Antero-posterior View of Shoulder :

The middle and outer parts of the clavicle are well seen and are common fracture sites. Check the acromioclavicular joint to see if there is any subluxation or dislocation present. This should be confirmed by a weight-bearing view if suspected. Look for fractures and dislocations of the humeral head. Both anterior and posterior dislocations can be missed on this view unless another radiogram at a different angle is performed. Look for supraspinatus tendon calcification. Look for deformities of the rotator cuff, evidence of recurrent dislocation or occasional congenital foramina of the scapula.

   Superoinferior View of Shoulder (Axial with Abduction) :

This projection shows the position of the head of the humerus in relation to the glenoid cavity. It also shows, on this normal x-ray, that there is no dislocation. In patients with suspected dislocation, this x-ray may not be possible to obtain and a lateral shoot-through is a further method of evaluating displacement. Fractures of the coracoid process and acromion, although uncommon, can be visualized on this film. Fracture of the greater tuberosity, which may be missed on the anteroposterior projection, can again be seen.

   Antero-posterior and Lateral Views of Elbow :

Effusions into the elbow joint are commonly associated with undisplaced fractures of the radial head due to trauma. These radial head fractures may be difficult to see unless full projections are taken. The anterior and posterior fat pads are a particularly useful guide in assessing an effusion, as both will be elevated from their resting position against the distal end of the humerus. The two views are again needed in trauma cases to show any dislocation with or without associated fractures. A supracondylar fracture in children is particularly important because of the risk of a Volkmann's contracture due to ischaemic fibrosis. When the forearm bones are x-rayed for trauma, it is essential to have views of the joints at either end. This applies to any long bone examination. Fractures of the forearm bones are often paired, and if single fractures with displacement occur, then either wrist or elbow dislocation of the other bone must be looked for. Examples of this are fracture of the ulna with forward dislocation of the radial head (Monteggia) and fracture of the radial shaft with distal radio-ulnar dislocation (Galeazzi).

   Hand and Wrist :

Fractures and dislocations are particularly important in the wrist, as considerable incapacitation with osteoarthritis can result from delayed treatment. Note that fractures of the scaphoid may not show for 10 days following the injury. If a fracture of the waist of the scaphoid is mistreated, ischaemic necrosis of the distal fragment may result. It is important to learn the normal appearance of the positions of the carpal bones so that dislocations are not overlooked. Common fracture sites include the following: fracture of the distal radius and ulna with backward displacement (Colles' fracture); forward displacement of this fracture may occur which is relatively rare (Smith's fracture); fracture of the base of the first metacarpal (Bennett's fracture). Spiral fractures of the metacarpals and distal shaft fractures of the fourth and fifth metacarpal bones may follow a punch! Note that many systemic diseases have bony and soft tissue abnormalities which can be seen on a hand x-ray, e.g. hyperparathyroidism, scleroderma and rheumatoid arthritis.

   Postero-Anterior view of the Thorax :

This is the commonest radiogram taken and thus it is important that the normal anatomy is known thoroughly. As with any x-ray, a system must be devised so that all the film is looked at in turn. However, certain hidden areas on a chest film warrant special attention and these include: behind the first ribs, behind the heart shadow, the posterior costophrenic angles which are obliterated on this view by the diaphragmatic shadows, and the hilar regions. Note the air in the trachea and main extrapulmonary bronchi. Note that the hilar shadows are composed only of vessels and the normal intrapulmonary bronchi cannot be visualized. The right heart border is formed from the superior vena cava, right atrium and inferior vena cava. The left heart border is formed from the aortic knuckle, the pulmonary conus, the left atrial appendage and the left ventricle.

   Left Lateral View of Thorax :

The projection demonstrates mediastinal divisions into the superior, anterior, middle and posterior. Note the backwards slant of the trachea from the thoracic inlet to the carina. This slant should be borne in mind when tracheal tomograms are performed. Note the position of the outflow tract of the right ventricle and the high position of the left atrium. Note the position of the lung fissures, the left oblique fissure reaching its inferior limit about 5 cm behind the sternum. The right oblique fissure travels more anteriorly at its lower limit. Note also the apparently translucent anterior mediastinum in the normal.

   Antero-posterior View of Plain Abdomen :

This is a supine view to show the general layout of abdominal viscera. Note the slightly lower position of the right kidney compared to the left, due to the liver mass. Note the position of the spleen and liver edge. Note also the normal gas shadow in the antrum of the stomach. When considering abdominal films in patients with abdominal pathology, it is often essential to have an erect film in addition to the one shown. These two films are complementary in showing abnormalities. Look for bowel gas patterns, renal and gall bladder calculi, the psoas outlines, the normality of the bone structure, and check also the hernial orifices.

   Antero-posterior View of Pelvis :

The bones and soft tissues of the pelvis should be studied in this view. We have not included AP sacrum and specialized sacroiliac joint views as they do not add significantly to the normal anatomy demonstrated here. Fractures and dislocations occurring in the pelvic bones are particularly important in relation to their effects on the pelvic contents. As with any fixed bony ring, fractures and dislocations must be checked to make sure there is no further breach of the ring, as commonly occurs. Ramus fractures of the obturator ring are often multiple because of this. Look for dislocation of the femoral head in relation to the acetabular fossa and check the relationship of the SI joint. If there is suspected instability of the pubic symphysis, as occurs in professional sportsmen, particularly footballers, then films should be taken with the patient standing on one leg and then the other to see if there is any movement of the joint.