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Procedures & Analysis > HIP/PELVIS PROC. > Flashcards

HIP/PELVIS PROC. Flashcards

1
Q

How many bones consist of pelvis?
What are they?

What is pelvic girdle vs bony pelvis?

A

4:
2 hip (innominate - pelvic girdle)
sacrum & coccyx

bony pelvis = hip bone + sacrum & coccyx
pelvic girdle = formed by 2 hip bones

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2
Q

Division of hip bone & location of:

What is Acetabulum?
What is Obturator Foramen?

A

illium (superior to acetablum)
ischium (inferior & posterior to acetabulum)
pubis ( inferior & anterior to acetabulum)

Acetabulum = fusion of illium, ischiu & pubis & accepts femur head
Obturator Foraneb: Ichium & Pubis join together and form

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3
Q

Joints of Pelvis:
Type of each:

What makes pelvic brim?

A

Sacroiliac (SI) - synovial & amphiartrodial
Pubic Symphysis - cartilaginous & amphiartrodial
Hip Joint - Synovial, diathrodial & ball-socket

  • Superior portion of pubic symphysis anteriorly & sacral promontory posteriorly
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4
Q

Greater vs Lesser Pelvis:
Which is Birth canal?
Which is true pelvis & which is false pelvis?

A

Greater = False, area above pelvic brim
Lesser = True, area inferior pelvic brim

Lesser = birth canal

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5
Q

Oblique plane formed by brim of pelvis is _______ (AKA_____)
Two ischial tuberosities & tip of coccyx is ______ (AKA ______)
Area between these two is termed __________

A

Inlet - superior aperture
Outlet - Inferior Apeture
Cavity of True Pelvis

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6
Q

LABEL THE IMAGE

A

A. Obturator foramen
B. Pubic symphysis
C. Ischial tuberosity
D. Femoral neck
E. Greater trochanter
F. Ischial spine (or roof of acetabulum)
G. Coccyx
H. Sacrum
I. Wing of ilium (ala)
J. Femoral head

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7
Q

PROJECTIONS OF PELVIS
ROUTINE:
ADVANCED:
TECHNIQUE:
SID:

A

R: AP & FROG LEG (MODIFIED CLEAVES)
A: AP ACIAL OUTLET (TAYLOR METHOD)
- AP AXIAL INLET
- POSTERIOR OBLQIUE (JUDET METHOD)

75-80 @ 20-32
40 SID

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8
Q

AP PELVIS
CR:
POSITION:
IR:
ANATOMY:

A

CR: MIDWAY BTWN ASIS & PUBIC SYMPH (2in INFERIOR TO ASIS & 2in SUPERIOR TO PUBIC SYMOHYSIS)
POSITION: INTERNALLY ROTATE FEET 15-20*
IR: UPPER BOARDER 1-1.5in ABOVE ILLIAC CREST
ANATOMY: GREATER TROCHANTER IN PROFILE
- LESSER TROCH. NOT SEEN / MIN. SEEN
- FEMORAL NECK W/O FORESHORTENING
- SYMMETRIC APPEARANCE OF ILLIAC WINGS, ICHIAL SPINES & OBTURATOR FORAMINA

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9
Q

WHY 15-20* MEDIAL ROTATION?
WHAT IF FEET VERTICAL?
WHAT IF FEET EXTERNALLY ROTATED?

A
  • LESSER TROCHANTER NOT CISIBLE
  • FEMORAL NECKS NOT FORESHORTEN

VERTICAL = LESSER TROCHANTER PARTIALLY VISIBLE
- FEMORAL NECK PARTIALLY FORESHORTENED

EXTERNAL = LESSER TROCHANTER VISIBLE IN PROFILE INTERNALLY
- FEMORAL NECK GREATLY FORESHORTENED

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10
Q

BILATERAL FROG LEG PELVIS
AKA:
CR:
POSITION:
ANATOMY:

A

MODIFIED CLEAVES METHOD
3in BELOW ASIS (1in ABOVE SYMPH. PUBIS)
ABDUCT THIGHS 40-45*
ANATOMY:
- LESSER TROCHANTER IN PROFILE MEDIALLY
- FEMORAL NECKS FORESHORTENED
- GREATER TROCH SUPERIMP. BY FEMORAL NECKS

