Insofar as best practices for radiology in orthopedics are concerned, there are a number of crucial elements for doctors and specialists to observe and report.
Adequacy with regard to number of views taken. Minimum of 2, preference for 3 while some bones require 4; images should have adequate penetration
Normal x-rays should have normal alignment. Fractures and dislocations may affect the alignment on the x-ray
Bones are to be examined for fracture lines or distortions. The entire length of bone should be examined. Fractures may be subtle.
Cartilage implies examination of the joint spaces on x-rays, as cartilage actually cannot be seen on x-rays. Widening of joint spaces signifies ligamentous injury and/or fractures.
Soft tissue implies to look for soft tissue swelling and joint effusions. This can be a sign of occult fractures.
Open vs. closed fracture(s)
Closed fractures are simple fractures with no open wounds of skin near fracture
Open fractures can be compound or cutaneous, which is an open wound of skin near fracture site. The bone may protrude from the skin. Open fractures are open complete displaced and/or comminuted.
Open fractures are an orthopedic emergency which requires emergency orthopedic consultation. Bleeding must be controlled. Additionally, management can include IV antibiotics, tetanus prophylaxis, pain control, and surgery for washout and reduction.
Anatomic location of fracture(s)
Describe the precise anatomic location of the fracture
Include if it is left or right-sided bone
Include name of bone
Proximal, mid, distal
To aid in this, divide bone into thirds
Besides location, it is helpful to describe if the location of the fracture involves the joint space—intra-articular
Types include transverse, oblique, spiral, comminuted, impacted
Transverse fractures occur perpendicular to the long axis of the bone
Spiral fractures occur in a spiral fashion along the long axis of the bone
Usually caused by a rotational force
Comminuted fractures are those with two or more bone fragments present
Types of Fracture fragments
Alignment is the relationship in the longitudinal axis of one bone to another.
Angulation is any deviation from normal alignment. Angulation is described in degrees of angulation of the distal fragment in relation to the proximal fragment—to measure angle, draw lines through normal axis of bone and fracture fragment.
Apposition is the amount of end-to-end contact of the fracture fragments.
Displacement is used interchangeably with apposition.
Bayonette apposition is the overlap of fracture fragments.
Distraction is displacement in the longitudinal axis of the bones.
Dislocation is the disruption of normal relationships or articular surfaces. Dislocations are named by the position of the distal segment.