X-ray of fractures

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Author: Mikael Häggström [notes 1]



Patient groups:

General evaluation

Even if there's an initial obvious fracture, evaluate:

  • Bone contours for disruptions
  • Bone areas for unusual lines that are either hypoattenuating (in case of separation) or hyperattenuating (in case of compression)


On projectional radiography ("X-ray") in general, the main types of misalignment of a fracture are:

Types of fracture misalignment:[1]
  • Displacement
  • Angulation
  • Distraction (making bone longer)
  • Impaction or shortening
  • Rotation


See also: General notes on reporting

First images

If no signs of trauma are seen, it is generally appropriate to negate skeletal damage and dislocations, with the latter word also excluding joint dislocations.

In case of fracture:

  • Location.
  • In particular, note any intra-articular extension (or suspicion thereof)
  • Any misalignment. Mild misalignment can often be described simply as such. On the other hand, if it is close to having an impact on orthopedic care, or generally for more severe misalignment, it is more appropriate to specify it in distance or angle. Because geometric magnification makes absolute distances less certain, they displacement should be compared to for example the thickness of the cortex or entire bone where feasible.


  • Any misalignment, or negation of it.
  • Signs of healing
Screw fracture in osteosynthesis material.
  • In case of osteosynthesis material, look for absence or presence of:
  • Change in position
  • Lucent zones around screws
  • Fracture of the material
  • Screw tips penetrating into soft tissues, or protruding screw heads


  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.


  1. . Introduction to Trauma X-ray. Radiology Masterclass. Retrieved on 2018-07-03.