Hip and Pelvis Flashcards
What four bones does the pelvis consist of?
- right and left innominate ( os coxae) hip bone
- sacrum
- coccyx
What serves as the base of the trunk and a girdle for lower limb attachment?
Pelvis
How many bones is the pelvic girdle composed of?
two hip bones
What does the hip bone consist of?
- llium
- ischium
- pubis
What bones join together to form the acetabulum?
- ilium
- ischium
- pubis
What type of joint is the acetabulum?
A ball and socket joint
What does llium (I) belong to?
Belongs to the pelvis
What does lleum (e) belong to?
Belongs to the intestine
It consists of a body and a broad, curved portion called the ala
- Body forms superior two fifths of acetabulum
llium
What does “ala” mean?
Wing
What are the four prominent processes of the ilium?
- anterior superior iliac spine (ASIS)
- anterior inferior iliac spine
- posterior superior iliac spine
- posterior inferior iliac spine
What is the superior margin of the llium called?
iliac crest
What does the posterior inferior iliac spine end in?
the greater sciatic notch
What does the ischium consist of?
- body
- ischial ramus (superior and inferior)
What forms the posterior two fifths of the acetabulum?
ischium
What does the ischial ramus join with?
The inferior ramus of pubis
What are the only places that you are able to palpate on the pelvic girdle?
- anterior superior iliac crest (ASIS)
- iliac crest
Expanded portion on which the trunk rests when seated (what we sit on)?
ischial tuberosity
Located on the upper, posterior part of the ischium body?
ischial spine
Is the indentation located just below the ischial spine?
Lesser sciatic notch
What does the pubis consist of?
- body
- superior ramus
- inferior ramus
Is the side down elongated or foreshortened?
Elongated
Is the side up elongated or foreshortened?
Foreshortened
What forms approximately one fifth of the anterior acetabulum?
The body of the pubis
Formed by junction of the ischial ramus and pubis inferior ramus
Obturator foramen
What helps form the obturator foramen?
Ischial tuberosity
Tell tail sign if there’s a fracture
Obturator foramen
What does the proximal femur consist of?
- head
- neck
- greater trochanter ( out to the lateral)
- lesser trochanter ( out to the medial)
An imaginary line that goes from greater to lesser on the anterior aspect?
Intertrochanteric line
Located on the posterior aspect of the proximal femur that is actually grooved in?
Intertrochanteric crest
Articulation between the right and left ilia and the sacrum?
- expand during pregnancy
Sacroiliac (SI) joint
The Sacroiliac (SI) joint is considered a?
irregular, gliding type
Articulation of the head of the femur with the acetabulum?
Hip joint
What is the hip joint considered to be?
Synovial, ball and socket type
How much do you need to turn your feet in to see the neck of the femur?
20 degrees
Junction of right and left pubic bones in the midline?
Pubic symphysis
What joint is the pubic symphysis considered to be?
Cartilaginous, slightly movable joint
At what angle do the (SI) joints come in?
Angles of 25 to 30 degrees
Can we palpate the pubic symphysis?
Yes but we do not touch the pubic symphysis
Pelvic anatomy
- heavier, narrower, and deeper
- angle at pubic symphysis is acute
Males pelvis
Pelvic anatomy
- wider, shallower and lighter
- angle at pubic symphysis is obtuse
Females pelvis
Forms the superior aperture or inlet of the true pelvis?
Brim of the pelvis
What does the inferior aperture form of the pelvis
The outlet
The region above the brim is called the?
false or greater pelvis
The region below the brim is called the?
true or lesser pelvis
The bony landmarks used in a radiography of the hip and pelvis?
- iliac crest
- ASIS
- pubic symphysis
- greater trochanter of the femur
- ischial tuberosity
- tip of the coccyx
What consists of the true pelvis?
bladder, colon, female reproductive organs and rectum
Lies in the same horizontal plane as the midpoint of the hip joint and coccyx?
Highest point of greater trochanter
What is in the same horizontal plane as the pubic symphysis?
The most prominent point of the greater trochanter
What three joints lie on the same horizontal plane?
greater trochanter, tip of coccyx, and the pubic symphysis
How to localized hip joint?
Make an imaginary line from the anterior superior iliac spine (ASIS) to the superior margin of the pubic symphysis draw a right angle and go down 2 1/2 inches and the neck will be right there. For the head of the femur go down 1 1/2 inches and the head will be there
What is the essential projection of the pelvis?
AP
What should you never do if there is a foot straight out to one side?
