Ch. 8 Pelvis and Hip Flashcards
Which bones make up the pelvis?
4 Bones
- Two hip bones, Sacrum, and Coccyx
What bones form the pelvic girdle?
Only the two hip bones
The hip bone is often referred to as the __
Os Coxae
The hipbone is composed of these 3 bones ___ which join together to form the ___, a cup-shaped socket that receives the head of the femur.
- Ilium, Ischium, and Pubis
- Acetabulum
The hip bone is further divided into two distinct areas:
What are these columns used for?
ilio-pubic column, and ilio-ischial column
These columns are used to identify fractures around the acetabulum
The ilium consists of a body and a board, a curved portion called the ___.
The body of the ilium forms the __ acetabulum
- Ala
- 2/5th of the superior acetabulum
The ala has 3 borders:
Anterior, Posterior, and Superior
The anterior and posterior borders present four prominent processes called:
Anterior superior iliac spine
Anterior inferior iliac spine
Posterior superior iliac spine
Posterior inferior iliac spine
The ___ is an important and frequently used radiographic positioned reference point
ASIS
The superior margin of the ilium is called the ___
iliac crest
The posterior inferior portion of the ilium ends in the ___
Greater sciatic notch
The pubis consists of a:
Body, the superior ramus, and the inferior ramus
The body of the pubis forms approximately __ of the ___ acetabulum.
- One-fifth (1/5th)
- Anterior
The inferior ramus of the pubis joins the:
ischium
The ischium consists of:
A body and ischial ramus
The body of the ischium forms the ___ of the acetabulum.
Posterior 2/5ths
The ischial ramus joins with the ___ of the pubis.
Inferior Ramus
The expanded portion on which the trunk rests when seated is called the ____.
ischial tuberosity
The rami of the pubis and the ischium enclose the ___.
Obturator Foramen
At the super posterior border of the body ischium is a prominent projection called the ___
ischial spine
An indentation just below the ischial spine is called the ___
Lesser sciatic notch
The longest, strongest, and heaviest bone in the body is the ____
Femur
The proximal end of the femur consists of a ___ and ___ and two large processes called the ____
- Head and neck
- Greater and lesser trochanter
The femur neck projects ___from the body
Medially, superiorly, and anteriorly
The __ is constricted near the head but extends to a broad base at the body of the bone.
(Femur)
Neck
The ___ are situated at the junction of the body and the base of the neck.
(Femur)
Trochanters
The less prominent ridge connecting the trochanters anteriorly is called the ___.
Intertrochanteric line
The __ trochanter is at the superolateral part of the femoral body and the __ trochanter is at the posteromedial part.
Greater trochanter, lesser trochanter
The femur ___ and ___ are two common sites of fracture in elderly adults
Femoral Neck and intertrochanteric crest
The prominent ridge between the trochanters at the base of the neck on the posterior surface of the body is called the ___.
(Femur)
Intertrochanteric crest
The angulation of the femoral neck varies with, ____ , ____ , & ____
age, sex, and stature
In the average adults, the femoral neck projections anteriorly from the body __ and superiorly at approximately ___.
- 15 to 20 degrees
- 120 to 130 degrees
The longitudinal plane of the femur is __ from vertical
10 degrees
In ___ the latter angle is wider, meaning the neck is more ___
(Femur)
Latter angle is the angle between the femurs neck and shaft. (I think)
-Children
-Vertical
A wide pelvis results in a ___ angle meaning the neck is more ___
- Narrower
- Horizontal
The articulation of the head of the femur and the acetabulum is a ___ type of joint
Synovial ball and socket
The junction of right and left pubic bones in the midline forms the __.