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11
Q

AP AXIAL OUTLET PELVIS
AKA:
CLINICAL INDICATION:
CR:
ANGLE:
POSITION:
ANATOMY:

A

TAYLOR METHOD
- BILATERAL PUBIS & ISCHIUM FOR ASSESMENT OF PELVIC TRAUM, FX OR DISPLACEMENT

  • 1-2in DISTAL TO SUPERIOR BORDER OF PUBIC SYMPH. OR GREATER TROCHANTER
  • 20-25* CEPHALIC MALES
  • 30-45* CEPHALIC FEMALE
  • PT SUPINE & LEGS EXTENDED

-SUPERIOR & INFEREIOR RAMI OF PUBIS & BODY & RAMUS OF ISCHIUM SEEN WITH MINIMAL FORESHORTENED

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12
Q

AP AXIAL INLET PELVIS
CLINICAL INDICATION:
CR:
POSITION:
ANATOMY:

A
  • ASSES PELVIC TRAUMA
  • 40* CAUDAD (PERP. INLET) AT LEVEL OF ASIS
  • PT SUPINE & LEG EXTENDED
  • PELVIC INLET (RING) DEMONSTRATED ENTIRELY
  • ICHIAL SPINES FULLY DEMONSTRATED
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13
Q

PELVIS-ACETABULUM: POSTERIOR OBLIQUE
AKA:
CLINICAL INDICATION:
CR:
POSITION:
ANATOMY:

A

JUDET METHOD
- R/O ACETABULAR FX OR PELVIS INJURY

CR:
- AFFECTED SIDE DOWN: 2in DISTAL & 2in MEDIAL to DOWNSIDE ASIS
- AFFECTED SIDE UP: 2in DISTAL UPSIDE ASIS

POSITION:
- RIGHT & LEFT OBLIQUES TAKEN FOR COMPARISON
- 45* POSTERIOR OBLIQUES
- RPO & LPO

ANATOMY:
- UPSIDE ACETABULUM: POSTERIOR RIM OF ACETAB.
- ANTERIOR ILIOPUBIC COLUMN & OPEN FORAMEN
- DOWNSIDE: ANTERIOR RIM OF ACETAB.,
- POSTERIOR ILIOISCHIAL COLUMN & CLOSED FORAMEN

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14
Q

WHAT PROJECTION IS SHOWN?
LABEL IMAGE

A

JUDET METHOD
IMAGE 1:
1. ILIOPUBIC COLUMN (ANT)
2. POSTERIOR ACETBULAR RIM
3. ACETABULAR ROOF
4. OBTURATOR FORAMEN

IMAGE 2:
1. ILIOICHIAL COLUMN (POST)
2. ANTERIOR ACETABULAR RIM
3. ROOF ACETABULUM
4. ILIAC CREST

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15
Q

IN JUDET, AFFECTED SIDE UP:
LPO SHOWS:
RPO SHOWS:
CR:
ANATOMY:

A

LPO = RIGHT
RPO = LEFT HIP
- 2in DISTAL UPSIDE ASIS
- ANAT: POSTERIOR RIM, ILIOPUBIC COLUMN & OPEN FORAMEN

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16
Q

IN JUDET, AFFECTED SIDE DOWN:
LPO SHOWS:
RPO SHOWS:
CR:
ANATOMY:

A

LPO = LEFT HIP
RPO = RIGHT HIP
CR: 2in distal & 2in medial downside ASIS
- ANAT: ANTERIOR RIM, POSTERIOR ILIOISCIAL COLUMN & CLOSED FORAMEN

