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Questions and Answers
What characterizes a compound fracture?
What characterizes a compound fracture?
Which type of fracture results from mechanical forces exceeding the bone's ability to withstand them?
Which type of fracture results from mechanical forces exceeding the bone's ability to withstand them?
In a Boxer's fracture, which metacarpal is typically affected?
In a Boxer's fracture, which metacarpal is typically affected?
What type of fracture is a Salter Harris fracture identified as?
What type of fracture is a Salter Harris fracture identified as?
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What is the most common type of dislocation mentioned?
What is the most common type of dislocation mentioned?
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What is the primary role of a radiographer during a radiographic examination?
What is the primary role of a radiographer during a radiographic examination?
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Which of the following is NOT a step the radiographer takes to verify patient identity?
Which of the following is NOT a step the radiographer takes to verify patient identity?
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What does FFD stand for in radiographic positioning?
What does FFD stand for in radiographic positioning?
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Which instruction should NOT typically be given to the patient during the examination?
Which instruction should NOT typically be given to the patient during the examination?
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Which technical parameter is essential for determining the quality of the radiographic image?
Which technical parameter is essential for determining the quality of the radiographic image?
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Which material is likely harder to detect in imaging due to its density?
Which material is likely harder to detect in imaging due to its density?
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What is a common follow-up measure for stabilizing fractures in pediatric patients?
What is a common follow-up measure for stabilizing fractures in pediatric patients?
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What is required in imaging to accurately locate a foreign body within the body?
What is required in imaging to accurately locate a foreign body within the body?
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Which option describes a characteristic of K-wires used in treatment?
Which option describes a characteristic of K-wires used in treatment?
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What does the imaging process require if a foreign object is not visible externally?
What does the imaging process require if a foreign object is not visible externally?
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What is the primary factor that determines the exposure level for a radiograph?
What is the primary factor that determines the exposure level for a radiograph?
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What is the purpose of collimation in radiography?
What is the purpose of collimation in radiography?
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Where is the central ray often aimed during positioning for a radiograph?
Where is the central ray often aimed during positioning for a radiograph?
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Which of the following is NOT typically a criterion used in image evaluation for quality?
Which of the following is NOT typically a criterion used in image evaluation for quality?
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Which carpal bone is considered the 'Most commonly fractured'?
Which carpal bone is considered the 'Most commonly fractured'?
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What does the mnemonic 'So Long To Pinky Here Comes The Thumb' help to remember?
What does the mnemonic 'So Long To Pinky Here Comes The Thumb' help to remember?
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In terms of bone age, which method is commonly used to assess this in pediatric patients?
In terms of bone age, which method is commonly used to assess this in pediatric patients?
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Which of the following is a sign that might indicate imaging is necessary?
Which of the following is a sign that might indicate imaging is necessary?
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What does the evaluation criterion of 'no rotation – symmetry' ensure during the assessment of a radiograph?
What does the evaluation criterion of 'no rotation – symmetry' ensure during the assessment of a radiograph?
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What is the significance of positioning the central ray on the anatomy of interest?
What is the significance of positioning the central ray on the anatomy of interest?
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What is the minimum number of projections required for a radiographic examination of long bones?
What is the minimum number of projections required for a radiographic examination of long bones?
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Which of the following is NOT a responsibility of a radiographer during an examination?
Which of the following is NOT a responsibility of a radiographer during an examination?
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Why is FFD (Film-Focus-Distance) important in radiographic positioning?
Why is FFD (Film-Focus-Distance) important in radiographic positioning?
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What should a radiographer communicate to the patient before taking radiographs?
What should a radiographer communicate to the patient before taking radiographs?
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What do the exposure factors kVp and mAs influence in a radiographic image?
What do the exposure factors kVp and mAs influence in a radiographic image?
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Which type of foreign object is most likely to be easily seen in imaging?
Which type of foreign object is most likely to be easily seen in imaging?
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What is the minimum number of projections required for effective imaging of a foreign body?
What is the minimum number of projections required for effective imaging of a foreign body?
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What is a key characteristic of K-wires when used in pediatric settings?
What is a key characteristic of K-wires when used in pediatric settings?
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What is one of the common methods of stabilization after a fracture during follow-up imaging?
What is one of the common methods of stabilization after a fracture during follow-up imaging?
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What should be done if a foreign object is not visible externally on imaging?
What should be done if a foreign object is not visible externally on imaging?
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What type of fracture involves a fracture through the growth plate?
What type of fracture involves a fracture through the growth plate?
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Which fracture is characterized by a dorsal angulation and typically affects the shaft of a metacarpal?
Which fracture is characterized by a dorsal angulation and typically affects the shaft of a metacarpal?
