Holmblad Method of Tibia Fracture Reduction Quiz

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Questions and Answers

What is the central ray entrance point for the PA Axial Projection Holmblad Method 2?

Through the patellar apex - about 1-inch proximal to popliteal crease

In the PA Axial Projection Holmblad Method 3, how is the patient positioned?

Kneeling on the table with the knee over the Image receptor

What structures are seen in the Axial Patella- Settegast Method (sunrise method)?

Patella in profile, open patellofemoral joint space, surfaces of femoral condyles

What type of fracture is the sunrise view particularly good at visualizing?

Vertical patellar fracture Signup and view all the answers

In the Axial Patella Merchant Method, where is the Central ray directed?

Midway between both patellae, at the level of the patellofemoral joint space Signup and view all the answers

What structures are seen in the Axial Patella Merchant Method bilat tangential view?

Bilateral patellae in profile, femoral condyles, intercondylar sulcus, open patellofemoral joint space Signup and view all the answers

What is another name for the Axial Patella Hughston Method?

Prone flexion tangential view Signup and view all the answers

In the PA Patella position, how should the foot be rotated?

Laterally 5-10 degrees Signup and view all the answers

What is the Central ray entrance point for the PA Patella projection?

Mid-popliteal area exiting the patella Signup and view all the answers

How should the patient be positioned in the mediolateral Patella projection?

Rolled onto the affected knee, with the opposing leg thrown over for true rotation Signup and view all the answers

What is the central ray angle for an AP knee X-ray?

5-7-degree cephalic angle Signup and view all the answers

In which position is the patient placed for a lateral oblique knee X-ray?

Supine Signup and view all the answers

How should the leg be rotated for a medial oblique knee X-ray?

Rotate the entire leg medially 45 degrees Signup and view all the answers

What is the criteria for a thin pelvis in terms of tube angle for an AP knee X-ray?

3-5 caudal angle Signup and view all the answers

What structures should be seen in a mediolateral knee X-ray?

Open patellofemoral joint space Signup and view all the answers

What is the patient position for a PA knee X-ray?

Prone Signup and view all the answers

Describe the patient position for the Holmblad method.

Standing with knee flexed and resting on a stool Signup and view all the answers

What is the angle of knee flexion for the PA Axial Projection Holmblad Method?

70 degrees from full extension Signup and view all the answers

What structures are seen in a lateral oblique knee X-ray?

Patella overlapping the lateral femoral condyle Signup and view all the answers

How should the patient's leg be rotated for an AP oblique tibia/fibula X-ray?

Roll medial or lateral 45 degrees Signup and view all the answers

What is the image receptor size for tibia/fibula?

14" x 17" Signup and view all the answers

What is the image receptor size for knee and patella?

10" x 12" Signup and view all the answers

What is the source to image distance for tibia, fibula, patella, and knee views?

40 inches Signup and view all the answers

How should the patient be positioned for an AP tibia/fibula view?

-leg straight forward - femur, knee, lower leg all on same plane - femoral condyles parallel to Image receptor - dorsiflex the foot to open lower ankle joint Signup and view all the answers

Where should the Central ray be positioned for an AP tibia/fibula view?

mid-shaft (or couple inches higher/lower for upper and lower images) Signup and view all the answers

What considerations should be taken if the image receptor is too small for an AP tib fib view?

clip the knee if necessary, increase Source to image distance to 48 inches, take an additional AP knee Signup and view all the answers

How much collimation is needed for an AP tibia/fibula view?

1-inch side-to-side, 1 and 1/2 inches beyond the knee and ankle joints Signup and view all the answers

Which structures should be seen in an AP tibia/fibula view?

no rotation, open interosseous space, proximal and distal tibia/fibula articulations moderately overlapped Signup and view all the answers

Which fracture can indicate a fracture of the proximal fibula?

distal tibia Signup and view all the answers

How should the patient be positioned for a mediolateral tibia/fibula view?

roll the patient toward the affected side, slightly flex the knee, dorsiflex the foot, femoral condyles perpendicular to the Image receptor Signup and view all the answers

Where should the Central ray be positioned for a mediolateral tibia/fibula view?

midshaft including both joints (or include the ankle if both joints not available) Signup and view all the answers

How much collimation is needed for a mediolateral tibia/fibula view?

1-inch on sides, 1 and 1/2 inches beyond knee and ankle joints Signup and view all the answers

Study Notes

Patella Projections

The central ray entrance point for the PA Axial Projection Holmblad Method 2 is mid-patella.
In the PA Axial Projection Holmblad Method 3, the patient is positioned with the knee flexed 40-50 degrees.
The Axial Patella-Settegast Method (sunrise method) visualizes the patella, patellofemoral joint, and surrounding soft tissues.
The sunrise view is particularly good at visualizing fractures of the patella.
In the Axial Patella Merchant Method, the central ray is directed to the mid-patella.
The Axial Patella Merchant Method bilat tangential view visualizes the patella and surrounding soft tissues bilaterally.
The Axial Patella Hughston Method is also known as the "Inferior-Superior" method.
For the PA Patella position, the foot should be rotated 10-15 degrees internally.
The central ray entrance point for the PA Patella projection is 1-2 inches below the inferior pole of the patella.
For the mediolateral Patella projection, the patient should be positioned with the affected side against the image receptor.

Knee Projections

The central ray angle for an AP knee X-ray is 0-5 degrees.
For a lateral oblique knee X-ray, the patient is placed in a lateral position with the affected side closest to the image receptor.
For a medial oblique knee X-ray, the leg should be rotated 45-60 degrees internally.
A thin pelvis is considered when the tube angle is 5-10 degrees for an AP knee X-ray.
A mediolateral knee X-ray should visualize the medial and lateral condyles, tibial plateau, and fabella.
For a PA knee X-ray, the patient should be positioned with the knee extended and the patella facing anteriorly.
The patient position for the Holmblad method involves the knee flexed 40-50 degrees and the foot rotated 10-15 degrees internally.
The angle of knee flexion for the PA Axial Projection Holmblad Method is 40-50 degrees.
A lateral oblique knee X-ray visualizes the medial and lateral condyles, tibial plateau, and fabella.

Tibia/Fibula Projections

The patient's leg should be rotated 15-20 degrees internally for an AP oblique tibia/fibula X-ray.
The image receptor size for tibia/fibula is 10 x 12 inches, and for knee and patella is 8 x 10 inches.
The source to image distance for tibia, fibula, patella, and knee views is 40 inches.
For an AP tibia/fibula view, the patient should be positioned with the knee extended and the foot rotated 15-20 degrees internally.
The central ray should be positioned at the midpoint of the tibia for an AP tibia/fibula view.
If the image receptor is too small for an AP tib/fib view, the technologist should collimate to the area of interest.
A minimum of 2-3 inches of collimation is needed for an AP tibia/fibula view.
An AP tibia/fibula view should visualize the superior and inferior tibial articular surfaces, and the proximal and distal tibial and fibular metaphyses.
A Maisonneuve fracture can indicate a fracture of the proximal fibula.
For a mediolateral tibia/fibula view, the patient should be positioned laterally with the affected side closest to the image receptor.
The central ray should be positioned at the midpoint of the tibia for a mediolateral tibia/fibula view.
A minimum of 2-3 inches of collimation is needed for a mediolateral tibia/fibula view.

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Tibia, Fibula, Patella, Knee Quiz