AP Pelvis Flashcards
Check the lower 1/3 of the SI joints
DJD
OCI
AS
Check the inner portion of the pelvis for
Paget’s
Fractures
Protrusio Acetabuli
Check the outer portion of the pelvic inlet
Brim sign - early stage paget’s
Draw a line from outer portion of ilium to outer portion of ischium some portion of the femoral head is not inside this line
Kohler’s line
Congenital hip dysplasia
Hip dislocation
Congenital hip dysplasia
Putti’s triad - hypoplastic femoral head (smaller than usual)
Shallow acetabular shelf
Femoral head outside of acetabulum
Ortho exams congenital hip dysplasia
Telescoping
Ortolani’s
Barlows
Allis
DDX with hip dislocaiton by
Putti’s triad
Signs of trauma on film or in case hx
Refer congenital hip dysplasia
Pediatric orthopedist
Protrusio acetabuli
Axial migration of femoral head with uniform loss of joint space
Bilaterally most often occurs with RA
Seen with things that soften or weaken bone
Obliteration of kohler’s teardrop
Both heads of femur completely inside line - otto’s pelvis
Line of mensuration congenital hip dysplasia
Kohler’s
M/c/c protrusio acetabuli
RA (otto’s pelvis)
Causes of protrusio acetabuli
Pagets Fibrous dysplasia DJD Trauma Osteomalacia
Compare side-to-side ilium ischium and pubis
Color
Shape
Size
Pagets aka
Osteitis deformans
Pagets demographic
Males >50
Stages pagets
Stage 1 = lytic or destructive
Stage 2 = combined
Stage 3 = sclerotic
Stage 4 = malignant (osteosarcoma)
Causes cortical thickening in the spine called picture frame vertebrae
Increased bone density
Coarsened trabeculae
Bone enlargement
Bone softening causing basilar invagination
Paget’s
Bowing deformities
Pagets
Saber shin and sheppard’s crook
Radiographic signs in extremities
Pagets
Cotton wool appearance Blade of grass appearance Candle flame appearance Sheaves of wheat Sheaves of grain Brim sign
Labs pagets
Increased alkaline phosphatase
Urinary hydroxyproline
Special test pagets
Bone scan
If not malignant stage pagets refer to
Orthopedist
Physiologic resorption of normal bone replaced by fibrous tissue fills medullary cavity
Fibrous dysplasia
Saber shin tibia
Sheppard’s crook
Pagets
Fibrous dysplasia
Ground glass appearance
Cafe au leit spots with coast of maine appearance
Rind sign
Fibrous dysplasia
Cob web appearance
Fibrous dysplasia
Thick slerotic rind around radiolucent center
Rind sign
Fibrous dysplasia NEVER goes
Into epiphysis
Pagets vs fibrous dysplasia
Go to medulla vs soft tissue
Same color = fibrous dysplasia
Medulla whiter = pagets
Saddle fracture
Bilateral ischial and pubic fx
Avulsion fractures
ASIS - sartorius
AIIS - rectus femoris
Rider’s bone
Avulsion of the ischial tuberosity caused by forceful hamstring contraction - kicking horse to move
Compare side-to-sside femoral head and acetabulum
White = AVN until prover otherwise
DJD
AVN
Mallum Coxa Senilis
DJD of the hip
> 40
Superior lateral joint space is decreased or missing
Whitening of femoral head similar to whitening on acetabulum above
AVN of the hip
Superior lateral joint space is PRESERVED
Femoral head is whiter in appearance/thickness compared to acetabulum above
M/c/c AVN of the hip
Trauma
2nd = corticosteroids
Mallum coxa senilis
Severe DJD of the hip
Decreased or missing superior lateral joint space
Lipping/spurring
Whitening of femoral head and acetabulum above
May see subchondral cyst (geode) with this condition
Compare side-to-side femoral neck and shaft
Shape - PFF, SCFE, etc
Deformity due to pagets or fibrous dysplasia in femoral shaft
Sheppards crook deformity
SCFE
Boys 10-16
Usually overweight
Salter harris type 1 fracture
Femoral head slides inferior and medial/femoral neck slides superior and lateral
Slipped capital femoral epiphysis
SCFE
Slipped capital femoral epiphysis
Lines SCFE
Klein’s
Skinner;s
Shenton’s
View SCFE
Frog leg view
Case management SCFE
Orthopedist
Legg calve perthes
AVN of the femoral head
Boys 4-9
Painless limp or referred pain to groin and knee with lots of abduction and internal rotation
Radiographic signs legg calve perthes
Fragmentation of the femoral head (crescent sign)
Flattening of the femoral head
Increase white denisty of the femoral head (snowcap sign)
Increased joint space
Healed legg calve perthes
Mushroom shaped appearance
Case management legg calve perthes
Refer to orthopedist for A brace
If left untreated legg calve perthes
Can lead to early DJD (mallum coxa senilis) or hip replacement
Takes ___ for AVN to show up on x-ray
2 months
No open growth plates
No SCFE
M/c femoral fx
Subcapital
2nd m/c femoral fx
Intertrochanteric
2 avulsion fx
Greater trochanter - glute med/min
Lesser trochanter - iliopsoas
Check the soft tissue inside the pelvic inlet
Uterine fibroid Calcified prostate Ureter stones Phelboliths Bladder calculi
Mulberry round mass appearace
Round white density in center of pelvic inlet
Uterine fibroid
Fibroid cyst
Leiomyoma
M/c benign tumor in females
Uterine fibriod
Pain, abnormal bleeding
Uterine fibroid
Location uterine fibroid
Midline horizontally
Case management uterine fibroid
Refer to OB/GYN
imaging = US
White spotty raspberry or blackberry on top of pubic symphysis
Calcified prostate
Dysuria
Urinary hesitancy
Male
>50
Calcified prostate
Labs calcified prostate
PSA
Acid phosphatase elevated
metastasis prostate
Lumbar spine
Mets
Alkaline phosphatase
White densities upper half and lateral portion of pelvic inlet
Ureter stones
Line on top of femoral heads
Above line = ureter stones
Below line, size of eraser tip = phleboliths
Below line much larger = bladder calculi
Calcifications within veins, asymptomatic
Phleboliths
White densities bottom half of pelvic inlet within the bladder location
Bladder calculi
