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Diagnostic Imaging 2 > Hip > Flashcards

Hip Flashcards

1
Q

routine view of the pelvis

A

AP

typically includes both proximal femurs

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2
Q

AP view should notice:

A

Symmetrical appearance:

  • pelvic halves
  • obturator foramen
  • acetabular depth
  • cartilage thickness
  • femoral head shape
  • rotation of femurs

Alignment:

  • pubic symphysis
  • SI joints
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3
Q

AP view outline:

A

L5

Pelvis

  • bones of the coccyx
  • SI joint
  • sacrum, sacral forament
  • PSIS, ASIS, AIIS
  • sciatic notch
  • acetabulum (roof, ant and post rims)
  • pubic symphysis
  • sup and inf pubic ramus
  • radiographic teardrop
  • obturator foramen

Proximal femur

  • head
  • neck
  • greater trochanter
  • lesser trochanter
  • angle of inclination
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4
Q

routine unilateral view of the hip

A

AP view

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5
Q

what to notice in unliateral AP view of hip

A
  • spherical femoral head
  • thickness of cartilage (radiologic joint space)
  • bone density
  • osteophytes?
  • Shenton’s hip line
  • iliofemoral line
  • femoral neck angle (normal=125-135 deg)
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6
Q

unilateral AP view of the hip outline

A

Pelvis:

  • sacrum
  • obturator foramen
  • ischial tuberosity
  • acetabulum (sup, ant, post rims)
  • radiographic teardrop

Femur:

  • head
  • neck
  • greater trochanter
  • lesser trochanter
  • intertrochanteric crest
  • angle of inclination
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7
Q

Uni-lateral frog leg

A

routine view

  • femur is now viewed medial to lateral because of rotated position
  • better view for lesser trochanter
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8
Q

what to notice in unilateral frog-leg?

A
  • spherical femoral head
  • thickness of cartilage
  • bone density
  • osteophytes?
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9
Q

outline unilateral frog-leg

A

Pelvis:

  • sacrum
  • obturator foramen
  • ischial tuberosity
  • acetabulum (sup, ant, post rims)
  • radiographic teardrop

Femur:

  • head
  • neck
  • greater trochanter
  • lesser trochanter
  • intertrochanteric crest
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10
Q

oblique views

A

??
AP shows fractures around the acetabulum but bc of overriding it is difficult to determine where the fx is.

oblique views can better show the ilioischial and iliopubic bridges and the ant/post rims of the acetabular rim

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11
Q

stable pelvic fractures

A

don’t disrupt any of the joint articulations

Include:

  • avulsion fractures of the ASIS, AIIS< or ischial tuberosity (typically seen in athletes-forceful/repetitive ms contractions)
  • iliac wing fracture
  • sacral fracture
  • ischiopubic ramus fractures (at most 1 fx through the pelvic ring)
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12
Q

dashboard fractures

A

knee strikes the dashboard in a collision resulting in forces transmitted up the femur and into the acetabulum

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13
Q

unstable fractures

A

frequently associated w/ internal hemorrhage and life threatening

includes:

  • at least 2 or more fractures through the pelvic ring (can include dislocated SI joint)
  • vertical shear or malgaigne fractures
  • straddle fractures (all 4 ischiopubic rami)
  • bucket handle fractures (ischial and ipsilateral pubic ramus, and contralateral SI)
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14
Q

treatment for unstable pelvic fractures

A

internal fixations: compression screws/plates

external fixations

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15
Q

treatment for stable pelvic fractures

A

brief period of bed rest, analgesics and ROM exercises as tolerated.
rehab focuses on progressive mobility and

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16
Q

fractures of the proximal femur

A

classified as intra- or extra- capsular

intracapsular fractures have higher incidence of complications from disruption of circumflex femoral artery

  • avascular necrosis
  • delayed union
  • non-union
17
Q

intracapsular fractures

A

femoral head fx
subcapital fx
femoral neck fx

18
Q

extracapsular fractures

A

intertrochanteric fx
subtrochanteric fx
shaft fx

19
Q

hallmarks of DJD

A
  • joint space narrowing
  • sclerotic subchondral bone
  • osteophyte formation
  • cysts of pseudocysts in subcondral bone
  • superior migration of the femoral head
20
Q

difference b/w OA and RA

A

RA= entire joint space narrows. femoral head migrates into acetabulum

OA= WB surface loses cartilage space. femoral head moves superiorly

21
Q

RA of the hip

A
  • periarticular osteoporosis
  • symmetric concentric joint space narrowing
  • synovial cysts in periarticular bone
  • axial migration of femoral head
  • acetabular protrusion
22
Q

avascular necrosis of the hip

A
  • unilateral or bilateral
  • crescent sign early
  • disruption of blood supply near or within the proximal femur (trauma, infection, prolonged steroids)

thickening of the vessel wall

  • radiation therapy
  • lupus
  • giant cell arthritis

thromboembolism

  • alcoholism
  • diabetes
  • sickle cell disease
23
Q

slipped capital femoral epiphysis (SCFE)

A

=post/med displacement of the proximal femoral epiphysis (head of femur slips off neck at the growth plate)

  • most common disorder of the hip in adolescence
  • onset often coincides with growth spurts
24
Q

Developmental dysplasia of the hip (DDH)

A

=malformation of the hip joint found at birth or in young children learning to walk.

-because the head of the femur has not yet ossified, evaluation is often assessed by lines and angles between ossified structures

25
Q

DDH line A

A

Hilgenreiner’s line

horizontal junctions of iliac, ischial and pubic bones at the center of the acetabulum

26
Q

DDH line B

A

Perkin’s line
perpendicular line through outer edge of acetabulum

ossification of the femoral head, or the medial “beak” of the femoral metaphysis should be located in the lower, inner quadrant

27
Q

DDH line C

A

acetabular depth assessed by the angle of a line drawn joining the inner and outer edges of the acetabulum
this angle should be <30 degrees

28
Q

DDH line D

A

Shenton’s line
smooth continuous curve along the inferior border of the femoral neck connecting to the inferior border of the superior pubic ramus

29
Q

unipolar hip hemiarthroplasty

A

older design

solid ball the size of the original femoral head

30
Q

bipolar hip hemiarthroplasty

A
  • developed to try and reduce the motion and articular cartilage wear in acetabulum
  • despite lack of demonstrated benefit, bipolar prosthesis most commonly used today

Diagnostic Imaging 2 (6 decks)

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