OSCE Image Critique - Rotation, tilt and angulation

Superior midcoronal tilt anteriorly

Superior midcoronal tilt posteriorly

Inspiration did not occur, lungs are not filled with air

• Manubrium at 5th vertebrae

• More than 2.5cm of apices are demonstrated above clavicle

Patient’s superior midcoronal is tilted anteriorly

Lungs without full aeration 

Inferior sagittal plane tilted towards IR

Right thorax rotated posteriorly

Right thorax rotated anteriorly

• Unequal concavity between phalanges and MCs

• Hand was slightly externally rotated

• Distal phalanges are foreshortened and distorted

• Hands and fingers were flexed 

• 3rd - 5th bases of MT are not superimposed

• Under rotation with obliquity less than 45 degrees

• Bases of 3rd - 5th MT are overly superimposed

• Overrotation with more than 45 degrees obliquity

• base of 2nc MCP are not superimposed and carpal bones are not superimposed

• Internal rotation 

• 5th metacarpal is in profile

• Slight external rotation

• 2nd metacarpal is in profile

• Slight internal rotation

• The 2nd through 5th MC midshafts are not superimposed, and the 5th MCs anterior to the 3rd through 4th MCs.

• External rotation 

• Unequal concavity and greater concavity and soft tissue width is closer to the thumb

• External rotation of thumb

• Foreshortening of distal phalanx 

• Finger was not flexed 

What’s wrong with this oblique finger projection? 

• More than 45 degrees obliquity 

• Over-rotation 

What’s wrong with this oblique finger?

• Less than 45 degrees obliquity

• Under-rotation

• 1st and 2nd mc bases are superimposed

• Slight internal rotation

What is wrong with this oblique wrist xray

• Under-rotated

• Less than 45 degree obliquity

Proximal arm elevated

• 5th shaft of MC is in profile 

• External rotation 

• Shaft of thumb MC is if profile

• Internal rotation

• Proximal tib/fib are not superimposed

• Elbow externally rotated and wrist internally rotated

• Over superimposition of tib/fib

• Elbow internally rotated

• More than 1/8 of the radial head is superimposing with the ulna

• Less than 1/8 of the radial head is superimposing with the ulna

• External rotation

What is wrong with this external oblique elbow?

• Superimposition of proximal tib/fib

• Obliquity is less than 45 degrees, meaning its under-rotated

• Radius and ulna are not superimposed, but coronoid can be seen

• Over-rotation with obliquity of more than 45 degrees

• the distal capitulum surface is demonstrated too far distal to the distal surface of the medial trochlea and the radial head is placed too far posteriorly to the coronoid process

• Proximal humerus is elevated 

• Distal capitulum is too far proximal to the distal medial trochlear surface of the radial head is too far anterior to the coronoid process

• Distal forearm is depressed

What is the issue with this oblique foot? 

• First digit of the phalanx is superimposing with 2nd and third 

• Over-rotation with more than 45 degrees obliquity 

• The medial talar dome is demonstrated anterior to the lateral talar dome

• Over-rotated/ external rotation

• The medial talar dome is demonstrated posterior to the lateral talar dome

• Under-rotated/ internal rotation

• Medial talar dome is anterior to the lateral dome

• Fibula is more posterior

• Foot is externally rotated

• Medial talor dome is posterior to the lateral dome

• Foot is internally rotated

• tibia superimposes more than ½ of the fibular, medial mortise is closed

• Anterior tibial margin is lateral to posterior margin

• External rotation

• tibia superimposes less than ½ of fibula, medial mortise is closed

• Posterior tibial margin is lateral to anterior and is superimposed by talus

• Internal rotation

What are issues with this mortise ankle?

• Insufficient obliquity/ under-rotated

• the tibia superimposes more than 1/4 of the fibula, and the lateral and medial mortises are closed

What are the issues with this mortise ankle?

• the tibia superimposes less than 1/4 of the fibula, and the lateral and medial mortises are closed

• Excessive obliquity/ over-rotated 

What are the issues with this mortise ankle?

• Posterior and anterior tibial margin can be seen

• Distal leg is elevated

What are the issues with this mortise ankle?

• Medial mortise is closed, and anterior tibial margin has been projected proximal to the posterior margin

• Distal tibia has been elevated

What are the issues with this ankle?

• Foot is not dorsiflexed

• the medial talar dome is demonstrated posterior to the lateral talar dome and the fibula will be demonstrated more anteriorly on the tibia

• Internal rotation

• the medial talar dome is demonstrated anterior to the lateral talar dome and the fibula is more posterior on the tibia 

• External rotation 

• The lateral talar dome is proximal to the medial dome, the height of the medial longitudinal arch appears less than it actually is, and the talocalcaneal joint is narrowed.

• Proximal lower leg has been elevated

• Tibia superimposed with less than ¼ of fibula head

• Internal rotation

• Tibia superimposes more than ½  of the fibular head

• Internal rotation/ under-rotated 

• Tibia superimposes less than ½ of the fibular head

• External rotation/ under-rotated

• Less than ½ of the fibula head is superimposing with tibia 

• Internal rotation 

• More than ½ of the fibula head is superimposing with tibia

• External rotation

What are the issues with this AP knee?

• Intercondylar fossa is shown

• Knee is flexed and not straight