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I'm 1/5 year medical student at the University of Aberdeen. And I'm just gonna teach you a lot of bit about X rays and how to interpret them. We'll be starting off with a chest X ray because that's probably the hardest to interpret. Um, but we'll also go into ordinary kind of fracture X rays as well. I don't plan on this session being too long, which will give you time to ask questions at the end. And also, I'm hoping it's gonna be quite interactive. So if I ask a question, pop your answer in the chat and we can go from there, if that's okay, So I'm going to ask you to picture the scene. Urine placement. You've been working hard, taking bloods and putting in cannulas. And your consultant walks into the ward. He hands you this chest X ray. Ask you what it shows. You freeze cold shiver runs down your spine, your palms become clammy and your forehead beads of sweat. Can you remember to what to look for? Will you answer his question correctly, or will you doom yourself to the You really need to read up on these before you come in conversation. So just as you're about to stutter out as subpar response, you remember I know what I'm doing. I had a lecture on this one evening. So how are we going to approach this? Well, we'll start off with the easiest thing. And surprisingly, unlike any exam, you do get brownie points, forgetting the name right at the start. So we'll begin with a nice professional introduction. This is an X ray of the name of the patient. You give the date of birth there kind number, although that's a Scottish thing. So if you are in England, it's just your n h s number and their sex, whether they're male or female. Next, you're going to move on to the X ray details when the time was when the X ray was taken and whereabouts. It's no look good looking at an X ray taken about three years ago when the problems right now. But quite often this can be a mistake we make. I'm gonna gloss over the image quality and right acronym a little bit. I don't think it's that applicable for medical students. Apart from the rotation rotation, you just want to make sure that everything is facing forward. If there's any odd rotation, you might see a pathology that isn't there. Inspiration. All Chest eight very should be taken on full inspiration, and the projection should be a P or P A. If it's not labeled, assume it's PA. If we're doing a chest X ray, we don't really like a P. And that's because the heart can create a massive shadow, which makes it look like cardiomegaly, even if it's not. Then we'll move on to our A to eat. And that's the main amount of chest X ray teaching I'm going to do today, so we'll start off with a So this is for Airway. So, um, the slides are presenting a little bit differently to how I'd arranged it, and I think that's just because it's on a different app. So I do apologize. But there's three main things. We're looking for an airway, and that's your trachea, your carina and bronchi and you're hilar lymph nodes. So first of all, we're going to look at the trickier position. Can I get people to put in the chat what we look for on a person rather than just the X Ray to assess trickier position. Just pop it in the chat. How would we identify trachea? Position anybody. Okay, so the main way we're gonna identify tracheal position. We've got a message. So I'm shadowing. Yes, on an x ray, you can see your trachea position in the shadowing. However, yeah, you're going to look at the neck and the sternal notch. So the sternal notch Can anybody tell me where the sternal notch is and what bony prominences we're looking for For the sternal notch? Yeah, in between the clavicles. So we know that when we're looking at a person straight on not looking at an X ray, we're looking to make sure the trachea is right in between the clavicles. So we're going to do the same on an X ray. So you'll identify where the two clavicles are and you'll see in the middle and make sure that the trachea runs straight with that. Does anybody know what can cause? Trachea, Deviation Say the trachea is pushed away from the side of the pathology. What could be causing that? So attention pneumothorax would cause it to Yeah, push away. Um, yeah. So sorry. I can see that somebody's put tension pneumothorax. I'm not just pneumothorax. Excellent. And what would cause it to pull towards the side of the pathology? Yeah, low bar collapse or a non tension pneumothorax. And that's why it's really important to differentiate between your types of pneumothorax, but yeah, that that's really good. You seem to have got that. Oh, possibly Possibly it would have to be pretty bad. Um, for that too, cause tracheal deviation. But possibly, uh, So we'll move on to the Carina and bronchi. So does anybody know which side of the Carina you're most likely to get a foreign object stuck in which I Yeah, which bronco? Bronchial side, one side of the carina in the right side. And why is