Hip and Pelvis

Question 1

2 hip bones

Answer 1

•Sacrum
•Coccyx

Question 2

Hip bone

Answer 2

•Os coxae, coxal, or innominate bones
•Comprised of ilium, ischium, and pubis

Question 3

Acetabulum of the hip is the

Answer 3

Deep cup shaped depression on the lateral aspect of each hip bone

Question 4

The Obturator Foramen is the

Answer 4

•Large, oval shaped opening on inferior aspect of each coxal bone
•Formed by ilium, pubis, and ischium

Question 5

Joints of the Pelvis and Hip

Answer 5

Sacroiliac joint
•Synovial Gliding

Hip Joint
•Synovial Ball and Socket

Pubic Symphysis
•Cartilaginous symphysis

Question 6

Pelvis AP IR, Position, CR

Answer 6

IR: 14x17 CW
Top of IR usually 1-1.5” above iliac crests

Position:
•Supine with MSP centered
•Medially rotate the legs 15-20º (unless fractured)
•Pelvis is not rotated

CR: Perpendicular to IR; Midway between ASIS and pubic symphysis
Collimation: 14x17
Respiration: Suspend

Question 7

Pelvis AP Evaluation Criteria

Answer 7

-Entire pelvis and proximal femora
-Both ilia and greater trochanters equidistant to edge of the image
-Lower vertebral column centered No rotation of pelvis:
•Both ilia symmetric
•Symmetric obturator foramina
•Ischial spines equally seen
•Sacrum/Coccyx aligned
-Proper rotation of femora:
•Femoral necks
•Greater trochanters in profile

Question 8

For the hip and pelvis images ALWAYS include…

Answer 8

Entire length of hardware/appliance

Question 9

If leg is shorter than the other and resting on the side it could mean…

Answer 9

Fracture, do NOT rotate

Question 10

Hip AP IR, Position, CR, Collimation

Answer 10

-IR: 10x12 LW

-Position: Supine
•No rotation of pelvis (ASIS equidistant to table)
•Medially rotate the affected leg 15-20º (if no fracture/dislocation)

-CR: Perpendicular to the femoral neck
•2.5” distal on a line drawn perpendicular to the midpoint of a line between the ASIS and the pubic symphysis
•Alternative:
1-2” medial and 3-4” distal to ASIS

-Collimation: 10x12
-Respiration: Suspend

Question 11

Hip AP Evaluation Criteria

Answer 11

-Hip joint with ilium and pubic bones
-Proximal one third of the femur
-Entire long axis of femoral neck not foreshortened
-Greater trochanter in profile
-Lesser trochanter usually not projected beyond the medial border of the femur
-Any orthopedic appliance in its entirety

Question 12

Hip AP Oblique Modified Cleaves (Unilateral) IR, Position, CR, Collimation, Respiration

Answer 12

-IR: 10x12 CW

-Unilateral Hip Position:
•Center ASIS of affected side
•Flex knee, draw foot up to the opposite knee
•Abduct thigh laterally to 45º

-CR: Perpendicular to the femoral neck
-Collimation: 10x12
-Respiration: Suspend

Question 13

Hip AP Oblique Modified Cleaves (Bilateral) IR, Position, CR, Collimation, Respiration

Answer 13

-IR: 14x17 CW

-Bilateral “Frog Leg” Position:
•Flex hips and knees to bring femora in vertical position
•Center 1” superior to pubic symphysis at MSP
•Abduct thigh laterally to 45º and place soles of the feet together

-CR: Perpendicular entering the MSP at the level 1” superior to the pubic symphysis
-Collimation: 14x17
-Respiration: Suspend

Question 14

Hip AP Oblique Modified Cleaves Evaluation Criteria

Answer 14

-No rotation of pelvis
Acetabulum, femoral head, and femoral neck
-Femoral neck without superimposition by greater trochanter
-Lesser trochanter on the medial side of the femur

Question 15

Hip Lateral (Lauenstein Method) IR, Position, CR, Collimation, Respiration

Answer 15

-IR: 10x12 CW

-Position:
•From supine, rotate toward affected side
•Flex knee and draw thigh up to right angle to hip
•Body of femur parallel to the table
•Rotate pelvis no more than necessary

-CR: Perpendicular to the hip joint
•Midway between ASIS and the pubic symphysis
-Collimation: 10x12
-Respiration: Suspend

Question 16

Hip Lateral(Lauenstein method) Evaluation Criteria

Answer 16

-Hip joint centered
-Hip joint, acetabulum, and femoral head
-Femoral neck overlapped by greater trochanter

Question 17

The Hip Lateral is used to show the relationship of…

Answer 17

The femoral head to acetabulum

Question 18

What view do you do if patients hip is fractured?

Answer 18

Hip axiolateral aka the Danelius Miller Method

Question 19

Hip axiolateral (Danelius Miller Method) IR, Position, CR, Collimation, Respiration

Answer 19

-Cross table or surgical lateral
-IR: 10x12 LW grid cassette
-Position: Supine
•Elevate patient
•Flex knee/hip of unaffected side and rest on sponge or leg holder

-CR: Perpendicular to the femoral neck
•Enters groin midway between the anterior and posterior surfaces of the thigh

-Collimation: 10x12
-Respiration: Suspend

Question 20

Hip axiolateral (Danelius Miller Method) Evaluation Criteria

Answer 20

-Hip joint with acetabulum
-Femoral neck without overlap from the greater trochanter
-Small amount of lesser trochanter on the posterior surface of femur
-Small amount of greater trochanter on the ant/post surfaces of the proximal femur
-Ischial tuberosity below the femoral head and neck
-Any orthopedic appliance in its entirety

Question 21

What if patient can’t raise unaffected side of the hip?

Answer 21

Hip: modified Axiolateral Clements-Nakayama modification

Question 22

Projection used for bilateral hip fractures or patient is unable to move unaffected side?

Answer 22

Hip: modified Axiolateral Clements-Nakayama modification

Question 23

The Axiolateral Danelius Miller method is used for ________ patients

Answer 23

Trauma

Question 24

Hip axiolateral (Danelius Miller Method) has the same evaluation criteria as the…

Answer 24

Hip: modified Axiolateral Clements-Nakayama modification

Question 25

In which view does the femoral neck overlap the greater trochanter?

Answer 25

Hip Lateral(Lauenstein)

Question 26

Which bones of the pelvis compromise the acetabulum?

Answer 26

Pubis, ischium, ilium

Question 27

Which method of the hip joint requires the femur to be abducted and parallel with the table?

Answer 27

Lauenstein hip

Question 28

On the Danelius-Miller method and Clements Nakayama method, a small amount of the _________ trochanter is shown on the posterior surface of the femur and a small amount of the ________ trochanter is shown on the anterior/posterior surfaces of the proximal femur

Answer 28

Lesser; Greater

Question 29

On the danelius-miller and Clements nakayama the ______ ________ is below the femoral head and neck

Answer 29

Ischium tuberosity