ROGER M. LAVADIA, RRT.

Radiologic Technologist II
Philippine Orthopedic Center
BEDSIDE RADIOGRAPHY – an X-ray
examination done for patients who are
not suitable in the x-ray room, Through
the use of Portable or Mobile x-ray unit.
Classification of Patient
 Pre-Operative
a) Pt. with traction attachment
b) Neuro cases & Unconscious
c) Seriously- ill Patients
d) Patient needing Doctors assistance
e) (oftentimes VIP) Immediate Post-Op.
 Intra –Operative
a) Pt. during surgery (inside the operating room)
 Post-Operative
a) Pt. After surgery (inside recovery room/ward )
Radiographic Approach
1.Position the portable x-ray machine, applicable
to the second exposure.
2.Patient cooperation is the help to attain proper
positioning.
3.Begin Initial preparation. Use any device to help
ensure neutral positioning w/o affecting the
traction. Like pillows, sandbags etc.
4.Place the cassette nearest to the affected side to
minimize magnification and distortion.
5. Introduce to patient, the possible instruction.

6.Select the proper factor & Technique.

Pre-Operative Radiography
Purpose :
1.To provide surgeons adequate information .
2.Planning & surgical approach must be reviewed prior
to initial surgery.
3.To measure the length & appropriate size of implant
to be selected prior to the surgery.
4.For comparison, sizing & positioning the prosthetic
components.
5.To provide guidance as to the extent of restoration
of surgical length & level.
Intra –operative (during surgery)

Important: Once
inside the operating
room, care should be taken not to
touch sterile instruments.
Intra-op. Radiographic Approach
1.Use sterile O.R. gown provide by the operating room
staff.
2.Let the surgeon wrapped the cassette with sterile linen.
3.Let them facilitate the insertion of cassette and
appropriate level of the part being x-rayed.
4.Suggest a proper positioning and assessment of the
cassette to allow correct length & angle.
5. Check the instability and contact of the cassette by
determining the tip of the instrument as landmark or
reference. common errors includes the upside down of
cassettes.
6. Select the proper factor and technique.
Post-Operative (after Surgery)
Purpose:
 It is recommended for close comparison with
immediate post-op condition.
 Post- Operative complication can be identified on
periodic routine AP and Lateral x-rays.
 Radiographic Approach
1.Use extreme care in patient handling. Improper handling
& positioning can result in instability & dislocation.
2.Gently elevate the patient by using the linen in order to
place & position the cassette.
3.Use any device to help ensure neutral positioning. Like
pillows, sandbags etc.
4.Double check the stability & contact of the cassette to
the part being examine or radiograph.
5.Correct selection of tube direction can minimize patient
movement.
6.Observe patient comfort to avoid motion
7.Select the proper factor & technique.
 Orthopedic Implants
Objectives: To familiarize the different types of metallic
plates in the radiograph. It’s size and location.
 Implants – a material such as tissue or metal in sheets
w/c is grafted or inserted into the pt. body.
 Plates -a thin flat piece of material usually metal used
to fix or set securely in fracture bones.
 Prosthesis - an artificial replacement for missing body
part.
 kinds of Orthopedic Implants
1. Hip Prosthesis- a total or partial
replacement of hip joint
made -up of stainless steel
and polyethylene plastic .
Two types
a) Partial Hip Prosthesis Partial
b) Total Hip Prosthesis

Partial Total
Total
2. Intra medulary nail – a
stainless steel rod commonly
use in femur and tibia.
Two Types
a) Dynamic locking -
forceful movement. Dynamic

b) Static locking -
little change or action.

Static
 Elizarov External Fixator

 For non-union fracture

of femur and tibia.

In the early fifties, GAVRIJL

ABRAMOVITCH ILIZAROV,
develop this circular fixator
which permitted to stabilise
bone fragment and maintain
to its original length.
Proximal femoral Nail

 For femoral neck

fracture.
 Main component,

 NAIL
 HELICAL BLADE
 SCREW
3. HRI (Harrington Rod Instrumentation)

 for scoliotic patient, it can

be found in whole spine

HRI
 4. Luque Rod Instrumentation

 Also use in thoraco-lumbar

spine (an inverted “L” type)
 Pedicular Screw Fixation
For lumbar
spine
 Pedicular Screw Fixation

 For Whole
 spine
12. Multiple Pinning
 Commonly used to patients
who have not yet
reached full maturity.
5.CHSF (compression hip screw fixation)
 For subtrochanteric
fracture.
 Composed of :
 Log screw
 Angle plate
 Cancellous crew
6.Multiple Screw Fixation
 For femoral neck fracture
particularly to patients
who have reached full
maturity.
Angle Plate

 For proximal tibia and

femoral neck.
Total Knee Prosthesis
 Total replacement of
knee joints by using
knee prosthesis.
COMPONENT
1. FEMORAL PLTE
2.TIBIAL INSERT
3. TIBIAL PLATE
7. Steinman Pin (cross pinning)
 For colles fx. In wrist joint.

 For supracondylar fx. In

elbow joint.
 Serve as guide pin.
8.Circlage Wire
 Used to fasten or
attached segments of
bone.
example:
a) Patillar & cervical
fracture.
9. Buttress Plate

 For tibial plateau and

proximal tibial
fracture.
 For humeral neck
fracture.
10. DCP (dynamic compression plate)
 6-8 holes or more.
 For forearm & arm
fracture.
10. Tubular Plate

 Particularly in radius-ulnar
fracture w/ at least
4- 6 holes.
MIPO (Minimal Invasive Plate Osteosynthesis)

 For multiple fracture of

tibia.
11.RAEF (Roger Anderson External fixator)

 Used to aligned or secure firmly

segments of non- union
bone formation.
Example: in tibia
13. Antibiotic Beads

 A string of antibiotics made up

of ceramic & metal wire
- used to fight infections.
Different Types of Bone Screws
Types of Orthopedic Bone Screws
Here is a list of some of the major types of bone screws that are categorized on the
basis of the kind of fractures and the consistency of bone tissues.
Cortical Screw
This type of orthopedic bone screw is used particularly for hard bone tissue, such as
shaft of long bones.
Cancellous Screw
Cancellous Screw is specifically made for spongy bones present at the ends.
Pedicle Screw
Pedicle Screws are used by orthopedists for spine fusion or fractures.
Cannulated Screw
These are used to pass a guide wire through it for perfect placement of the screw.
Herbert Screw
This screw is designed for internal fixation of broken bones that includes the joint
cartilage. The major feature of these screws is that they are headless, so even after the
settlement of the screw; the joint movements are not clogged by a screw head.
Malleolar Screw
Specialists use Malleolar Screws for the fixation of ankle fractures.
All these bone screws play a vital role in the treatment of serious bone injuries. However,
it is necessary to use them properly; otherwise improper use can result in nonunion of
the fractured bones, damage to body tissues and infection.
Thank you