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Introduction ⬇

Orthopedic radiography, or orthopedic x-rays, examines a particular bone, group of bones, or joint. The bony or osseous system presents five functions of radiologic significance: structure support of the body, locomotion, red marrow storage, calcium storage, and protection of underlying soft tissue and organ structures. Orthopedic radiography is performed on the following structures:

  1. The extremities (e.g., hand, wrist, shoulder, foot, knee, hip)

  2. The bony thorax (e.g., ribs, sternum, clavicle)

  3. The spine (e.g., cervical, thoracic, lumbar, sacrum, coccyx)

  4. The head and skull (e.g., facial bones, mastoids, sinuses, skull)

Optimal results from orthopedic x-ray examinations depend on proper immobilization of the area being studied. To produce a thorough image of the body part, at least two projections are required. These are taken at angles of 90° to one another (e.g., anteroposterior and lateral views).

To examine more complex structures such as the spine and skull, or to examine a structure in greater detail, several projections from various angles may be required.

Procedure ⬆ ⬇

  1. Inform the patient that dietary restrictions are not necessary.

  2. Have the patient assume the specific positions most favorable to capturing the best images, based on the area of concern. However, the degree of patient mobility and physical condition may also need to be considered. Typically, the anatomic structures being studied are examined from several angles and positions. This may require the technologist to manipulate the body area physically into a position that will allow optimal visualization.

  3. Tell the patient to remove or reposition jewelry, zippers, snaps, monitoring cables, and so forth, as they may interfere with proper visualization and must be removed from the visual field if possible. Skull x-rays require removal of dentures and partials.

  4. Removal of any surgical-type hardware used to stabilize a traumatized area should be done only under the direction of the attending primary provider.

  5. Follow guidelines in Chapter 1 for safe, effective, informed intratest care.

Clinical Implications ⬆ ⬇

Abnormal orthopedic x-ray results may reveal the following conditions:

  1. Fractures

  2. Dislocations

  3. Arthritis

  4. Osteoporosis

  5. Osteomyelitis

  6. Degenerative joint disease

  7. Hydrocephalus

  8. Sarcoma

  9. Abscess and aseptic necrosis

  10. Paget disease

  11. Gout

  12. Acromegaly

  13. Metastatic processes

  14. Myeloma

  15. Osteochondrosis

    1. Legg–Calvé–Perthes disease

    2. Osgood–Schlatter disease

  16. Bone infarcts

  17. Bone tumors (benign and malignant)

  18. Foreign bodies

  19. Scoliosis

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain the purpose and procedure of the test. Tell the patient that no preparation or dietary restrictions are necessary. Screen for pregnancy status of female patients. If positive, advise the radiology department.

  2. Assure the patient that the procedure in and of itself causes no pain. However, necessary manipulation of the body area concerned may cause discomfort. If appropriate, administer pain medication before the procedure.

  3. Advise the patient that all dentures, partials, jewelry, and other ornamentation worn in the anatomic area being examined must be removed before the x-ray. Tell the patient that loose, comfortable clothing should be worn, and the previously mentioned items should be left at home or locked in the patient’s room or locker room of the radiology department.

  4. Emphasize the importance of not moving during the procedure unless specifically instructed otherwise. Explain that movement distorts or “blurs” the image and often requires repeat exposures.

  5. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Review test results; report and record findings. Modify the nursing care plan as needed. Advise the patient to monitor for and report signs and symptoms of fractures, dislocations, and other orthopedic disorders. Counsel the patient about need for follow-up procedures and treatment.

  2. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Clinical Alert

  1. Orthopedic radiography also can provide information about soft tissue structures, such as swelling or calcifications. However, radiography alone cannot provide data about the condition of the cartilage, tendons, or ligaments.

  1. Portable x-ray machines can be used in the nursing unit if the patient cannot be transported to the radiology department. Nursing personnel may need to assist the technologist in the process. The x-ray technologist is responsible for clearing all unnecessary personnel from the immediate radiation field before activating the exposure.

Interfering Factors ⬆ ⬇

Images of the lumbosacral spine, coccyx, or pelvis must be completed before barium studies because residual barium may interfere with proper visualization. Jewelry and accessories, heavy clothing, metallic objects, zippers, buttons, snaps, cables, and monitoring equipment and supplies can interfere with optimal views and need to be removed before the examination.

Reference Values ⬆

Normal

Normal osseous (bone) and supporting tissue structures; no evidence of fracture