that? Well, see it when we look at the X rays. Yes, the right side is more vertical. So when you're coming down from the trachea, the trachea splits at the Carina into the two bronches. The right main bronchus leads almost directly on from the trachea, whereas the left main bronchus does go at more of an angle. And so if anybody inhales a foreign object, gravity will naturally pull that foreign object more into the right main bronchus. Another thing we can check for when we're looking at the Carina and bronchi is N g tube placement. So the N G tube should perfectly by set the Carina and that tells you that it's in the correct place. If it doesn't, you want to reconsider where you put your n G tube. So once we've checked the trade deal position and the Carina and the bronchi, we're going to have a look at the hilar lymph nodes now the hilar lymph node to run either side of your trachea. And they can be enlarged, in which case you'll see them quite well on X ray, and that will look like a fuzzy whitening. If they're only enlarged on one side, then that tends to be due to a sort of malignancy, often on the side of the enlargement. However, if it's enlarged on both sides, that's often related to sarcoidosis. There are other causes, but then the main causes to remember so we'll have a quick look on our chest X ray. So here we've got it nice and drawn out. First of all, you can see where the two clavicles end the trachea runs straight down the middle, and that's shown in red, so there's no trick you'll deviation in this X ray in the blue. You can see where the Carina and Bronchi are. You can see kind of where the right main bronchus is slightly straighter. However, I will admit it's not the best drawing. I apologize, and you can see in green where the hilar lymph nodes are. So if there was highly lymphadenopathy, there would be more whitening in these areas. Okay, so we'll move on. We've done a So now it's on to be breathing. We split breathing into two parts the lungs and the pleura. Now, to interpret a chest X ra, it's really difficult. So when we're looking at the lungs, we like to split the lungs into thirds to make it a little bit easier to compare. This should be done by looking at the height of the lung. It is not in relation to the lung lobes. This is because the left lung only has two lobes. But to be able to compare it to the right lung, we still need it in three sections. So if we section the lungs into three zones, we'll compare each zone with the other side. So some asymmetry is quite normal because, you know, we have things like the heart, which lies more on the left, and we have other anatomical structures that make them look a little asymmetrical. But most of the time it shouldn't look too different. If you see an obvious capacity on one side that is not on the other side, then you know to be a little bit worried Now. Sometimes things like edema can cause a symmetrical change in the lung fields, and that can make it slightly more difficult to recognize. So it's important to keep that in mind. Although again as a medical student it can be quite hard to identify. And so if you were to miss this, it's not the end of the world. You also want to be looking for an increased airspace in any given area of a lung field, as that can indicate things like consolidation, which is where all your secretions of your lung kind of build up. It's not particularly pleasant malignancy or pneumothorax, and then this is in block capitals because it's really important you can get these things called Pancoast Tumor's which are tumor's, that at the A pieces of your lungs now they're really important to spot. They can be very, very dangerous for the fact that they're often missed until it's too late. So you always need to take the A pieces of the lungs for pancoast tumors, so it's sorted out the lungs and breathing. We'll move on to the pleura so the pleura shouldn't be visible. If the pleura is visible, then that can indicate pleural thickening. And that's typically associated mesothelioma. So to see if we can see the pleura will inspect the borders of each lung to make sure the lung markings extend all the way to the edges of the lung fields. If they don't, then we need to make sure that it's not just pleural thickening, or to see if there's any widening of the pleural space. If the plural spaces widened, that can be due to three main things, and that's a pneumothorax. Now can anybody put in the group chat? What is in the pleural space If you've got a pneumothorax? So the yeah, perfect a hydrothorax? Can anybody tell me what's in the pleural space? If you've got a hydrothorax Yeah, water tends to be fluid, so it might not necessarily just be water. Um, but it is a type of fluid. So, yes, serious fluid. And then a hemothorax. Blood? Yes. So these can all look slightly different on X ray again. I wouldn't expect you guys to be able to tell the difference, but it's just one thing to note that if it's widening the