It is a ___ joint
- Pubic Symphysis
- Cartilaginous symphysis
The articulation between the right and left illa and the sacrum form the _
Sacroiliac joints (SI)
The two SI joints angle ___ from the MSP and are ___ joints
- 25-30 degrees
- Synovial irregular gliding
The female pelvis is __in structure than the male pelvis
Lighter
In shape, the female pelvis is __ and __ and the inlet is __ and more __ in shape
- Wider
- Shallower
- Larger
- Oval
The width and depth of the pelvis vary with __ and __
Stature and Gender
The region between the inlet and outlet is called the ___
(Pelvis)
Pelvic Cavity
The bony landmarks used in radiography of the pelvis and hips are _
iliac crest
ASIS
Pubic symphysis
Greater trochanter
Ischial tuberosity
Tip of coccyx
The highest point of the iliac crest is located on the posterior aspect of the _
ilium
The highest point of the greater trochanter lies in the same horizontal plane as the midpoint of the _ and _
- Hip Joint
- Coccyx
The most prominent point of the greater trochanter is in the same horizontal plane as the _
Pubic Symphysis
When used properly ___ rotation assists in the localization of the hip and pelvis centering points and avoids __ of the femoral neck during radiography
Medial, foreshortening
The greater trochanter is most prominent __ and more easily palpated when the lower leg is __ rotated
- Laterally
- Medially
The __ can be localized by palpitation of the lateral surface of the hip region because it lies in the same horizontal plane as the ___
Pubic symphysis
Greater trochanters
The hip joint can be localized by palpating the ___ and the ___ to ascertain the ___ of the pubic symphysis.
- ASIS
- greater trochanter
- superior margin
The midpoint of an imaginary line connecting the ASIS to the pubic symphysis is directly above the center of the dome of the _
Acetabular Cavity
An imaginary line drawn at a _ from the first line lies _ to the long axis of the femoral neck
- Right angle to midpoint
- Parallel
The femoral head lies __ distal and the femoral neck is __ to this midpoint
1.5 inches
2.5 inches
For an AP projection of the pelvis, place patient ___ on the table
Supine
For an AP projection of the pelvis, An IR size of _ crosswise is used
14 x 17 Crosswise
For an AP projection of the pelvis, Center the ___ plane to the midline of the grid, and medially rotate the feet and lower limbs ___ degrees to place the femoral necks ___ to the IR
- MSP
- 15-20 degrees
- Parallel
For an AP projection of the pelvis, The heels are placed _ apart for the AP pelvis projection
8-10 inches
For an AP projection of the pelvis, Check for __ distance on each side to ensure no rotation of the pelvis
Equal
For an AP projection of the pelvis, The upper border of the IR should be __ above the iliac crests
1 and a half inches
For an AP projection of the pelvis, The central ray is __ to the IR entering 2” inferior to the __ and 2’ superior to the __
- Perpendicular
- ASIS
- Pubic Symphysis
AP Pelvis projection, Adjust the radiation field to ___ on the collimator. For smaller patients collimate ___ beyond the skin shadow on the sides
-14x17 Crosswise
-1 inch
AP Pelvis Projection, What structures are shown?
(Pg. 395)
An AP projection of the pelvis and of the head, neck, trochanters, and proximal one-third or one-forth of the shaft of the femur
Evaluation Criteria for an AP Pelvis Projection:
(Pg. 395)
-entire pelvis and proximal femur
-both ilia and greater trochanters equally distance from the edge of the radiograph
-lower vertebrae column centered to the middle of the radiograph
No rotation of pelvis
- ischial spines equally seen
- Sacrum and coccyx aligned with the pubic symphysis
Proper rotation of proximal femurs
- femoral necks in their full extent without superimposition
- greater trochanters in profile
- lesser trochanters, if seen, visible on the medial boarder of proximal femur
An AP oblique projection of the femoral necks is called the ___ method; commonly called the bilateral __ position.
This method is contraindicated if __ is suspected
- Modified Cleaves
- Frog-leg
- Fracture of pathology
An AP oblique projection of the pelvis, The patient is placed __ on the table. Center the __ to the midline of the grid and adjust the patient so there is _ of the pelvis
- Supine
- MSP
- No rotation
(AP Oblique, Modified Cleaves, Frog-Leg)
For a bilateral projection equally __ the thighs as much as possible and turn the patients feet inward to place the __ against each other.
