Knee

Published on 01/04/2015 by admin

Filed under Radiology

Last modified 01/04/2015

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15

Knee

The standard radiographs

AP and Lateral.

Suspected patella fracture, but AP & lateral are equivocal: Skyline view.

Occasionally, a Tunnel view to evaluate the intercondylar area.

Analysis: the checklists

The AP radiograph

Adults: a five-point checklist

Check:

Normal AP.

image

In the normal knee a perpendicular line drawn at the most lateral or medial margin of the femur should have no more than 5 mm of adjacent tibia outside of it. If this rule is broken suspect a plateau fracture.

image

The lateral radiograph

It is important to understand the normal and abnormal appearance of the suprapatellar bursa—if abnormal, this often suggests a fracture or ligament damage46.

Adults and children: a six-point checklist

Check:

Effusion with a fat–fluid level.

In the Emergency Department the lateral view of the knee is obtained with a horizontal X-ray beam (conventionally referred to as a “HBL”). A fat–fluid level occurs when fat (arrowheads) lies on top of blood in the suprapatellar bursa. The fat has been released from bone marrow and consequently the fat–fluid level indicates an intra-articular fracture79.

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