pleural space, don't immediately always think, Oh, it's a pneumothorax. Because there's also Hydro Thor. It sees. And him authorities, which, uh, interesting in the room. Right. Okay, so we'll have a quick look at that on an X ray again. So here you can see with the pink lines. This time I split lungs into thirds. Can anybody see any abnormalities between the two thirds? The tooth has the three thirds. I'm assuming by the lack of answers, I'm going to say no, because I can't see any. Um excellent. Right? I'm glad somebody agrees with me. So then if we look at the top, you can see that I've circled Where the long a pcr to again. I can't see anything in this chest X ray. Yep. Excellent. Um and so I'm happy to move on. So we've done airway. We've done breathing, so that's a and be sorted, so we'll move on to see which is circulation or cardiac. Depends what you want to remember. So your heart size should be less than 50% of the thoracic width in the PA view. Now, if you remember earlier, I said it had to be p A because a P films get a heart shadowing, and so it makes it look a lot bigger. And you can think, and you might think that that might be cardiomegaly when it's not. You should also look to make sure that there's a well defined heart border around the heart, so the right atrium makes up most of the right heart border. The left ventricle makes up most of the left heart border, but if you can't see the heart borders clearly, then that might be due to pathology in the overlying lung tissue. So you do need to try and make sure that you can distinguish the heart borders clearly. So if you've got reduced right heart border definition, so that's over the right atrium. You're going to be thinking more of middle lobe consolidation. If you've got reduced left heart border definition, then you might be thinking more of lingula consolidation. There's not that much to the circulation or cardiac section, which might be a bit of a relief to you guys. You've just got to remember that the heart should be less than 50% of the thoracic width. Otherwise, it's cardiomegaly, and you should be able to see the heart borders. And most of the time, if the heart borders aren't easy to see, it's due to consolidation. So we'll have a look at that chest X ray again. You can see clearly hear that the width of the heart is less than 50% of the width of the thorax and the heart borders are well defined in green. Okay, so we've done our A B C. We're more than halfway through, so we're on two D for the diaphragm. So I was going to ask the question, Why is the right side of the diaphragm higher the answers on the slide? Sorry. Apologize for that. However, on the left side, what might you see under the diaphragm to indicate the presence of the stomach? I'll give you a clue. A lot of people have this in their stomach, and it results in burping. Espace. Yeah. So a gas bubble? Yeah, that's correct. So you'll look for a gas bubble in the stomach. Unfortunately, my X ray that I've been using for these slides is a slightly also the fund issue. Yeah. So the gas bubble will be seen in the fungus of the stomach because it's gas, so it will float to the top of the stomach. And we do our chest X rays erect, so gas will always float to the top. So, yeah, that's correct. Am sorry with I forgot where I was going. Now I'll come back to that. So Well, then, as we have now spoken about gas always rising A Why might there be free gas under the diaphragm? So I'm not talking just about in the stomach. I'm talking under the diaphragm. Just gas floating about splitting between the region, the region of the liver and the diaphragm. Could we get a little bit more detail than just perforation? So is perforation, but it's perforation yet is perforation of the bowel. So free gas tends to build up under the diagram. Fram if the bowel perforates because the bowel is so full of gas a lot of the time. Uh, the bowel is so full of gas a lot of the time. If you have a bowel Perth and the gas escapes and when you do an erect chest X ray, the gas goes to the top, and so it will push your diaphragm up, creating that airspace. Now, if you ever see a space of air between the diaphragm and the liver, you should pretty much immediately call your general surgeon. And that's because it's really, really dangerous to have a bowel perforation. Your patient could die pretty quickly from sepsis, and so you always want to be really alert to the free gas under the diaphragm. Okay, so there are a few conditions that we won't go into that can cause a false impression of free gas under the diaphragm. But they are really rare, and they will be highlighted in the patient's notes. So another thing that we look at with the diaphragm is costophrenic blunting. So you get these lovely, sharp costophrenic angles, which are formed in the dome of each Hemi diaphragm and the lateral chest wall I'll be able to show you this better on the chest X ray. They're normally quite acute angles, so