can kind of make the x the fracture on this view as well but not very clearly. But again, this highlights the reason why we need to always get two views of fractures. So this hair would be a weather bee fracture. Ok. What about this one? Whether A B or C, yeah, A B or C, anyone know? Yeah, perfect. So this is clear, this is definitely a weber see fracture because it's above the level of the syndesmosis. And again, you can see here that it's an oblique fracture and this would definitely need to be operated on for it to be fixed. As I said before, it's difficult to make up the fracture on the lateral view, which is why it's very important that we get two views of the x rays. Ok. Moving on to case number four. So a 30 year old male falls off a bicycle whilst cycling in wet conditions, walks into ed complaining of right sided wrist pain, no other injuries. Examination reveals an obvious deformity of his right breast. Otherwise he's, well, he's right handed and he works as a lawyer. Bloods and X ray are fine, an X ray bloods and observations are fine. An X ray is ordered. Does anyone want to comment on this x-ray? Even if you're wrong, take a guess. What can you see? Ok. What part of the, what part of the body is the X ray? OK. So this is an X ray of a right, right wrist, right forearm and wrist. Um So can anyone see any sort of fractures if we look, I appreciate that? It does tell sometimes take some time. Um So to me, all the wrist bones look, OK, the ulna looks OK. But here we can see that there is um there is a small break here. Can everyone see that? So there's a small fracture here. Yeah. And then on this, can you see here that there is a bit of a break here? So this is the same, same person and we can also see that there is quite a lot of swelling around the wrist. OK. So this is a distal radius fracture. There are two types of distal radius fractures, Collies and Smiths. I feel like these are quite common passed questions. But does anyone know the difference between, between a collies and a Smith's fracture or what is this one? The Q or a Smith's any idea? So I used to find this quite confusing as well. So uh this is a Smith's fracture. So it's a distal radius fracture with volar angulation. So the management would be the first thing would be to check for. Um the first thing would be to check to make sure all the pulses are present and there's no loss of any nerves. Um And then you will either have to manipulate the arm and Ed and put a back slap on it or you'd have to take the patient to theater. So, a Smith's fracture is a distal radius fracture, but results in volar angulation. So volar angulation means that the bit that's displaced. So the bit that's come off, that is towards the palm if that. So the bit that's come off if it goes towards the palm, that's volar angulation, that's the way I've remembered it. That's why it's very important in this case to get uh ap under lateral view. So this is also a disor rupture quite a bit bit more difficult to see. For example, in this view, it's very difficult to see, but here would be our break and here as well. So this is our break. But in this scenario, the broken bit is going away from the palm. And therefore, if something is going away from the palm, it means it's dorsally angulated. And therefore, that means that it's a Collie's fracture and a similar thing here where the break is here and then this is your bit coming off and that's going away from the palm and therefore that's a dorsal angulation, which means that it is a Collies fracture. Both Smiths and Collies most common with a fall on an outstretched hand. So here this is quite an extreme distal radius fracture. But the broken bit here is it, it's going towards the palm. If it's going towards the palm, it is a volar angulation. And therefore that means it is a Smith's fracture. So, yeah, distal radius fractures very, very common, usually due to a fall on an outstretched hand. The most common types are Collies and Smiths. So Collies is dorsal angulation which is away from the palm and bowlers is Smith's angulation which is towards the palm the bit that's broken off. Ok. Well done if you have any questions, honestly, just let me know. Um we have two more cases, I think. So case number 5, 10 year old child has a bad fall, complains of severe pain around her entire wrist and elbow, otherwise she's fit and well, this is her x-ray and I've already kind of told you what's going on. So anyone know what this is? So these are two very common fractures that we're about to talk about. So I'm also very rightly pronouncing. So please don't, but this is this is one fracture. Um And as you can see here, there is a clear fracture of the ulnar here and here and here and then there's also a dislocation at the radial head of here. So this, it's a pronounced, I wanna say it's pronounced montague. This is a montague fracture uh with uh basically a fracture of the ulnar and then a displacement of the radial head, anterior, anterior, anterior body towards the elbow. And again, these fractures quite obvious, clearly oblique here and here you can see. So this here, this is indicating that there is a cast already around the x-ray already around the arm. So this is without the cast. And then we've put the patient in a cast here. So that's this fracture. And then we have this one. So these are all both, again, distal radius fractures, again, very common exam questions. So a galaxy fracture is one that is um a fracture of the radius. So the distal third of the radius here and then it's got a dislocation of the radioulnar joint. So up here. So as you can see, this is clearly dislocated, it should be a bit higher and a bit more um angulated. So that's called a galaxy fracture. So yeah. Uh so this one is an fracture of the ulnar with a displacement of the radial head at the uh anterior anteriorly. And then this one is a fracture of the radius with a dislocation of the radial ulnar joint near the rest. These are very, very common exam questions as well. OK. And then we've got case number six. So this is a five month year old, falling off her bunk bed. She's got pain and swelling in the left elbow region, uh and some tingling in the left hand. So, on examination, it's swollen and deformed. The elbow is swollen and deformed. There is reduced sensation in the medial 3.5 digits and she can't make a pin secret. Currently, refill time is two seconds and she's warm and well perfused any idea