Never rotate the leg because that’s an indication that they have a broken or fractured hip
What is the patient position for an AP Pelvis and Upper Femora?
Supine
How much should you rotate the feet for an AP Pelvis and Upper Femora?
Medially rotate the feet and lower limbs 15 to 20 degrees allowing for the foot to touch each other
When we medially rotate the feet 15 to 20 degrees in the AP Pelvis, what happens?
It allows for the femoral necks to be parallel with IR so that they are not foreshortened
What is the part position for the AP Pelvis and upper femora?
- Median sagittal plane (MSP) centered to midline
- Equal ASIS to table distance on both sides
What is the CR for AP Pelvis?
Perpendicular to IR enters 2 inches superior to symphysis pubis or 2 inches below ASIS
Where should the IR be for AP Pelvis?
Upper border of IR 1 to 1/2 inches above crests
What is in profile in the AP Pelvis and upper femora?
Greater trochanter
What should be included in the AP Pelvis and upper femora?
- top of crests
- pubic symphysis
- necks of femur should be parallel
- llium of equal shape
- ischial spine equal distance
- sacrum and coccyx equal distance
- obturator foramen should look equal
- full wings on both side
- all the Ischial tuberosity
- SI joint to outer wing looks equal
What happens if you see too much of the lesser in profile in an AP Pelvis and that the femoral necks are foreshortened?
You did not turn your feet in medially 15 to 20 degrees
What is the breathing technique for AP Pelvis and upper femora?
Suspended breathing (respiration) or hold your breath
What happens when there is poor positioning of the feet for the AP Pelvis and Upper Femora?
- the lesser will be in profile instead of the greater
- there is foreshortening of the femoral necks
What is the essential projection of the femoral neck?
AP oblique (modified cleaves method)
- we do not do this if there is a suspected fracture
- oblique of hip joint
What is the patient position for AP Oblique Femoral Necks (Modified Cleaves)?
Supine
What is the other name for the AP Oblique Femoral Necks (Modified Cleaves)?
Bilateral frog leg
What is the SID for AP Pelvis?
40 inches
What is the part position for AP Oblique Femoral Necks (Modified Cleaves)?
- flex hip and knees
- draw feet as much as possible
- abduct thighs equally and maximally 45 degrees from table
- places soles of feet together
How many degrees oblique is the AP Oblique Femoral Necks (Modified Cleaves)?
45 degrees
Where do we center for the AP Oblique Femoral Necks (Modified Cleaves)?
Center 1 inch above pubic symphysis
What is the CR for bilateral AP Oblique Femoral Necks (Modified Cleaves)?
Perpendicular to MSP at level 1 inch above pubic symphysis
What is the CR for unilateral for AP Oblique Femoral Necks (Modified Cleaves)?
Perpendicular to femoral neck
What is the part position for unilateral AP Oblique Femoral Necks (Modified Cleaves)?
- center ASIS of affected side to midline of grid
- flex affected hip and knee
- draw a foot up to opposing knee as much as possible
- abduct thigh approximately 45 degrees laterally
How much should the thigh be abducted in the unilateral AP Oblique Femoral Necks (Modified Cleaves)?
45 degrees laterally
What happens if the leg is completely flat in an unilateral AP Oblique Femoral Necks (Modified Cleaves)?
It will be considered a lateral projection not an oblique
What are the essential projections of the Hip
- AP
- Lateral (Lauenstein and Hickey methods) mediolateral
- Axiolateral (Danelius-Miller method) crosstable
What is the patient position for AP Hip?
Supine
What is the part position for AP Hip?
Make sure the ASIS-to-tabletop distance is equal on both sides
How much do you rotate the lower limb and foot for the AP Hip?
15 to 20 degrees medially which places femoral necks parallel to the IR
What is the CR for AP Hip?
perpendicular to femoral neck
- adjustment may be necessary if orthopedic device is present
What is the criteria for AP Hip?
- femoral head and seen through the acetabulum
- femoral neck not foreshortened
- greater trochanter in profile to the lateral
- pubic symphysis must be seen
- ischial tuberosity
- don’t need crest unless protocol
What is the patient position for lateral hip (lauenstein method)?
Rotate slightly toward affected side to an oblique position supine position
What is the part position for lateral hip (Lauenstein method)?
- center affected hip to midline of grid
- flex affected knee and draw thigh to almost right angle to hip
- body of femur parallel to table
- support opposite hip and knee
What is the CR for Lateral hip (Lauenstein method)?
Perpendicular through hip enters midway between ASIS and pubic symphysis center at the neck of the femur
Criteria for lateral hip (lauenstein method)?