17
Q
  1. The body is placed at what angle for the AP oblique
    projection (Judet method) of the acetabulum?
    a. 45 degrees
    b. 50 degrees
    c. 40 to 50 degrees
    d. 45 to 60 degrees
  2. The external oblique position (with the affected side down) of the AP oblique projection (Judet method) demonstrates the _____ column and _____ rim of acetabulum.
    a. iliopubic; posterior
    b. iliopubic; anterior
    c. ilioischial; posterior
    d. ilioischial; anterior
A
  1. 45* Posterior Oblique
  2. D. Ilioischial, anterior
18
Q
  1. What does the RPO position (Judet method) of the right acetabulum demonstrate?
  2. Examine this AP oblique (Judet) image of the right hip
    obtained with the patient positioned for the internal oblique. What patient position is shown?
    a. 45* RPO
    b. 45* LPO
    c. 45* RAO
    d. 45* LAO
  3. A patient enters the ED with a possible separation of the
    symphysis pubis caused by trauma. The AP pelvis projection is inconclusive for determining the extent of the injury. What other projection can be taken to evaluate this region without excessive movement of the patient?
    a. Posterior oblique (Judet) projection
    b. AP axial “inlet” projection
    c. Axiolateral (inferosuperior) projection
    d. AP axial (Taylor) outlet projection
A
  1. Ilioischial, anterior
  2. 45* LPO
  3. D. AP AXIAL OUTLET (TAYLOR)
19
Q
  1. How do you locate head & neck of femur?
    Method 1:
    Method 2:
  2. Femur shaft slants _____ * ______
  3. Proximal femur consist of: (4 things)
  4. Head & neck of femur form _____* angle _____ to femur body
A
  1. Determine midpoint of line between ASIS & Pubic Symp
    - Then, right angle 1.5 dital = head & 2.5 distal = neck
    Method 2: Femoral neck is 1-2 in medial & 3-4 in distal to ASIS
  2. 5-15 Medially
  3. Greater & Lesser Troch, head & neck
  4. 15-20* anterior
20
Q
  1. Location of greater trochanter:
    - Lesser:
  2. What is name of ridge where trochanters join?
    - Is it anterior or posterior?
  3. What is the fovea capitis?
A
  1. Superior & lateral
  2. Medially & posterior
  3. Intertrochanteric Crest
  4. Depression in center of femur head
21
Q

Projections of the Hip:
Routine:
Advanced:
Technique:

A

R: AP & Frog Leg Meidiolateral (Modified Cleaves)
A: Axiolateral inferosuperior (Danielius-Miller)
- Modified Axiolatral (Clements-Nakayama)

T: 75-80 @ 16-20

22
Q

AP Hip
CR:
Position:
Anatomy:

A

CR: Perp. Perp. Femoral Neck, 1-2in medial & 3-4in distal ASIS
Position: Internal rotate lef internally 15-20* (Femoral neck parallel IR)
Anatomy: Greater trochant in profile lateral
- Necks without foreshortened
- Lesser superimp. by femoral neck

23
Q
  1. Axiolateral Inferosuperior Hip
    AKA:
    Replaces:
    Clinical Ind:
    CR:
    Position:
    IR Alignment:
    Anatomy:
A
  • Danelius-Miller Method
  • Replaces frog-leg view
  • cross table latreal for tauma / patient cant move
  • Supine, pelvis elevated
    • unaffected leg near vertical position rested above / on support
    • affected leg 15-20* medially

IR: IR parallel to femoral head & perp to CR
- In crease above iliac crest

CR: Perp. long axis of femoral neck & IR
Anat: distal femur neck superimp by greater troch.
- Lesser slightly seen
- No soft tissue of unaffected thigh in ROI

24
Q
  1. Modified Axiolateral Hip
    AKA:
    Clinical Ind:
    CR:
    Position:
    IR Alignment:
    Anatomy:
A

AKA: Clements-Nakayama
Clinical Ind: Hip fx with arthroplasty (surgery for hip prothesis) & pt has limited movement of legs

CR: Perp. Femoral Neck, Angled 15-20* from horizontal

Position: Affect side near IR, both legs extended
- Legs in neutral / anatomical position

IR Alignment: Bottom 2in below table top
- Parallel to femoral neck
- Tilt IR 15* from vertical & align IR perp CR

Anatomy: Slight superimp. of femoral neck by greater troch.
- Lesser Troch min. seen

Procedures & Analysis (14 decks)

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