what's going on. So this is so this is a fracture. So here we can clearly see some swelling here. We can clearly see that this has been completely dislocated and there is a break here as well. So this is a supracondylar fracture. So these are common in, these are the most common in Children. They most commonly occur when falling over on an outstretched hand. It's very important to look at the neurovascular status of these um of these Children as um all the nerves run through here. Um So we do a full at e make sure there's no opening wounds, check pulses and nerves. We have to get someone urgent there to do above elbow back slab and then sometimes we can operate if we have to. But again, so it can be non displaced like this, it can be displaced, very displaced or completely displaced. So it's called the Gotland classification. So I think these are probably the most common x-rays that you'll get asked about in medical school. The uh hip, knee, ankle, the radius and the elbow. They're probably the most common fractures and maybe shoulder as well as something that I haven't included, but it's probably worth looking into. Um, so there are all the cases, but just, um, at the end, what do these x rays show? Can anyone see what, what, what these x rays show? Yeah. So these x rays here, did they show a fracture or did, did they show something else? So, you've got a hand in a young adult, 100 and 45 year old and 100 and 80 year old. Can you see a difference in them? Can you think what they could be, what we could be indicating any others? Ok. So if we look in detail at the hand of the young adult and the hand of the 80 year old, do we see any differences? Yeah, perfect joint caps are narrowing and that's indica indicative of what something like osteoarthritis. Yeah. So that's also a very, very common question that we can be asked in an exam. So from looking at the hand in the young adult to the hand in an 80 year old can clearly see. Yeah, there is some joint space narrowing. So there are four key features of osteoarthritis in a x-ray. So we are. So there's four. So the first one is loss of joint space. So joint space narrowing. Second is four osteophyte formation. The second one, the third one is subchondral sclerosis and the fourth one is subchondral cyst formation So I like to say loss, loss of joint space, osteophyte formation, subchondral sclerosis and subchondral cysts. Does that make sense? Ok. So here we can clearly see that the cartilage has lost from the b the bone. And therefore, there's a lot of joint space narrowing, which clearly indicates that there, there is o osteoarthritis and then if we look in a bit more detail. So here we have a normal joint and here we've got a joint with subchondral sclerosis. So subchondral basically just means under the cartilage and sclerosis is the name given when the bone appears a bit thicker or whiter on an X ray as as you can see here. So when cartilage is lost from the joint, then there's a new process of trying to kind of rebuild the bone or protect the bone that's remaining and therefore, it becomes a bit more dense. And that's how we get this sort of whitening here as the joint space decreases. And then the second one, the third one is osteophyte formation. So again, as the bone surfaces wear away, the ligaments become a bit too long. So there's the ligaments between the bones become a bit too long. Therefore, the bones kind of move in a bit of an abnormal way and then they kind of get large, they kind of lay extra bone around the joint, therefore making it more stable. And this extra bone is known as the osteophytes. So very very small movements, but it leads to extra bone formation and that's lead to osteophytes. And that's what usually causes the bones to get the bones to become stiffer when patients come in with arthritis. And then the last one here is cyst formation. So this is where um the bo the bone has been reabsorbed or dissolved away. They occur in arthritic joints and they tend to respond when there's an increased pressure in the arthritic joint. So therefore, there's an increase in pressure, an increase in blood flow and increase in fluid and that sometimes causes a cyst. So other than fractures, osteoarthritis is probably the most common x-rays that you'll have to interact with as a med student. Um So here, not really gonna go into much detail, but can you see that there is clearly some loss of joint space and some sub chondro sclerosis both here and here indicating that this poor Margaret Jones has um been having osteoarthritis for a good two years now. Yeah. Ok. So I hope that makes sense. Um That's everything that I was going to present. If anyone has any questions, then please let me know. I'm happy to answer them. Happy to answer any questions you might, you may have. And if people could just quickly fill in the feedback form, it would be really helpful for us. Um I've sent in the chart you should be able to see it. So please make sure you fill that in and then after that, we can send everyone the recording. Yeah, but if anyone has any questions, I'm happy to put my email in the chart. If anyone wants to email me about anything related to imaging x rays or any sort of um arthriti, any sort of questions about the future. Very happy for and you want to email. Yep. And if people could please fill in the feedback form, it helps us to run these events and you know, keep them going for the future. So um please make sure you fill it in and you'll also get a certificate uh when you fill it in saying that you've come to these sessions. Oh, I put the wrong. I'm sorry guys. Yeah, I'm happy to send the slides. So if you guys fill in the feedback form, we can also upload the slides to the middle page, right? Thanks for running the talk. Um is very good. Uh Yeah, thanks everyone. Yeah, we'll just wait until like everyone does it and then it'll be uploaded soon. So then why everything will be up, waiting a few more people to do it. I think there's about 20 people. Um Let's see. Great. Well, yeah, thanks for running the lecture. As soon as we end the call, the live recording should already be automatically uploaded and then I'll just upload your slides. Is that, is that all good? Yeah. All right, perfect. I guess that's it for if you want. Yeah. You've given your email for the slides, they'll be on the middle page, on the event page, so you'll be able to access them anyway. Um Yeah, thanks so much for your time.