 Hello everyone, I'm Dr. Chaitani Parekh, consultant musculoskeletal interventional radiologist, practicing advanced gen of diagnostic centers in Mumbai and today's session is a spotter session. It's on knee radiographs, particularly on internal derangement of the knee. We come across knee radiographs in a routine day-to-day life and knee radiographs actually provide us more information than just mere traumatic fractures. So just get your pen and paper and be a judge of yourself for this spotter session and I hope you learn something new from this session. Thank you. So now time for some spotters. What soft tissue structures were injured previously? Okay, think there are two soft tissue structures. Yes, yeah. So there is obviously an evidence of ACL reconstruction. So there was an ACL injury and yes, if you see here is your pelagrenous tata lesion. So obviously there was an ACL injury as well in the past. Okay, next spotter, 20 seconds, quick. You need your format, medial compartment, lateral compartment. Come on, start doing it. Hint, the left knee is involved. So just start looking at the left knee. Come on, come on, fast. Yeah, so this is a subtle finding. This was a OCD, medial femoral contract. You can see there is an auspicious defect. I don't, I have not put the lateral view and there was, believe me, there was no auspicious fragment which I could identify on the case basis. So it was a lateral femoral OCD. Next, what is the diagnosis? Again, this is a very subtle finding. If you go through your format, you'll find it. Be specific. Okay, time's up. So this was a second fracture which means that this patient had or has an ACL injury. Next, is this a primary or a secondary OA? Okay, I'm proud. Nobody is telling it's a primary OA. Very good. Yeah. So first thing, you can see that there is spices. So obviously this is a child. Okay. Child having an OA, primary is out of question. Secondly, you can see that there is a lot of irregularity, erosion and blah, blah, blah. So this was nothing but a post TB that child had landed up into OA. So it was a secondary OA. Next, this is again a very subtle finding. You need to run through your format to get this. Yeah. Evaluent fracture. Yes. But what Evaluent fracture? Okay, TBL spine is very broad. You have to be a bit specific. It's not Osgoode-Schlatter. Okay. Right. So it is an ACL Evaluent fracture. You can see this is your ACL Evaluent fracture. And this important thing is the fracture is displaced superiorly. You can see this superior displacement, which is very important to put in the report. Okay, because then the patient will be walked up ahead and he needs to fix the bone back. Sorry for the X-ray quality. This was the best I could get. Again, come on. What is the diagnosis? Yes. So this is a PCL Evaluent fracture and this wasn't displaced. So I think everybody has got this answer. Right. Okay. What is the deformity? This is a very obvious thing. I'm just testing if somebody was sleeping in my lecture. Yes. Yes. Yes. This is not some rocket science. This is a valgus deformity. Very true. Okay. What is the diagnosis? Come on. No, it's not stress fracture. You don't get such big horrid stress fractures. It's not stress fracture. No, it's not even a lateral femoral condyle fracture. It's not Hofars. Yes. Mohan is the first person to get it right. It's not Osgoode-Schlatter. I don't see anything over here. Yes. Perfect Shubham. So it is an intra-articular fracture. So this is nothing but a shatka fracture. Someone else also reported as a shatka fracture. And if you'll see the fracture line is extending up to the medial fondyle as well. And it is reaching here up to the articular surface. There is no obvious articular surface step-up of gap. It's not a post osteotomy. It doesn't happen that way. Post osteotomy, you'll see a radionucent gap. So it's a shatka fracture. Last x-ray of the session. What is the diagnosis? The person who gets this right surely deserves a treat from. It's that difficult. And you have 20 seconds. I've only given you more time. I'm sure nobody's going to report this x-ray. Okay. Yes Shruti, you really deserve a treat from me. That's perfect. So this is a normal x-ray guys. Please remember when you start to report in a routine day life after out of 20 x-rays, your 18x's are going to be normal. So just because you have a format, don't start looking for something. Okay. If it's normal, it's normal. Have confidence and give it normally. Okay. And please remember, you cannot get quadriceps rupture on a radiograph unless there is a OSHA's evolution. You cannot diagnose quadriceps rupture. Many of you have been giving an answer as a quadriceps injury. Unless you see an evolution at the superior pole of Patila, I don't know if there is a quadriceps injury. It's as simple as that. I don't have MRI eyes in myself. Okay. So please don't report that. So this was a normal x-ray and thank you so much. I hope you've enjoyed the session. And by now you must have realized that knee radiographs provide much more information than just routine fractures. And I hope you will look out for these findings in your routine day to day radiograph reporting for the knee joint. If you have any queries, please write them in the comment section below and I'll get back to you. And if you've liked the session, please hit the like button and subscribe for the channel. Thank you.