Well-chosen imaging is the cornerstone of diagnosis for most injuries. The most commonly employed technique is plain radiography, or “x-ray” imaging. Though newer modes such as nuclear medicine, ultrasound, computed tomography and magnetic resonance imaging are being employed at an increasing rate, Xray remains the first investigation that is performed when injury occurs.
A physician must develop enough skills to read and correctly interpret Xrays. Today I would discuss briefly how an injured bone might look on Xray.
Typically a fracture would appear as break in the continuity of the bone. But appearance may vary.
In adults a cortical break is usually a complete one. It is visible like a crack inn the intact bone or bone might appear divided into two parts.
In contrast, in children there may be partial cortical break (greenstick fracture), buckling of cortex on one side (torus fracture), or bending without a cortical defect (plastic fracture).
Impacted fracture is a type of fracture where it may show only increased area of bone density, but usually there is some disruption of cortex.
Fracture margins ar sharp and not corticated, in contrast with sesamoid bones or accessory ossification centers (or old fractures), which are smooth and well corticated.
in addition to this there might be associated signs in the soft tissue. For example there might be a break in the skin visible.
Above all, clinical correlation is most important.In case one finds that the xray is not correlating with clinical examination, one should proceed with better investigations.
Xray is basic investigation. For decision making one might require a different modality of investigation.
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