The thighs should be approximately ___ from the vertical plane if possible.
Center the feet to the ___ of the grid.
Center the IR 1 inch superior to the __
- Abduct
- Soles of the foot
- 25-45 degrees depending on how vertical the femur can be placed
- Midline
- Pubic Symphysis
The CR for the bilateral projection is perpendicular to the __ plane and ___ to the pubic symphysis.
For the unilateral projection, the central ray is perpendicular to the ____ .
- MSP and 1 inch superior
- Femoral neck
For a unilateral projection, center the ASIS of the __ to the midline of the grid.
Flex the ___ & ___ and draw the foot up to the ___ as much as possible; abduct the thigh approximately ___ laterally. The pelvis may slightly rotate.
- Affected Side
- Hip and Knee
- Opposite Knee
- 45 degrees
For the bilateral projection adjust the radiation field to __ and collimate __ beyond the skin shadow on the sides. For the unilateral projection, adjust the radiation field to __ beyond the skin shadow on the sides.
14 x 17 Crosswise
1 inch
1 inch
For a bilateral image, AP Oblique
Structures Shown Include:
(Pg. 399)
Femoral heads, neck and trochanteric areas onto one radiograph for comparison.
AP Oblique (Modified Cleaves, bilateral frog-leg)
Evaluation Criteria:
(Pg. 399)
-no rotation of the pelvis, as demonstrated by a symmetric appearance
-acetabulum, femoral head and femoral neck
-Lesser trochanter on the medial side of the femur
-femoral neck without superimposition by the greater trochanter; excess abduction causes the greater trochanter to obstruct the neck
-femoral axes and extended from the hip bones at equal angles
For an AP projection of the hip, an IR size of __ is used
10 x 12 lengthwise
For an AP projection of the hip, Place the patient __ on the table and adjust the pelvis so that it is __.
This is done by making sure the ASIS-to-tabletop distance is ____ .
- Supine
- Not rotated
- Equidistant from table
For an AP Projection of the hip, Medially rotate the lower limb and foot approximately _ to place the femoral neck _ to the IR
- 15-20 degrees
- Parallel
For an AP Projection of the hip, The CR is perpendicular to the __.
This is done by using the localization tech in which the CR is placed approximately __ to a line drawn perpendicular to the midpoint of a line between the ASIS and the _
- Femoral neck
- 2.5 inches distal
- pubic symphysis
For an AP Projection of the hip, Center the IR to the central ray and adjust the radiation field to __
10 x 12 lengthwise
Structures Shown for an AP Projection of the Hip include:
(pg. 403)
Do you need to include the iliac crest on an AP projection of the hip?
The head, neck, trochanters, and proximal one-third of the femur body.
- No!
Evaluation criteria for AP Projection of the Hip:
(Pg. 403)
-regions of the ilium and pubic bones adjoining the pubic synthesis
-proximal 1/3 of the femur
-Femoral head, penetrated and seen through the acetabulum
-Entire long axis of the femoral neck, not for shortened
-greater trochanter in profile
-lesser trochanter usually not projected beyond the medial border of the femur or only a very small amount of the trochanter visible
For a lateral projection (Lauenstein and Hickey) of the hip, an IR size of ___ is used
10 x 12 crosswise
For a lateral projection of the hip, Place the patient in the _ position and rotate slightly _ to an oblique position. The degree of obliquity depends on how much the patient can _
- Supine
- Towards the affected side
- Abduct the leg
For the Lauenstein method, the CR is __ through the hip joint and enters midway between the ___
- Perpendicular
- ASIS and pubic symphysis
For a lateral projection of the hip, Center the __ hip to the midline of the grid, __ the affected knee and draw the thigh up to almost a __ to the hip bone.
Keep the body of the affected femur __ to the table.
