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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 15-20 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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