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What type of fracture results when a fragment of bone is pulled off by a tendon?
What type of fracture results when a fragment of bone is pulled off by a tendon?
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In a Boxer's fracture, what characteristic is NOT typically observed?
In a Boxer's fracture, what characteristic is NOT typically observed?
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Which type of fracture is most commonly associated with joint involvement?
Which type of fracture is most commonly associated with joint involvement?
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What is the primary function of collimation in radiography?
What is the primary function of collimation in radiography?
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What criteria should be met for an optimal PA finger radiograph?
What criteria should be met for an optimal PA finger radiograph?
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Which joint is referred to by the abbreviation MCP?
Which joint is referred to by the abbreviation MCP?
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Which of the following exposures is typically required for paediatric patients?
Which of the following exposures is typically required for paediatric patients?
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In the evaluation of radiographs, what does the term 'critique' refer to?
In the evaluation of radiographs, what does the term 'critique' refer to?
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What is the significance of centering the central ray on joint spaces?
What is the significance of centering the central ray on joint spaces?
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Which bone is not part of the carpal bones?
Which bone is not part of the carpal bones?
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Which indication might require imaging of a patient's hand?
Which indication might require imaging of a patient's hand?
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Which of the following is a recognized part of the skeletal age assessment?
Which of the following is a recognized part of the skeletal age assessment?
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What is one of the criteria for ensuring no rotation in a radiograph?
What is one of the criteria for ensuring no rotation in a radiograph?
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Study Notes
Hand and Thumb Anatomy
- The hand has a minimum of 27 bones
-
Phalanges
- Distal, Middle and Proximal
- Metacarpals - 5 bones
-
Carpals - 8 bones
- Scaphoid
- Lunate
- Triquetrum
- Pisiform
- Hamate
- Capitate
- Trapezoid
- Trapezium
-
Joints
- Distal Interphalangeal (DIP)
- Proximal Interphalangeal (PIP)
- Thumb Interphalangeal (IP)
- Metacarpophalangeal (MCP)
- Carpometacarpal (CMC)
Hand and Thumb Radiographic Examination
-
Basic Radiographic Procedures
- Obtain patient’s identity
- Position the body part
- Align body part with x-ray image receptor
- Align the x-ray tube to the central ray
- Radiation protection measures
- Select exposure factors
- Provide patient instructions
- Process the image
- Procedure - Performed with multiple projections for a complete view of the anatomy
-
Technical Parameters
- Positioning of patient and tube- Important for each anatomical region to be displayed adequately, based on FFD
- Exposure (kVp and mAs) - Adjusted based on patient size, a paediatric patient will receive lower exposure than an adult.
- Collimation - area of exposure to radiation using lead shutters
- Centring - Placing the central ray (CR) focused onto the anatomical area of interest
- Evaluation - Performed using a set of criteria to ensure the image can be repeated
Hand and Thumb Injuries
-
Common Indications for X-Ray
- Trauma
- Pain
- Lumps
- Foreign Body
- Swelling
- Infections
- Cuts
- Congenital abnormalities
- Metabolic diseases
- Osteoporosis
- Bruising
- Loss of function
- Deformity
- Reduced range of motion (ROM)
- Bone age
- Follow up from previous injury.
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Types of Hand Injuries
-
Fractures
- Complete - transverse, oblique, spiral, comminuted
- Incomplete - bowing, buckle, greenstick
- Phalanges - distal phalanx, Salter Harris, shaft fractures
- 4th and 5th Metacarpal - Boxer's fracture (anterior angulation of head)
- Metacarpal Shaft - dorsal angulation
- Avulsion fracture - fragment of bone pulled off by a tendon
- Salter-Harris fracture - fracture through the growth plate
- Base of Thumb Fracture - Bennett Fracture (intraarticular fracture/dislocation)
- Compound fracture - broken bone that penetrates the skin
-
Dislocations
- Dorsal dislocations - usually caused by a hyperextension injury
-
Foreign Body
- Localised using two or more views
- Open Reduction Internal Fixation (ORIF) - Post-operative imaging to ensure adequate fixation
- K-Wire Fixation - temporary measure for stabilizing fractures, particularly in paediatric patients.
-
Fractures
Bone Age
- Chronological age vs skeletal age
- Growth plates are assessed
- Exam performed on the non-dominant hand
- Dates of appearance and fusion
- Growth plates
- Bone age studies are used to assess the growth and development of bones.
Hand, Fingers, and Thumb Radiography
- Minimum of two projections are required for any long bone region. This typically includes an AP (anteroposterior) and lateral view.
- Lower leg examinations require an AP and lateral view of the tibia and fibula.
