Hip/Pelvis Flashcards
lesser trochanter is on (med/lat) aspect of prox femur?
med
small depression located near center of femoral head
fovea capitis
lesser trochanter projects (ant/post) from the junction btw the neck and the shaft
posteriorly
4 bones that make up pelvis
R/L hip bones (ossa coxae), sacrum, and coccyx
2 bones that make up pelvic girdle
R/L hip bones (ossa coxae)
3 divisions of hip bone
ilium, ischium, pubis
3 hip divisions fuse at _____ at age of ______
acetabulum; mid-teens
upper margin of greater trochanter is about _____” above the sup. border of pubic symphysis, and the ischial tuberosity is about ____” below
1”;
1.5 - 2”
imaginary plane that divides the pelvic region into the greater and lesser pelvis is called
the pelvic brim
greater pelvis aka
false pelvis
lesser pelvis aka
true pelvis
major f(x) of greater pelvis
supports lower abdominal organs and fetus
major f(x) of lesser pelvis
forms actual birth canal
3 aspects of lesser pelvis, which also describes the birth route
inlet (sup. aperture), cavity, outlet (inf. aperture)
what possesses a large tuberosity found at the most inf. aspect of pelvis
ischium
what contains the lesser sciatic notch
ischium
what contains PSIS
ilium
what possesses a slightly moveable joint
pubis
what forms the ant., inf. aspect of the lower pelvic girdle
pubis
what articulates w the sacrum to form SI joints
ilium
what imaging modality has replaced cephalopelvimetry?
sonography - U/S
what is the advtg of using 90 kV rather than a lower kV for hip/pelvis XRs on younger pt’s on analog system?
reduces pt dose
what is the disadvtg of using 90 kV for hip/pelvis XR, especially. on older osteoperotic pt’s?
reduces contrast
whic condition is a common clinical indication for hip/pelvic exams on newborn pt’s?
DDH
which imaging modality is most sensitive in diagnosing early signs of metastatic carcinoma of pelvis?
nuclear med
degenerative joint disease
osetoarthritis
most common fracture in older pt’s bc of high incidxence of osteoporosis/avascular necrosis
prox. hip fracture
malignant tumor of hip cartilage
chondrosarcoma
disease producing extensive calcification of the longitudinal ligament of the spinal column
ankylosing spondylitis (bamboo spine)
fracture resulting from severe blow to one side of the pelvis
pelvic ring fracture
malignancy spread to bone via the circulatory and lymphatic systems or direct invasion
metastatic carcinoma
aka DDH
congenital dislocation
what will improve overall visibility of prox hip shown on an axiolateral (inferosuperior) projection?
compensating filter
what modality best shows pelvic ring fracture
CT
where is CR centered for AP pelvis?
midway btw pubic symphysis and ASIS
what error is present when the L iliac wing is elongated on AP pelvis?
rotation toward L side
what error when L obturator foramen is more open than the R side?
rotation to R
Is the axiolateral, inferosuperior (Danelius-Miller) XR trauma or nontrauma?
T
is unilateral frog (modified cleaves) trauma or non trauma?
NT
is modified axiolateral (Clements-Nakayama) trauma or nontrauma?
T
is AP axial for pelvis “outlet” trauma or nontrauma?
T
what XR best shows the superoposterior wall of acetabulum?
PA Axial obl
how many degrees are femurs abducted from vertical for bilat frog?
40-45 degrees
where is CR centered for bilat frog?
3” below ASIS
where is CR centered for AP unilat frog
midfemoral neck
what CR angle is required for “outlet” XR (Taylor method) for female pt?
30-45 degree cephalad
what path is best shown w post. obl (Judet method)
acetabular fractures
how much body obliquity is required for post obl (Judet method)
45 degrees
what CR angle is used for PA axial obl (Teufel)?
12 degree cephalic
how is body positioned for a PA axial obl (Teufel)?
PA 35-40 degrees toward affected side
how is unaffected leg positioned for the axiolateral hip projection
flexed/elevated to prevent from being superimposed over affected hip
the modified axiolateral requires the CR to be angled ______ degrees posteriorly from horizontal
15-20
which hip XR shows the ant. and post. rims of the acetabulum and the ilioischial and iliopubic columns?
post obl XRs of acetabulum (Judet method)
name of special pelvic XRused to assess trauma to pubic and ischial structures?
AP axial outlet (Taylor method)
axiolateral (inferosuperior) aka
Danelius-Miller
modified axiolateral aka
Clements-Nakayama (trauma hip)
bilat/unilat frog-leg aka
modified cleaves
PA axial obl for acetabulum aka
Teufel
AP axial for pelvic “outlet” bones aka
Taylor
Post. obl for acetabulum aka
Judet
optimal amount of hip abduction applied for the unilateral frog-leg XR to show the femoral neck w/o distortion?
20-30 degrees from vertical
how much is the IR tilted for the modified axiolateral XR of hip
15 degrees from vertical
an axiolateral (inferosuperior) XR shows that the post aspect of the acetabulum and femoral head were cut off at the bottom. What can be done on repeat?
elevate pt at least 2” by placing sheets/blankets under pelvis
pt enters ER w pelvic injury from MVA. initial AP pelvis shows possible fracture of L acetabulum. no other possible fractures detected and pt can move comfortably. what other XR can show this possible acetabular fracture?
PA axial obl (Teufel method); or post obl (Judet)
when using AEC for AP pelvis, what must be activated?
R & L ionization chambers
pt w/ hip pn from fall enters ER. Dr. orders L hip study. when moved to table, pt complains loudly. which positioning routine should be used?
