Knee and Femur

Question 1

Identify

Answer 1

Question 2

Identify

Answer 2

Question 3

Patella

The patella, AKA the ___, is the largest and most constant ___ bone in the body.

The patella is a flat, ___ bone situated at the ___ ___ surface of the femur.

The ___, or the tip, is directed ___, lies ___ inch above the joint space of the knee, and is attached to the ___ of the tibia by the patellar ligament.

The superior border of the patella is called the ___.

Answer 3

Patella

The patella, AKA the knee cap, is the largest and most constant sesmoid bone in the body.

The patella is a flat, triangular bone situated at the distal anterior surface of the femur.

The apex, or the tip, is directed inferiorly, lies 1/2 inch above the joint space of the knee, and is attached to the tuberosity of the tibia by the patellar ligament.

The superior border of the patella is called the base.

Question 4

What are the routine projections, SID, and kVp of the knee?

Projections =

SID =

kVp =

Answer 4

What are the routine projections, SID, and kVp of the knee?

Projections = AP and Lateral

SID = 40”

kVp = 60 tabletop

Question 5

Knee - AP

Patient is in ___ position with the affected leg ___.

Place IR under ___ so the joint is in the center of IR.

Adjust affected leg so that femoral ___ are ___ with the IR for a true AP.

Direct the CR __ inch ___ to the ___ apex.

A tube angle may be neccessary based on the patient’s body habitus.

A) For a patient with a thinner pelvic thickness of (___cm and below), use a ___° ___ tube angle).

B) For an average sized patient with a pelvic thickness of ___-____cm, ___ tube angle is necessary.

C) For a patient with a larger pelvic thickness, (___cm and above), use a ___° ___ tube angle.

This projection demonstrates the open ___ joint space and the ___ completely superimposed on the ___.

Answer 5

Knee - AP

Patient is in supine position with the affected leg fully extended.

Place IR under knee so the joint is in the center of IR.

Adjust affected leg so that femoral epicondyles are parallel with the IR for a true AP.

Direct the CR 1/2 inch inferior to the patellar apex.

A tube angle may be neccessary based on the patient’s body habitus.

A) For a patient with a thinner pelvic thickness of (18cm and below), use a 5° caudal tube angle).

B) For an average sized patient with a pelvic thickness of 19-24cm, no tube angle is necessary.

C) For a patient with a larger pelvic thickness, (25cm and above), use a 5° cephalad tube angle.

This projection demonstrates the open femorotibial joint space and the patella completely superimposed on the femur.

Question 6

Knee - Lateral

Turn the patient toward ___.

The unaffected leg is placed ___ of the affected side to achieve a true lateral.

Center the IR under the affected knee.

Flex the knee ___ -___ ° to ___.

Direct CR to ___ of the leg at a level ___ inch ___ to the patellar ___.

On this projection, the femoral ___ should be superimposed and the ___ joint space should be open, showing the ___ in a lateral profile.

Answer 6

Knee - Lateral

Turn the patient toward the affected side.

The unaffected leg is placed in front of the affected side to achieve a true lateral.

Center the IR under the affected knee.

Flex the knee 20-30 ° to open the joint space.

Direct CR to middle of the leg at a level 1/2 inch inferior to the patellar apex.

On this projection, the femoral condyles should be superimposed and the patellofemoral joint space should be open, showing the patella in a lateral profile.

Question 7

Identify

Answer 7

Question 8

Identity

Answer 8

Question 9

Knee - Special Request

A 3 view series knee consists of what projections?

Answer 9

Knee - Special Request

A 3 view series knee consists of what projections?

AP, Lateral, and Settegast or Hughston

Question 10

Knee - Special Request

1. Settegast Method (___ view)

Patient is ___ on the table.

___ the knee as much as possible or until the ___ is ___ to the IR which is placed on the distal ___. Have the patient hold IR in place.

Direct CR ___ to the joint space between the ___ and the ___. The angulation of the CR depends on the degree of ___.

The Settegast Method demonstrates ___ fractures of the ___ and the ___ articulation.

2. Hughston Method

The patient is in a ___ position with thr IR centered under the patient’s affected knee.

___ the knee so that the lower leg forms an angle of ___-___° from the table.

The CR is angled ___° ___ and directed through the ___ joint.

Rest the foot against the collimator for stability.

The Hughston Method demonstrates the same anatomy as the Settegast Method.

Answer 10

Knee - Special Request

1. Settegast Method (Sunrise view)

Patient is seated on the table.

Flex the knee as much as possible or until the patella is perpendicular to the IR which is placed on the distal femur. Have the patient hold IR in place.

Direct CR perpendicular to the joint space between the patella and the femoral condyles. The angulation of the CR depends on the degree of flexion.

The Settegast Method demonstrates vertical fractures of the patella and the patellofemoral articulation.

2. Hughston Method

The patient is in a prone position with thr IR centered under the patient’s affected knee.

Flex the knee so that the lower leg forms an angle of 50-60° from the table.

The CR is angled 45° cephalad and directed through the patellofemoral joint.

Rest the foot against the collimator for stability.

The Hughston Method demonstrates the same anatomy as the Settegast Method.

Question 11

Knee - Special Request

A 4 view series knee consists of what projections?

Answer 11

Knee - Special Request

A 4 view series knee consists of what projections?