- Radiographers are responsible for checking the patient's identity, positioning the body part for the exam, selecting appropriate exposure parameters, and ensuring patient safety.
- Positioning and imaging require an understanding of the patient's range of motion (ROM) to achieve the optimal view.
Anatomy of the Hand and Wrist
- Distal Interphalangeal (DIP) joint: The joint between the distal phalanx and the middle phalanx.
- Proximal Interphalangeal (PIP) joint: The joint between the middle phalanx and the proximal phalanx.
- Thumb Interphalangeal (IP) joint: The joint between the two phalanges of the thumb.
- Metacarpophalangeal (MCP) joint: The joint between the metacarpal bone and the proximal phalanx.
- Carpometacarpal (CMC) joint: The joint between the carpal bones and the metacarpal bones.
-
The carpal bones:
- Scaphoid
- Lunate
- Triquetrum
- Pisiform
- Hamate
- Capitate
- Trapezoid
- Trapezium
- Mnemonic for remembering the carpal bones: "So Long To Pinky Here Comes The Thumb"
Indications for Hand and Wrist Radiography
- Trauma: Fractures, dislocations, sprains, and other injuries.
- Pain: Arthritis, tendonitis, and other inflammatory conditions.
- Lumps: Cysts, tumors, and other masses.
- Foreign bodies: Objects embedded in the hand or wrist.
- Swelling: Inflammatory conditions, infections, and other causes.
- Deformity: Birth defects, injuries, and other causes.
- Loss of function: Weakness, numbness, and other issues caused by injury or disease.
- Bone age: To assess skeletal maturity in children and adolescents.
- Follow-up from previous injury: To monitor healing and assess treatment effectiveness.
Technical Parameters
- Positioning of the patient and the tube: This is customized for each anatomical area to be displayed adequately. The "FFD" (Film-Focus-Distance), the distance from the x-ray tube to the film, is specified for each view to ensure consistent exposure.
- Exposure: Determined by the radiographer based on the patient's size (kVp and mAs).
- Collimation: The size of the area to be included in the radiograph. Lead shutters open or close to adjust collimation size, ensuring only the target area is exposed to radiation.
- Centring: Positioning the central ray (CR) at the center of the beam, which is aligned towards the anatomy of interest. This ensures proper image visualization.
Evaluation Criteria for Hand and Wrist Images
- Regional anatomy included: Tip of digit to distal metacarpal, including the soft tissue.
- Digit free of superimposition: Ensure proper alignment to view each digit distinctly.
- No rotation: Symmetry in the image, indicating proper positioning.
- Metacarpophalangeal (MCP) and interphalangeal (IP) joints open: Joint spaces should be clearly visualized.
- Density and contrast optimal: Visualize bony trabecular pattern and soft tissue adequately.
Pathology
-
Fractures:
- Types: Complete (transverse, oblique, spiral, comminuted) and Incomplete (bowing, buckle, greenstick)
- Location: Specifies the bone and specific part of the bone affected
- Displacement: Describes the angulation of the distal fragment relative to the proximal fragment
-
- Complications:* Compound fractures, joint involvement
-
Types of Bone Fractures:
-
Phalanges:
- Distal phalanx fracture
- Salter Harris fracture
- Shaft fracture
-
Boxer's fracture:
- 4th or 5th metacarpal neck fracture, with anterior angulation of the head.
- Shortening and rotation of the distal fragment.
- Shaft fracture: Usually of the 3rd or 4th metacarpal, with dorsal angulation.
- Avulsion fracture: A fragment of bone pulled off by a tendon.
- Salter Harris fracture: Fractures through the growth plate, classified into different levels.
-
Base of First Metacarpal Fracture (Thumb):
- Bennett Fracture
- Fracture-dislocation with dorso-lateral displacement.
- Intraarticular fracture, affecting the joint.
-
Phalanges:
-
Dislocations: Often involve dorsal displacement of the distal part relative to the proximal part.
-
Foreign Body:
- Requires localization of the object, noting type and material.
- Glass and metal are easier to visualize than less dense materials like wood.
- Two projections or more may be necessary, with tangential projections for optimal positioning.
-
Follow-up Imaging:
- Open Reduction Internal Fixation (ORIF): To assess fixation and healing after surgical repair.
- K-wires: Temporary stabilization measure for fractures, particularly in children. They may protrude from the skin for easy removal.
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Description
Test your knowledge on the anatomy of the hand and thumb, including the bones, joints, and radiographic examination procedures. This quiz covers essential concepts from bone structure to imaging techniques relevant for medical professionals. Prepare to dive into the intricate details of one of the most used body parts.
