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🦴 Orthopaedics, without the boring bits.
📚 Trauma • Sports • Arthroscopy
🧠 Learn the bone. Understand the biomechanics.

A systematic approach to reading midfoot radiographs is essential for accurately diagnosing Lisfranc injuries. This caro...
19/09/2026

A systematic approach to reading midfoot radiographs is essential for accurately diagnosing Lisfranc injuries. This carousel breaks down the three critical radiographic alignments you must evaluate:
🔹 The AP View: The medial border of the 2nd metatarsal must align perfectly with the medial border of the middle cuneiform. Any widening indicates potential instability.
🔹 The Oblique View: The medial border of the 4th metatarsal must align continuously with the medial border of the cuboid. This is necessary to catch lateral column disruption.
🔹 The Lateral View: The dorsal cortices of the metatarsal bases and cuneiforms should form a smooth, continuous line. A dorsal step-off signifies major plantar ligamentous disruption.
The slides also cover essential clinical pearls, including the requirement for weight-bearing or stress views (since non-weight-bearing films can spontaneously reduce) and the diagnostic significance of a plantar ecchymosis.
Review the full breakdown in the carousel and test your knowledge with the clinical scenario on slide 6.
Let us know your answer to the quiz (A, B, C, or D) in the comments below.
💾 Save this reference for your next ER shift or clinic.
🔗 Visit ORTHOMCQ.IN for more orthopedic education.

Measure a distal radius in 8 steps. Three numbers, two views, one axis.Every wrist film you read, whether in casualty, o...
18/09/2026

Measure a distal radius in 8 steps. Three numbers, two views, one axis.
Every wrist film you read, whether in casualty, on a ward round or in a viva, comes down to three parameters. Here is how to draw each one on a real film.
PA view
Radial inclination: the angle between a line perpendicular to the shaft axis and a line from the radial styloid tip to the ulnar corner of the lunate fossa. Normal is about 22 degrees.
Radial height: the gap between two perpendiculars to the axis, one through the styloid tip and one through the ulnar corner. Normal is 11 to 12 mm.
Lateral view
Volar tilt: the angle between a perpendicular to the axis and the line joining the dorsal and volar lips. Normal is about 11 degrees. If the surface faces the palm, the tilt is volar. If it faces the back, as in the Colles dinner-fork deformity, it is dorsal.
Remember 22 – 11 – 11.
Common targets for an acceptable reduction: radial shortening under 5 mm, inclination above 15 degrees, dorsal tilt under 10 degrees and articular step-off under 2 mm. Targets vary with age, functional demand and fracture pattern.
Two challenges are waiting at the end:
Your Turn: is the tilt on that lateral film volar or dorsal?
Quiz: which post-reduction parameter is not acceptable?
Drop both answers in the comments. The explanation goes up in 24 hours.
Save this for your wrist viva and share it with someone who still guesses the volar tilt.
More step-by-step X-ray guides at orthomcq.in
WristXray RadialInclination VolarTilt RadialHeight Orthopaedics OrthoResident MSOrtho DNBOrtho FRCSOrth NEETPG INICET FMGE MBBS Radiology XrayInterpretation MedicalEducation HandSurgery

18/09/2026

How to Measure Tip Apex Distance
Step 1: Establish the AP Reference Lines
On the AP radiograph, draw a line across the widest part of the femoral head, approximately perpendicular to the axis of the femoral neck. Draw a second line across the femoral neck, parallel to the first line.

Step 2: Determine the AP Apex
Mark the midpoints of both lines and connect them to create the central axis. Extend this line until it intersects the outer margin of the femoral head. This intersection point is the "Apex" for the AP view.

Step 3: Measure AP Distance
Measure the distance from the established AP apex to the tip of the lag screw or helical blade. Record this value as X_ap.

Step 4: Determine the Lateral Apex and Distance
Repeat the previous steps on the lateral radiograph. Establish the perpendicular lines, connect their midpoints to find the lateral apex on the femoral head outline, and measure the distance from this apex to the implant tip. Record this value as X_lat.

Step 5: Measure Apparent Implant Diameters
To account for radiographic magnification, measure the apparent width (diameter) of the lag screw or blade on both the AP view and the lateral view. Record these as D_ap and D_lat, respectively.

Step 6: Calculate the Final TAD
Identify the actual, known diameter of the specific implant being used (recorded as D_true). Calculate the final Tip Apex Distance using the standard formula to correct for magnification in both views:

TAD = (X_ap * (D_true / D_ap)) + (X_lat * (D_true / D_lat))

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