AP, Lateral, Settegast or Hughston and Beclere Method

Question 12

Knee - Special Request

Beclere Method (___ view)

The patient is in a ___ position.

___ the affected knee enough to place the ___ axis of the ___ at an angle of ___° to the ___ axis of the ___, so that the patient can place heel on table top.

Place the IR under the knee and build up on sponges or linens if possible to decrease ___.

Direct the CR ___ to the ___ axis of the ___ at a point ___ inch below the ___ apex.

Demonstrates the open Intercondylar ___, Intercondylar ___, and the ___ joint.

Answer 12

Knee - Special Request

Beclere Method (tunnel view)

The patient is in a supine position.

Flex the affected knee enough to place the long axis of the femur at an angle of 60° to the long axis of the tibia, so that the patient can place heel on table top.

Place the IR under the knee and build up on sponges or linens if possible to decrease OID.

Direct the CR perpendicular to the long axis of the tibia at a point 1/2 inch below the patellar apex.

Demonstrates the open Intercondylar fossa, Intercondylar eminence, and the knee joint.

Question 13

Knee - Special Request

Obliques

Medial Oblique

From ___ position, ___ rotate the lower leg about ___°

Direct the CR ___ inch ___ to the ___ apex.

This oblique position should demonstrate the ___ of the ___ separated from the ___ and the ___ condyles of both the tibia and femur.

Lateral Oblique

From the ___ position, ___rotate the lower leg about ___°.

Direct the CR ___ inch ___ to the ___ apex.

This oblique position will demonstrate the ___ superimposed over the ___ and the ___ condyles of both the tibia and femur.

Answer 13

Knee - Special Request

Obliques

Medial Oblique

From AP position, medially rotate the lower leg about 45°

Direct the CR 1/2 inch inferior to the patellar apex.

This oblique position should demonstrate the head of the fibula separated from the tibia and the lateral condyles of both the tibia and femur.

Lateral Oblique

From the AP position, externally rotate the lower leg about 45°.

Direct the CR 1/2 inch inferior to the patellar apex.

This oblique position will demonstrate the fibula superimposed over the tibia and the medial condyles of both the tibia and femur.

Question 14

Identify

Answer 14

Identify

Question 15

Identify

Answer 15

Identify

Question 16

Femur

The femur is the ___, ___, and ___ bones in the body.

When the femur is vertical, the ___ condyle is lower than the ___ condyle.

The superior portion of the femur articulates with the ___ of the hip joint.

The distal end of the femur is broadened and has two large eminences: the larger ___ and ___.

Anteriorly, the condyles are separated by the ___ surface - a shallow ___ depression.

Posteriorly, the condyles are separated by a deep depression called the ___.

A slight prominence above and within the curve of each condyle forms the medial and lateral ___.

Answer 16

Femur

The femur is the longest, strongest, and heaviest bones in the body.

When the femur is vertical, the medial condyle is lower than the lateral condyle.

The superior portion of the femur articulates with the acetabulum of the hip joint.

The distal end of the femur is broadened and has two large eminences: the larger medial and lateral condyles.

Anteriorly, the condyles are separated by the patellar surface - a shallow triangular depression.

Posteriorly, the condyles are separated by a deep depression called the Intercondylar fossa.

A slight prominence above and within the curve of each condyle forms the medial and lateral epicondyles.

Question 17

What are the routine projections, SID, and kVp of the femur?

Projections =

SID =

kVp =

Answer 17

What are the routine projections, SID, and kVp of the femur?

Projections = AP and Lateral

SID = 40”

kVp = 60 nongrid and 80 grid

Question 18

Femur - AP

The patient is in ___ position with both legs extended.

Position IR so that ___ edge is ___ inches below the ___ joint. The ___ edge should be at the level of the ___ to include the ___ joint as well.

___ rotate the limb about ___ ° to place the femur in true anatomical position.

Any orthopedic appliance must be included in its entirety as well as both the ___ and ___ joints. Two AP projections may be neccessary.

This projection should demonstrate a true AP projection of the femur and a small portion of the ___.

Answer 18

Femur - AP

The patient is in supine position with both legs extended.

Position IR so that bottom edge is 2 inches below the knee joint. The top edge should be at the level of the ASIS to include the hip joint as well.

Internally rotate the limb about 15° to place the femur in true anatomical position.

Any orthopedic appliance must be included in its entirety as well as both the hip and knee joints. Two AP projections may be neccessary.

This projection should demonstrate a true AP projection of the femur and a small portion of the lesser trochanter.

Question 19

Femur - Lateral

Have the patient turn towards the affected side and ___ the knee until the femur is in a lateral position.

Place the IR so that the ___ edge is ___ inches below the knee joint.

Direct the CR to the ___ and center of IR.

Both the ___ and ___ joints must be included on these films.

This lateral projection demonstrates the ___ superimposed and an open ___ space. The ___ will be in lateral profile.

Answer 19

Femur - Lateral

Have the patient turn towards the affected side and flex the knee until the femur is in a lateral position.

Place the IR so that the bottom edge is 2 inches below the knee joint.

Direct the CR to the midfemur and center of IR.

Both the knee and hip joints must be included on these films.

This lateral projection demonstrates the femoral condyles superimposed and an open patellofemoral space. The patella will be in lateral profile.