in healthy individuals they should be clearly visible on a normal chest X ray. However, this can be lost, and that's sometimes referred to to as cost a phrenic blunting, so that can show a few things. So if it's a cute quite often, it's fluid or consolidation in the area. And so it kind of blunts the corners of the lungs. They're not nice and neat, however, it can be secondary to lung hyperinflation. So when you think about a person with COPD, you and they're taking these big breaths and hyper inflating their lungs just to get as much air as they can into their lungs, the lungs start to flatten off at the bottom a bit more because they're being pulled down so much. And so the angle becomes less acute and so blunted. So be able to see that on this slide. Well, not the blunting, but we'll be able to see the costophrenic angles so you can see here. I've drawn the diaphragm in. You can see the right side is higher than the left, but Also, you can see the costophrenic angle between the lateral wall of the chest and the diaphragm. It's a nice sharp angle in this patient as there's no blunting. So we've done a airway, be breathing, see circulation D diaphragm, and now we're onto E everything else. That might sound quite intimidating, but these are slightly less important stuff or easier to pick up stuff. So the aortic knuckle I have never ever known a consultant should talk about an aortic knuckle in a chest X ray. However, it is in here for completeness. Also, it's quite important we don't really talk about the aortic knuckle, but you. It's so obvious you'd be able to see when it goes wrong. So if it is reduced definition, you can see the aneurysm. You can see the enlargement, so you want to make sure that it's there, and it's not particularly enlarged or anything, but it's just something that you'll pick up on Naturally, you'll also be looking at something called the a auto Pommery window, so that's a space located between the arch of the aorta and the pulmonary arteries, but that can be lost as a result of mediastinal lymphadenopathy So again, this is fine print things that might help you identify the mediastinal lymphadenopathy. However, if you can see the lymphadenopathy, then you don't really need to look for the aortopulmonary window. So next to look for bones to your ribs, any obvious fractures, any obvious scoliosis of the spine, any obvious abnormalities, you can have a quick look at bones. Can anybody tell me what might be wrong with the number of ribs that could be congenital and causing issues such as thoracic outlet syndrome? Pop it in the group chat, you know, So thoracic outlet syndrome is something that affects your arm. Um, yeah, so people can have these things called cervical ribs and they grow out of your cervical vertebrae, and that can cause nerve entrapment. And so you want to be looking for things like that on the X ray. They can be completely asymptomatic in some people with them, very symptomatic in others. So moving onto tubes, I named a tube earlier that you could see on an X ray. Can anybody tell me what that tube could be? I'll give you a clue, tends to bisect the Carina if it's in the right place. This is just a little bit of nice. Repetition. Yep. And then G tube. Okay, you can also see things such as lines, so lines that you'll be able to see on an X ray. Can anybody give me a few examples? They're really simple, the ones I'm thinking of anyway. I'm not a clever person. It's got to be simple pic line central lines. Yep, something even more simple than that. Something that's not invasive that you might have on a poorly patient. Yeah, and E C G so E. C. G s. You can see those lines coming straight across the chest X ray, and they can be really confusing at first because sometimes you might not see the sensors, and so they just look like strange lines on the lungs. But it's always worth checking if the patient's got an E c g on. Because that could be the cause of those strange lines. You might also see heart bells. So, of course, these aren't going to be the ones which are porcine or anything, but these will be the mechanical heart bells, and they'll look like little rings on their heart again. It's just something to look out for, and finally you might see a pacemaker. Okay, so with a pacemaker, they typically appear as a radiopaque disc or an oval section in the in for clavicular region, and you'll be able to see the wires going to the heart again. Quite cool to look out. But not much consequence when it comes to the X ray, because you already have it documented in the note. So we're looking here. I've drawn in red the aortic. Uh, sorry. The A aortic, not knob, but knuckle. Sorry. A lot of consultants call it the aortic knob, but it's the aortic knuckle and the aortopulmonary window again. We rarely use this in practice, but it's there for completeness. You can also see that this patient has no lines and no n g tubes in situ. While we're still looking at this chest X