AP pelvis, and then axiolateral (inferosuperior) L hip
pt has just been moved to his hospital room after a bilat hip replacement. surgeon orders a post-op hip routine for both hips. which specific pos routine should be used (pt can be brought to rads dept)
AP pelvis & modified axiolateral (Clements-Nakayama)
pt w possible pelvic ring fracture from trauma enters ER. AP pelvis XR is inconclusive, what other XR can be taken to better see acetabulum? and what other modality can determine a pelvic ring fracture?
post obl Judet method;
CT
what is the most common routine for very young child w DDH?
AP pelvis and bilat frog
shape of male pelvis
narrow, deeper, less flared
shape of female pelvis
wider, more shallow, more flared
angle of pubic arch of male
acute (< 90 degrees)
angle of pubic arch of female
obtuse (> 90 degrees)
pelvic inlet shape of male
more oval, heart-shaped
pelvic inlet shape of female
rounder, larger
where is the femoral neck?
1-2” med. and 3-4” dist. to ASIS
technique for osteoporosis
lower kV
external rotation of leg shows:
greatly foreshortened femoral necks, lesser trochanters visible in profile internally
routine for hip fracture?
AP both hips as-is, then inferosuperior (Danelius-MIller method) of affected hip
ischial tuberosities are where?
1.5 - 2” inf. to pubic symphysis
pt who’ve undergone hip replacement should NOT be placed in ______ pos; should perform ______ & _______ post-surgical XR’s
frog-leg;
AP & inferosuperior lat
initial fusion of SI joints, then calcification of ant. longitudinal ligament
aknylosing spondylitis (bamboo spine)
what is reqauired to detect a small avulsion fracture?
lower kV
narrowed R obturator foramen indicates….?
rotation to R
abduct femora _______ degrees from vertical for bilat frog
40-45 degrees
abducting femora 20-30 degrees from vertical will show
less foreshortening of femoral necks, but foreshortens entire proximal femora
how much internal rotation is required of legs for AP pelvis?
15-20 degrees
small depression located in center of femoral head
fovea capitis
AP bilat frog-leg shows?
most of greater trochanters appear superimposed over femoral necks, which appear foreshortened
CR for AP axial outlet (Taylor - anteriorinferior) for male?
20-35 degrees cephalad to 1-2” dist. to pubic symphysis
CR for AP axial outlet (Taylor - anteriorinferior) for female?
CR 30-45 degrees cephalic to 1-2” dist. to pubic symphysis
what XR is a bilat trauma view of bilat pubis/ischium?
AP Axial Outlet (Taylor - anteriorinferior)
CR for AP axial inlet?
CR 40 degrees caudad to ASIS
AP Axial Inlet pelvis shows?
to show pelvic ring/inlet (sup. aperture)
trochanters are joined posteriorly by thick ridge called ______
intertrochanteric crest
sup. and lat. to femoral shaft
greater trochanter
projects medially and posteriorly from junction of neck & shaft
lesser trochanter
what is the angle of neck to shaft on avg adult?
about 125 degrees +/- 15 degrees
longitudinal femoral plane is about ___ degrees from vertical
10
how much do you obl pt for post obl pelvis - acetabulum - Judet
45 degrees
what does the downside of post obl pelvis - acetabulum - Judet show
ant. rim of acetabulum, post. (ilioischial) cloumn, and iliac wing
what does the upside of post obl pelvis - acetabulum - Judet show?
post. rim of acetabulum, ant. (iliopubic) column, & obturator foramen
CR for downside post. obl pelvis - acetabulum - judet
CR perpendicular to 2” dist. & 2” med. to downside ASIS
CR for upside post. obl pelvis - acetabulum - judet
CR perpendicular 2” dist. to upside ASIS
In Judet method, (post obl pelvis), obturator foramen should be _____ for upside obl
open
In Judet method, (post obl pelvis), obturator foramen should be _____ for downside obl
closed
what CR shows concave area of fovea capitis & superoposterior wall of acetabulum
PA Axial obl - acetabulum (Teufel)
pt pos for PA Axial Obl - Acetabulum - Teufel?
affected side down, pt in 35-40 degree ant. obl
CR for PA Axial Obl - acetabulum - teufel
CR 12 degree cephalic to 1” sup. to greater trochanter and 2” lat. to MSP
CR for AP Unilat Hip? pt pos?
CR perpendicular to 1-2” dist. to midfemoral neck (1-2” med. & 3-4” dist. to ASIS;
int. rotate leg 15-20 degrees
where do you place IR for axiolat inferosuperior hip (Danelius-Miller)?
IR in crease above iliac crest so it’s parallel to midfemoral neck and perpendicular to IR
what is demonstrated on the axiolat inferosuperior Danelius-Miller method?
(in place of frog lat) entire femoral head/neck, trochanter and acetabulum. (only most dist. portion of femoral neck should be superimposed by greater trochanter)
what do grid lines indicate?
incorrect CR/IR alignment
what may be impossible on the inferosuperior Danelius-Miller method on pt w thick thighs?
demonstrating the most prox. portion of femoral head and acetabulum
What is common XR w arthroplasty (Hip prosthesis surgery)
Modified Axiolateral - Clements-Nakayama method
IR placement for modified axiolateral Clements-Nakayama method?
tilt IR 15 degrees from vertical and make sure it’s perpendicular to CR and parallel to midfemoral neck (above iliac crest)
CR for modified axiolat Clements-Nakayama method
angle CR mediolaterally to make CR perpendicular to midfemoral neck (about 15-20 degrees posteriorly from vertical)
what is demonstrated by the modified axiolat Clements-Nakayama method
shows the lat obl of acetabulum, trochanteric area, and femoral head/neck
