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Film Critique 1 st year 5 th class. Toes Standard views *AP *Oblique (medioblique) *Lateral (mediolateral/lateromedial)

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Presentation on theme: "Film Critique 1 st year 5 th class. Toes Standard views *AP *Oblique (medioblique) *Lateral (mediolateral/lateromedial)"— Presentation transcript:

1 Film Critique 1 st year 5 th class

2 Toes Standard views *AP *Oblique (medioblique) *Lateral (mediolateral/lateromedial)

3 Structures shown  AP projection of the phalanges of the foot (*1 st toe only has 2 phalanges the 2nd-5th have 3 phalanges) ***We need from distal phalanx to the distal end metatarsal.

4 AP Right 1 st Toe Sesamoids

5 Check the film for:  No rotation of phalanges  Interphalangeal and metatarsophalangeal joint spaces open (no bent toes)  Toes should be separated from each other so there is no soft tissue overlap  Soft tissue and bony trabeculation (this is to check for a good technique)

6 AP Rotation of toe Soft tissue overlap AP left 1 st toe

7 Oblique Toes

8 Oblique left 1 st toe

9 Structures shown **** We do a medioblique: **** We do a medioblique:  An oblique projection of the phalanges  The Interphalangeal joints and 2 nd -5 th metatarsophalangeal joints open ***Distal phalanx to the distal end of the metatarsal  Toes should be separated from each other  Both soft tissue and bony trabeculation should be seen (techn)

10 Oblique left 2 nd toe Cadaver bone LT

11 Lateral left 1 st toe  Might need tape, straw or tongue depressor to separate toes

12 Lateral toes  Do lateromedial (1st-3 rd ) and mediolateral (3 rd -5 th ) to get the toe closest to the film lateromedial Mediolateral Lateral left 2 nd toe Lateral left 3 rd toe

13 Structures shown: Lateral toe  A lateral projection of the phalanges: Phalanges in profile (toenail should appear lateral)  The interphalangeal joints spaces open. The MTP joints will be overlapped but may be seen in some patients. ***The distal phalanx to the distal ends of the metatarsals metatarsals  Phalanx, without superimposition of adjacent toes. When superimposition cannot be avoided, the proximal phalanx must be demonstrated.  Toes should be separated from each other  Soft tissue and bony trabeculation (techn)

14 Lateral left 1 st toe Lateral left 2 nd toe

15 Tongue depressor Lateral Left 2 nd toe

16 Foot  Standard views *AP * AP Oblique (medioblique) *Lateral (mediolateral)

17 Base of the 5th Common area for a foot fracture base of 5 th Jones fracture AP Right Foot Intermediate

18 AP Right foot **In this view you Will not see the Calcaneus!!

19 Structures shown:  Dorsoplanter (AP) projection of the tarsals anterior to the talus, the metatarsals,and the phalanges  You will not see the whole calcaneus on this view. Why?  Some people angle 10 degrees toward the heel on this view ***You want all of the phalanges, metatarsals and tarsals distal to the talus on your image

20 Check film for:  Motion  Rotation: there will be overlap of second- fifth metatarsal bases  Open joint space between medial and intermediate cuneiform  No overlap of toes  Density- are the toes burned out

21 Oblique Right foot

22 Oblique Right Foot medioblique

23 Structures shown:  AP medioblique projection of the phalanges and metatarsals  Interspaces open between the cuboid and calcaneus, the cuboid and the 4 th and 5 th metatarsals, the cuboid and the lateral cuneiform and the talus and the navicular  Cuboid is in profile  Sinus tarsi, calcaneus, navicular,& base of the fifth are seen

24 Oblique Left Foot Calcaneus?

25 Check for:  Enough rotation when the 3 rd – 5 th metatarsals bases are free from superimposition  The lateral tarsals with less superimposition than in the AP  Joint spaces open  Base of the fifth metarsal is seen  Density: are the toes seen and are the tarsal seen  Tip of toes to calcaneus on the image

26 Lateral Right Foot

27 mediolateral R

28 Structures shown:  Mediolateral projection of the entire foot. ***You need distal ends of the tib/fib, ankle joint, calcaneus to the distal phalanges.

29 Bad lateral foot

30 Check for:  Tip of toes to calcaneus and distal tib/fib on the image  Metatarsals nearly superimposed  Density to see toes, metatarsals and tarsals

31 Good Positioning Poor : knee elevated Poor : heel not flat Poor : foot not flat

32 NO!

33 CALCANEUS  Standard views *AP axial (plantodorsal) *Lateral (mediolateral)

34 Sustentaculum tali tuberosity Trochlear process

35 Structures shown:  An axial projection of the calcaneus ***from the tuberosity to the sustentaculum tali and trochlear process

36 AP Axial Right Calcaneus

37 Check for:  Calcaneus should be visualized to include the talocalcaneal joint  No rotation of calcaneus (check the first or fifth metatarsals)  Density to see joint without burn out of tuberosity (two films if not using DR or CR)

38 Rotation / foot flexion Good Rotation : can see 4 th & 5 th metatarsals Too much flexion Can’t see joint space


40 Structures shown:  Lateral projection of the ankle joint and the calcaneus and adjacent tarsals.

41 Lateral Left calcaneus

42 Check for:  No rotation of the calcaneus  Density can you see soft tissue and bone  Sinus tarsi seen  Ankle joint and adjacent tarsals should be on the film

43 Ankle  Standard views *AP *OBL (mortise) *Lateral (mediolateral)

44 AP Right Ankle

45 Structures shown  AP projection of the ankle joint, ***distal ends of tib/fib and the proximal portion of the talus

46 Dorsal flex AP Left ankle

47 Check for:  Talotibial joint space should be seen  Ankle joint should be centered  Moderate over lapping at the tibiofibular articulation is normal ***Area from the distal tibia and fibula to the talus should be included

48 Oblique Left Ankle

49 Structures shown:  Distal ends of the tib/fib with the entire ankle mortise joint demonstrated in profile.(all three sides of the mortise joint should be open.)

50 AP OBLIQUE ANKLE  The entire ankle mortise joint should be demonstrated in profile. We oblique degrees to open all three joints. AP Too much

51 Oblique Right Ankle is it open?

52 Don’t just dorsiflex the foot, roll the leg

53 Check for:  Entire ankle mortise joint  No overlap of the anterior tubercle of the tibia and the superolateral portion of the talus with the fibula  Talofibular joint space in profile  Talus demonstrated with proper density

54 Lateral Right Ankle

55 Lateral ankle (mediolateral)  A true lateral image of the lower third of the tib/fib, the ankle joint and the tarsals including the base of the 5 th metatarsal

56 Lateral Right Ankle Poor positioning Dorsiflex the foot

57 Check for:  Ankle joint should be centered  Talotibial joint should be well visualized  Fibula should be over the posterior half of the tibia  Density of ankle should be sufficient to see the outline of the distal portion of the fibula  Fifth metatarsal should be seen to check for a Jones fracture

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