ray, we just want to re review some areas right at the very end, the easily missed areas, So I tend to group that with everything else. So I'm going to have another look at the long apices because they're always easily missed. But there's nothing there today. I look at the region around the heart and make sure I'm not missing anything there. I'll look down by the diaphragm because quite often around the diaphragm there might be a little bit of consolidation that we just missed. It's blended in with the diaphragm, and so it's worth having a really close look there. I'll also look at the peripheries of the lungs as a lot of the time we focus more centrally and the hilar regions to make sure there's no hilar lymphadenopathy. So that ensures that you can comprehensively assess the chest X ray. So today we're not really going to go into pathologies on a chest X ray. We're just going through how to read a normal chest X ray, and we'll go onto pathologies another time. Sorry, I would now ask you how we'll present this this X ray. So I've written up an example presentation, and so I will read it out. However, I want you to think if there's any changes you might make or anything you might want to add in. So if I were to present this checks techs Ray, I would state this is an erect chest X ray of a 65 year old man. Bill Smith. Date of birth, 30th of October 1957 Chi 3010572 Double 36 And this X ray was taken yesterday morning at 10 AM at a ri for a suspected rib fracture. I couldn't identify any rotation of the patient. This image was taken on inspiration without contrast. It's an AP film. However it was under exposed the airway. The trachea is not deviated, and the carina and bronchial it clear. There's no evidence of highly lymphadenopathy for breathing. The lung markings are present, and there is no unexpected asymmetry. The pleura are not visible, and there is no increased capacity in the lung fields for circulation. The heart occupies less than 50% of the thoracic width, and its borders are well defined for the diaphragm. There's no evidence of free gas under the diaphragm or any costophrenic blunting and everything else. The aortic knuckle and aortopulmonary window are clearly visible, with no visible inter interventions. This X ray is normal now. I would absolutely love to say, hand on heart that I truly would present an X ray like this to a consultant. However, that's really unlikely. I would try my best to hit this, but we're not going to do it first time. So don't put yourself under too much pressure to get it perfect each time. Just try to remember the A t. E. And it'll make life a lot easier. Okay, so we've had a look at chest X rays. Are we ready to move on to every other X ray? I'm going to see me. What? Er anyway, so we are almost there with every other X ray. We're going to start off with how we started off with the chest X ray. So we want the who, The what? The why the where and the when. So who The chest X ray is off the date of birth. Their chi, their gender or their sex. The Why? So why did we do this? X ray? What were we looking for? The where So where it was taken. Was it taken at a community hospital straight after the accident? Or was it taken at this hospital? Now, if there's a fracture, you want to start off with the type of fracture and in which bone it is, there's no point if there's a fracture talking about all the other anatomy around. It will just get to the point of where the fracture is. You want to have a look to see if there's any displacement and what it looks like. So when describing a fracture, you really want to mention what type of fracture it is. And the fracture can be complete or incomplete. So complete is all the way through the bone. And we tend to look at transverse, which is straight across the bone oblique, which is a line that goes obliquely or at an angle to the cortex of the bone, a spiral which lots of people describe as a corkscrew. I wouldn't necessarily agree. I just think it looks like a spiral, Um, but you'll be able to see that in Earth a while are common muted, which is where there are more than two parts of the fracture, so you tend to get lots of different bone fragments. You can then also get incomplete fractures where the whole cortex is not broken, so that can be things like Boeing, where the bone has been bent. These incomplete fractures tend to be most common in Children, buckling where the fracture is on the concave surface of the bone greenstick fracturing where the fracture is on the convex surface and salt a Harris fractures that involve the growth plate. Now can anybody tell me why we worry about Salter Harris fractures and pediatrics? So there, through the growth plate, particularly, yeah, so stunted growth. So with Children, if they have a fracture through the growth plate of their bones, then you could get reduced growth in Children, which is a real worry, especially as if they, for example, fracture their arm. You don't want