Hip

Question 1

X-Ray views of Pelvis (5)

Answer 1

AP, Unilateral Frog Leg, Judet, Inlet, Outlet

Question 2

AP View

Answer 2

-typically includes both proximal femurs -Notice symmetrical appearance: pelvic halves, obturator foramen, acetabular depth, cartilage thickness, femoral head shape, femoral rotation -Alignment: Pubic symphysis, SI jt

Question 3

Shenton’s line

Answer 3

curve of medial femur –> pubis

Question 4

Iliofemoral line

Answer 4

curve of lateral femur from troch to ilium

Question 5

Femoral neck angle line

Answer 5

normal = 125-135

Question 6

Answer 6

draw in lines

Question 7

Unilateral frog Leg

Answer 7

• femur viewed Medial to Lateral because of rotated postion
• *Better view for Lesser Trochanter

Question 8

Radiographic Teardrop

Answer 8

• radiographic condensation of the innominate bone at the inferior end of the acetabulum. A normal teardrop is U shaped
• located at apex of obturator foramen

Question 9

Judet View

Answer 9

= Pelvic oblique view

-shows iliopubic bridge and posterior acetabular rim

OR

-ilioischial bridge and anterioir acetabular rim

Question 10

Pelvic Inlet/Outlet View

Answer 10

shows transverse diameter of pelvic outlet and anteroposterior diameter of pelvis outlet

Question 11

Stable Pelvic Fracture (4)

Answer 11

• At most one fx through pelvic rim
• Avulsions
• Iliac wing fracture
• Sacral Fx

Question 12

Unstable Pelvic Fx (3)

Answer 12

• At least 2 fx through pelvic ring
• Can include dislocated joint
• Often major hemorrhage and life threatening

Question 13

Answer 13

Stable

A) avulsions of ASIS, AIIS, Ischial tub

B) iliac wing fx

C) sacral fx

D) ipsalateral pubic rami fx

E) contralateral pubic rami fx

Question 14

Answer 14

UNSTABLE

A/B/C are vertical shear (Malgaine) fx, involving ischiopubic rami and disruption of ipsa SI jt

A) disruption through jt itself

B) fx through sacral wing

C) fx of iliac bone

D) straddle fx (all 4 ischopubic rami)

E) bucket handle – both ischiopubic rami on one side and contralateral SI

F) dislocations of one or both SI and pubic symphysis

Question 15

Fx of the Proximal Femur

Answer 15

• extra- or Intra- capsular
• Intracapsular have higher risk complications from disruption of circumflex femoral artery
• Comlications = AVN, delayed union, non-union

Question 16

DJD of Hip – Hallmarks (5)

Answer 16

• Jt space narrowing
• sclerotic subchondral bone
• osteophyte formation
• cysts/pseudocysts in subchodral bone
• superior migration of hum head

Question 17

DJD – RA vs OA

Answer 17

• RA: concentric narrowing of entire jt space, head migrates into acetabilum
• OA: WB surface loses cartilage, head moves sup.

Question 18

RA of the Hip (5)

Answer 18

• Periarticular osteoporosis
• Symmetric concentric jt space narrowing
• Synovial cysts in periarticular bone
• Axial migration hum head
• acetabular protrusion

Question 19

Avascular Necrosis

Answer 19

• Unilat or Bilat
• crescent sign early
• Casued by: trauma, infection, radiation, lupus, giant cell arthritis, thromboembolism

Question 20

Slipped Capital Femoral Epiphysis

Answer 20

• Most common disorder of hip in adolescence
• onset often coincides w growth spurt
• head of femur slips off neck at growth plate
• higher incidence heavier boys

Question 21

DDH of the Hip – Lines

Answer 21

• A = Hilgenreiner’s line – horizontal through junctions of iliac/ischial/pubic bones
• B = Perkin’s Line – Perpendicular line through outer edge of acetabulum.

*medial beak of femoral metaphysis should lie in lower inner quadrant

• C = Angle of a line connecting inner and outer edges of acetabulum (C) and horizontal (A), Should be <30
• D = Shenton’s Line – smooth continuous curve along inferior border of neck, connecting to inferior border of superior pubic ramus