-affected
-flex
-right angle
-parallel
For the Lowenstein method, Adjust the radiation field to _ inches
10 x 12 crosswise
Structures shown for the Lowenstein Method:
pg. 404
A lateral projection of the hip, including the acetabulum, the proximal end of the femur and the relationship of the femoral head to the acetabulum
Evaluation Criteria for Lateral Projection of the Hip
pg. 404
-hip joint center to the radiograph
-Hip joint, acetabulum, and femoral head
-Femoral neck overlapped by the greater trochanter in the Lauenstein method
-with the cephalic angulation in the hickey method, the femoral neck, free of superimposition
The Axiolateral hip, Danelius-miller method, is often called the __ or ___ projection. This is performed with the patient in the __ position
- Cross table or Surgical-lateral
- Supine
The Axiolateral hip; Danelius-miller method, When examining a patient who is thin or lying on a soft bed, __ the pelvis on a firm pillow or folded sheets to center the __ to the midline of the IR.
- Elevate
- most prominent point of the greater Trochanter
The Axiolateral hip, Danelius-miller method
Flex the __ and ___ of the unaffected side to elevate the thigh in a ___ position.
- knee and hip
- vertical
Rest the IR _ with the upper border _ above the _
Vertical, in soft tissue, iliac crest
For the Axiolateral hip, Danelius-miller method
Unless contraindicated, rotate the affected limb ___ medially
15-20 degrees
The Axiolateral hip, Danelius-miller method, Place the IR _ with the upper border __ above the __
- vertical
- in soft tissue
- iliac crest
For the Axiolateral hip, Danelius-miller method
Angle the IR __ until it is exactly __ with the long axis of the femoral neck.
Support the IR in this position with __
- Away from body
- parallel
- sandbags or IR holder, alternately the patient can support the IR with a hand
The Axiolateral hip, Danelius-miller method.
The CR is __ to the long axis of the ___
Adjust the radiation field to __
Perpendicular
femoral neck
10 x 12 lengthwise
Axiolateral Projection; Danelius-Miller Method
Structures shown include:
The acetabulum, head, neck, and trochanters of the femur
(Pg. 407)
Evaluation criteria for the Axiolateral Projection; Danelius-Miller Method
- hip joint with the acetabulum
- femoral neck without overlap from the greater trochanter
- small amount of the lesser trochanter on the posterior surface of the femur
- small amount of the greater trochanter on the anterior and posterior surfaces of the proximal femur when the femur is properly inverted
- ischial tuberosity below the femoral head and neck
407
When performing the AP pelvis projection, where do you center the IR?
2 inches inferior to the ASIS and 2 inches superior to the pubic symphysis
If the lesser trochanter is visible in the medial portion of the radiograph, what does that mean?
The patient’s feet weren’t rolled enough medially
The cross-table hip can also be called what?
Danelius-miller method, Cross-table or Surgical-lateral projection
Do you need the top of the iliac crest on an AP Oblique Projection?
(Modified Cleaves, Bilateral Frog-leg)
No!
What is the central ray for a lateral hip projection using the Lauenstein Method?
Perpendicular through the hip joint, which is located midway between the ASIS and the pubic symphysis for the Lauenstein method
What is the central ray for a lateral hip projection using the Hickey Method?
Perpendicular through the hip joint, which is located midway between the ASIS and pubic symphysis, at a cephalic angle of 20 to 25 degrees and an additional 1 inch more inferior for the Hickey Method!
AP Hip centering:
Central is perpendicular to the femoral neck
- 10 length wise 12 crosswise
- medially rotate lower limb and feet approximately 15-20 degrees to place femoral neck parallel with the IR
Modified Cleaves Projection
(AP Oblique, frog-leg)
What is the Lauenstein and Hickey methods used to show?
To show the hip joint and the relationship of the femoral head to the acetabulum.
This position is similar to the modified cleaves.
AP Oblique Projection, can also be called?
Modified Cleaves and often called bilateral frog-leg