them to be walking around with one arm longer than the other. It would really impair them. So we always want to make sure we pick up on Salter. Harris fractures really quickly, the next thing to describe. But once you said, what type of fracture is is where on the bone it is and which bone it's on. So the diet Assis, Can anybody tell me what the diagnosis is? What part of the bone is it? I'll give you options so you can choose the shaft, the widening portion next, the growth plate or the end of the bone just yet. So we got it to the shaft. Maybe I shouldn't have done it in the order of the answers. Oh, well. So, yes, the diagnosis is the shaft of the bone. The meta facist is the widening section as it comes to the growth lee. So it's not quite the end of the bone, but it's the bit that's getting a bit wider. And the epiphany sis is the end of the bone adjacent to the joint. That's why growth plates are also known as epiphany. Seal plates because they're at the end of the bone and they separate your epiphany sis from your metaphysis ISS. So in some cases that might change, and you'll use the anatomical name for a part of the bone. Um, that relates to that bone. So, for example, the metacarpals have a base shaft, neck and head, so you won't call it the diagnosis metaphysis and epiphysis. But instead you would just call it a base shaft, neck and head. But again, unless you're in orthopedics, people don't really mind what you call it, as long as you can correctly identify the location from your description. So fracture Displacement generally describes what's happened to the bone during the fracture. And it in general, when you describe a fracture, the body is assumed to be in the anatomical position, and the injury is then described in terms of the distal component with regards to the proximal component. So, for example, say, Oh, sorry. Um, say I fractured my little finger. My a proximal phalanx and it was my nail was pointing outwards. The end of my finger is pointing outwards. I would say that it was a lateral displacement of the fracture as the finger was going outwards. I wish I could show you. Um, so displacement can can be one or more of angulations translation rotation, distraction and impaction. So if we've had a look at what the boom looks like, we've had a look at where the fracture is, and we've had a look at the type of displacement. We've got a pretty good idea of what the fracture looks like when you're describing it. You also just want to have a quick look to see if anything else is going on in that X ray. So does the fracture go across the joint or anywhere near the joint? Is there another fracture? So, for example, in the ankle and quite often due to the strength of the ligaments. If you break your, uh, tibia, you'll break your fibula as well and vice versa. Um, so you do want to look around to see if there's another fracture. Uh, you want to make sure that you've imaged enough of that patient to make sure that you can see all around. You also want to see the underlying bone, See if there's any pathology going on it there. So can anybody say tell me on the group chat what underlying bone abnormality could cause pathological fractures? So one of them is really common. Yeah. Myeloma. Cyst. I think of another one. That's really common. Oh, yeah, I'll replace the you repeat the displacement of the bone in a sec and yeah, yeah. So metastases and osteoporosis. Yeah, very much so. So they are all very common causes of pathological fractures, so just very quickly repeat the different types of displacement of bone. Sorry about that. So different types of displacement of bone can include angulations translation rotation, distraction or impaction. So angulations is when the distal fragment of the bone is angulated compared to the proximal fragment translation is when it's moved completely off the fracture site, so it may not even be related anymore. Rotation is when the distal fragment of the bone has rotated on the fracture site. And so it is no longer in the same rotation as the proximal bone and distraction and impaction. So distraction is a slight movement of the bone off of the original fracture site. And impaction is when the bone is impacted with into the fracture. Does that make sense before I move on? Okay, I'm really hoping that the silence means yes. If not, I can come back to it at the end. Okay, so we'll have a look at this X ray. So who would like to describe this X ray for me? Excellent. Thank you. Who would like to describe this X ray for me? I'll give you two minutes. I'd like you guys to all type it up. Have a go with those x ray rules up here. I put up on the slide. I want you to all type it up and give me your best description of this X ray. There's no wrong answers for the rock, but okay, there's no silly answers Once you've written it, feel free to send it into the chat. Okay, so we're getting some through spiral fracture of TBS spiral fracture of distal right tibia with