- hip joint, acetabulum and femoral head
- femoral neck overlapped by greater trochanter
- lesser in profile to the medial
- pubic symphysis
- greater is over the neck
What is the part and patient position for the lateral hip (hickey method)?
the same as for lauenstein method
CR for lateral hip (hickey method)?
Angled 20 degrees cephalic
- enters hip joint
Why do we do an lateral hip (hickey method) and put an angle?
Allows for the greater trochanter to be off the neck so the neck is free of superimposition
What is the patient position for Axiolateral Hip (Danelius-Miller)?
Supine
The Axiolateral Hip (Danelius-Miller) is also known as?
The cross table hip
What is the part position for Axiolateral Hip (Danelius-Miller)?
- elevate pelvis for thin patients
- flex knee and hip of unaffected limb to place thigh vertical
- rest unaffected leg and foot on a support
- no rotation of pelvis
What is the CR for Axiolateral Hip (Danelius-Miller)?
Horizontal and peripendicular to long axis of femoral neck
In Axiolateral Hip (danelius- miller) CR is what?
Cr perpendicular to neck and cassetee
- cassetee parallel to neck of femur
- perpendicular to beam
Criteria for Axiolateral Hip (danelius -Miller)?
- hip joint with acetabulum
- greater is superimposed over the neck
- ischial tuberosity below femoral head and neck
What will you do if the patient can’t lift leg for axiolateral hip (Danelius -Miller) or have bilateral fractures of the hip?
Clements- Nakayama
For the crosstable hip
You will need to use a manual technique
What is the part position for Clements-Nakayama?
- Limbs remain neutral or external rotated
- grid is parallel to the axis of the femoral neck and tilt back 15 degrees
What is the CR for Clements-Nekayama?
Directed 15 degrees posteriorly and aligned peripendicular to the femoral neck and IR and beam perpendicular to cassette
- cassette and central ray need to be in the same degree of angulation
What is the essenetial projection for the Acetabulum?
AP oblique (Judet; modified Judet)
What is in profile in the Clements-Nakayama?(lateral hip)
Lesser in profile
In Clements-Nekayama the cassette and Tube is what?
Cassette tilt back 15 degrees while the tube will angle down 15 degrees perpendicular to IR they need to be in the same degree of angulation
To demonstrate posterior rim of acetabulum and iliopubic column?
Internal AP Oblique Acetabulum (Judet)
The 3 P’s
Posterior iliopubic Up
(side up)
Internal oblique
Used to demonstrate anterior rom of acetabulum and ilioischiel column?
External AP Oblique Acetabulum (Judet)
(side down)
Patient position for Internal Oblique Acetabulum (Judet)?
Recumbent 45 degrees posterior oblique position with affected side up (LPO)
CR for AP Internal Oblique Acetabulum (Judet)?
Perpendicular to IR
- Enters 2 inches inferior to ASIS of affected side
Patient position for AP Exteral Oblique Acetabulum (Judet)?
Recumbent 45 degrees posterior oblique position with affected side down (RPO)
Used to demonstrate posterior rim of acetabulum and iliopubic column
Internal Oblique (Judet Method)
Demonstrate anterior rim of acetabulum and ilioischial column?
External Oblique (Judet Method)
CR for AP Oblique External Acetabulum (Judet)?
Perpendicular to IR
-Enters pubic symphysis
Patient position for AP Axial Outlet (Taylor Method)?
Supine
Where are we centering for AP Axial Outlet (Taylor Method)?
Enters 2 inches inferior to the superior border of the pubic symphysis
CR for males for AP AXial Outlet (Taylor Method)?
20 to 35 degrees cephalic
CR for females for Ap Axial Outlet (Taylor Method)?
30 to 45 degrees cephalic
For the outlet view how do we angle?
We angle in to the body
For the inlet view how do we angle?
We angle outside the body
Criteria for Taylor Method outlet projection?
-elongates the superior and inferior rami of the pubic bone
- ramus of ischium
- nice view of pubic symphysis
- nice view of ischium
Patient position for superoinferior axial inlet projection (Bridgeman method)?
Supine
Why do we do an inlet view?
We are looking at the brim and elongating it, as well as the ischial spines
What is the rule of shielding?
Shield for reproductive years, do not shield if covering anything of necessity
What is the rule for Hip Dysplasia?
- AP
- Frog leg
table top
normally done on little kids - remove diaper, any power or diaper cream
CR for Superoinferior Axial Inlet Projection (Bridgemean method)?
CR directed 40 degrees caudal, entering the midline at the level of ASIS
