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  • AP, lateral, skyline (to assess osteochondral fractures of the patellar surface), intercondylar (osteochondral fractures of femoral condyles, tibial spines).

A. Alignment

  • Lateral tibial plateau line: the lateral margin of the femoral condyle should be no more thatn 5mm outside the lateral margin of the tibial condyle.

B. Bones: AP view

  • Schazkter classification of tibial plateau fractures.
  • Beware: bipartite patella = patella with unfused secondary ossification centre, usually in the outer quadrant. Pellegrini-Steida lesion = calcification of the MCL due to old injury.

B. Bones: lateral view

  • Patella length: infrapatellar length ratio. Should be approximately 1:1.1 to 1:1.2.
  • Assess the lateral tibial plateau as 80% of fractures occur due to violent impaction of the lateral plateau.
  • Beware: fabella = sesamoid boje in the lateral head of the gastrocnemius.

S. Soft tissue

  • Lipohaemarthrosis: fat-fluid level = sign of intra-articular fracture.
  • Separation of the pre-femoral fat pad (suprapatellar fat-pad): haemarthrosis.


1. Goodman, L. and Felson, B. (2015). Felson's principles of chest roentgenology. 3rd ed. Philadelphia, PA: Elsevier, Saunders.
2. Dähnert W. Radiology Review Manual. LWW. (2011) ISBN:1609139437. Read it at Google Books - Find it at Amazon
3. Elizabeth Puddy, Catherine Hill; Interpretation of the chest radiograph, Continuing Education in Anaesthesia Critical Care & Pain, Volume 7, Issue 3, 1 June 2007, Pages 71–75, https://doi.org/10.1093/bjaceaccp/mkm014

Ⓒ A. Manickam 2018

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