medial displacement. Thank you for correcting to be left. Yes. You can see the l in the corner and with medial displacement of distal fragment. Second view for full comment. Excellent. I like that interpretation. Okay, so yep. To be a complete spiral. Yep. Okay, so we'll get the hang of this, which is good. So, of course, the description that I'm about to give is exactly what I would give to the consultant if he asked me to interpret this X ray. I am joking. I would probably go very quiet and bright red and then stutter something out. However, this is what I would suppose would be supposed to give. So this is a spiral fracture of the distal third of the left tibia. There is mild various angulations in lateral translation and angulations. The fracture does not extend to the joint surface, so we're covering every single point that I put there. I'm never gonna give that in front of a consultant. Not unless they become an orthopedic trainee, But you've all had a really good girl. And I'm really impressed with you guys, and that's what we're gonna try and get in next time. So let's move on to the next X ray. So this one, it can be really simple because we don't have a left or right here. We can just make this really simple. So have another go two minutes. Honestly, this is our last one that you guys will have to interpret. So give it your all. So sorry. I've just seen that question third mean So it's just if we would split the bone into thirds, I'd be able to say that that was the distal third. So you've got If you were to just literally have your bone and draw two lines across it, that would split the bone into equal thirds, um, in length, then I'd be able to say Okay, so this is the proximal third. This is the middle third, and then this is the distal third. And that fracture was in the distal third of that bone. Does that make sense? Everybody else keep it in your answers because we've got some good ones. So far, a school, right? So the answers for this one we've got right midshaft ulna fracture and a bleak fracture of the ulna midshaft. Um and yeah, correct. Um, if we were going to be predicted, there might be some. Yeah, exactly. So that's dead on so bleak. Fracture to midshaft of left ulnar posterior displacement of distal fragment. So yes, correct. So you can see this is why you've got the two views on the X ray. So you can see that the, uh so actually, it would be slight anterior displacement due to the fact that, um, the displacement is of the distal fragment of the bone compared to the proximal rather than vice versa. And so if we have a look, the distal fragment of the bone is anterior, whereas the proximal is posterior. And so it would be anterior displacement. But apart from that, you're dead on. So, yes, it's an oblique fracture to midshaft of left armer with anterior displacement of distal fragment dead on. So you can see why it's anterior. Because there's also the thumb here that's at the front. Everybody happy with that? So our last slide and it's just something we want to make sure we look at when we're looking at hip fractures, because what's an orthopods favorite thing? It's a hip fracture. That's their bread and butter hip replacements. So you've got something called Shenton is line, and it's a pretty we arch that goes from your femur all the way around into your pelvis, and you can just see that it looks very nice on this one on your left hand side of your screen. Um, and it's a lovely line there now when a hip fracture occurs, so it's a neck of femur fracture. Um, you get disruption of this centonze line, and you can see here that drawn in red as Shenton line again. But it's been disrupted by the head of the femur falling and the neck of the femur collapsing. So that's just something to keep in mind just to remember. So that's the end of this. Does anybody have any questions? Sorry, it was very much a whistle stop tour. However, this is just to give you the simplified basis to then be followed on by our future lectures. So if there's no questions, then in the chat, we've got a lovely wee feedback link and I would really appreciate it if you filled out the feedback. And it just tells me how I can improve the future. So then you guys can get more out of these sessions. Um, and also, it just helps me to, you know, put this in my, uh, learning Opportunities folder. So, yeah, it would be really, really good if you could fill it out. Also, if you fill it out, they'll send you the recording. So it's a win win. Thank you for coming. Thank you so much, Catherine. It was really, really good. And yeah, guys, please, please fill in the feedback form because that's how we get people like Katherine, who's really good teaching to come along with us and teach as well as help them also improve and give you better, Um, sort of teaching events and yeah, thank you very much for coming. And if you have any suggestions of what type of things you'd like to see next, just let us know. Thank you.