Chapter 6 - Lower Limb Flashcards
The talus articulates with four bones
Tibia
Fibula
Calcaneus
Navicular bone
The lateral malleolus lies apporximately ________ degreea more posterior the medial malleolus
15-20 degrees
How many degrees difference does medial and lateral condyles have?
5-7 degrees
- on lateral radiographs of the knee the central ray is angled 5-7 degrees cephalad to “open” the joint space of the knee
Is a raised bony area that receives the tendon of the adductor muscle, located in posterolateral aspect of medial condyle, assists in identifying over or underrotation in lateral knee radiograph
Adductor tubercle
Provide stability for the knee and also act as a shock absorber, are commonly torn during injury
Menisci
- Knee Arthrogramm or MRI - to visualize menisci
Avulsion fracture of the medial malleolus with loss of the ankle mortise
Pott’s Fracture
Lucent lesion in the metaphysis, usually at the distal femur
Osteoclastoma or Giant Cell tumor
Tangential Patella
More comfortable for Px
Px seated at end of table, foot vertical, plantar surface - 75 degrees angle with IR
Px hold toes for flexed position with strip or gaize bandage
CR - perpendicular to the head of first metatarsal bone
Holly Method
Tangential sesamoid
Px prone
Rest great toe on table on a dorsiflexion, ball of the foot perpendicular to horiZontal plane
Center IR to 2nd metatarsal
Lewis Method
Tangential Sesamod
Px in lateral recumbent position, unaffected side, flex knees
Foot lateral position w/ first Metatarsopahlangeal jt perpendicular to horizontal plane IR
CR - prominence of the first metatarsopahangeal joint at an agle 40 degrees toward heel
Causton Method
In foot oblique how many degrees the foot forms to the plane of IR
30 degrees
- if more than 30 degrees, lateral cuneiforms tends to be theown over the other cuneiforms
This projection is used to demonstrate the structural status of the longitudinal arch.
Weight bearing method
Lateromedial - Standing
Exactly place ap and lateral projections
For radiography of clubfoot, used to demonstrate anatomy of foot and bones or ossification centers of the tarsals and their relation to one another
Kite Methods
Congenital Clubfoot
Infant is held in a vertical or bending forward position
Plantar of the foot on IR
CR 40 degrees anterior theough lower leg
Kandel Method
Axial - Dorsoplantar
Cr for Axial Calcaneus (plantodorsal)
CR for Axial Calcaneus (dorsoplantar)
40 degrees cephalad
40 degrees caudad
Weight bearing method of calcaneus also called as
Coalition Method because it demonstrate calcaneotalar coalition
CR - 45 degrees anteriorly & posterior surface of flexed ankle, level of the base of fifth metatarsal
Demonstrate posterior articular facet of the calcaneus to determine the presence of joint involvement in cases of comminuted fracture
Broden Method
AP Axial Oblique Method
For demonstration of anterior talar articular surface - 45degrees oblique
CR - 1 inch distal & 1 inch anterior to the lateral malleolus
Isherwood Method (AP Axial Oblique)- Medial Rotation foot
Demonstration of the moddle talar articulation surface - 10 degrees
Demonstration for the posterior talar articulation surface - 10 degees cephalad to
CR - 1 inch distal to the medial malleolusp
Isherwood Method (AP Axial Oblique): medial rotation ankle
Isherwood Method: lateral rotation ankle
Shows posterior articulation of the subtalar joint in profile
Isherwood Method (AP Axial Oblique) - Lateral rotation ankle
Superior portion of calcaneus
Calcaneal sulcus
Are obtained after an inversion or eversion injury to verify the presence of a ligamentous tear
Stress studies of the ankle joint
Rupture in the ligament of ankle joint is demonstrated by
Widening of the joint space on the side of injury
CR for Knee AP, ASIS and the table top <19 cm (thin pelvis)
3-5 degrees caudad
CR for AP Knee, ASIS and tabletop 19-24 cm
0 degrees
CR for AP Knee, ASIS and tabletop >24 cm (large pelvis)
3-5 degrees cephalad
Why to we need to flex the knee in lateral position to 20-30 degrees
This position relaxes the muscles and shows the maximum volume of joint cavity
To prevent fragment separation in new or unhealed patellar fractures, the knee should not be flexed more than
10 degrees
CR for lateral knee
5-7 degrees cephalad
Leach, Gregg and Siber recommended that a bilateral weight bearing AP projection be routinely included in the radiologic examination of arthritic knees. Why is that?
They found that a weight nearing study often reveals narrowing of joint space that appears normal on the non-weight bearing study.
PA projection with knee flexed 45 degrees and CR directed 10 degrees caudad. Useful for evaluating joint space narrowing and demonstratong of articular cartilage disease.
Rosenberg Method
Px in kneeling position on the table, flex knee 70degree from table, CR 20 degrees for intercondylar fossa
Holmblad Method
Px in prone position, flex knee to either 40 or 50 degree angle, and rest foot on a suitable support. Angle CR according to the angle of the flex knees.
*Demonstrates an obstructed projection of the ontercondyloid fossa and the medial and lateral intercondylar tubercles of the intercondylar eminence.
Camp Coventry Method
PA Axial
Is usually included to detect loose bodies (“joint mice”), also used in evaluating split and displaced cartilage in osteochondritis dissecans and flattening, or underdevelopment of the lateral femoral condyle in congenital slipped patella.
Intercondylar fossa projection
In PA patella, how many degreas will the heel be rotated
5-10 degrees laterally
PA patella provides sharper recorded detail than in AP because
Closer OID
In Lat patella, how many degrees should the knee flexed
5-10 degrees flexion
- increasing the flexion reduces the patellofemoral joint space
☑️Px in prone position
☑️Elevate hip affected side 2-3 inches
☑️Laterally rotate knee 35-40 degrees from prone position
☑️CR at joint space bet patella and femoral condyles at an angle 25-30 degrees
☑️Will show a slightly oblique PA projection of patella with most patell free of superimposition
Kuchendorf Method (PA Axial Oblique)
☑️Px in prone position
☑️flex knee so that tibia and fibula form a 50-60 degree angle from table
☑️CR angle 45 degrees cepahalad to patellofemoral joint
☑️will show subluxation of patella and patellar fractures and allow assessment of the femoral condyles (all tangential)
Hughston Method (Tangential)
☑️Px supine both knees at end of table
☑️quadriceps muscle should be relax
☑️demostrates an axial projection of the patellae & patellofemoral joints
☑️ CR 30 degrees caudad with 40 knee flexion (60 degrees from vertical)
Merchant Method
Tangential Projection
☑️This projection should not be attempted until a transverse fracture of patella has been ruled out with lat image or if the patient is in pain
☑️Px prone or supine
☑️shows vertical fractures of bone and articulating surfaces of the patellofemoral articulation
Settegast Method
For projection of distal femur, rotate the patient’s limb _________to place it in true anatomic position.
Epicondyles are ___________ IR.
Internally
Parallel
