lower extremity Flashcards
what are the plain films ordered for the pelvis
- AP
- WB views are not typically done and must be requested
- inlet and outlet (outlet god for innominate view) views are ordered if trauma is suspected
What does a femlae and male pelvis look like
female- rounded (ovoid) shape
male- triangular (android) shape
- unfused growth areas will be seen in a Skeletally immature pelvis
What can be seen in a AP vewi of the pelvis?
- Iliac crest
- Ilium
- Sacrum
- Ischial spine
- Acetabulum
- Superior pubic ramus 7.Inferior pubic ramus
- Pubic symphysis
- Ischial tuberosity 10.Femoral head
- Femoral neck
- Greater trochanter
A CT view of the pelvis is good for looking at which part of the pelvis
posterior ring- the space btwn the 2 SI joints.
-Pelvic trauma – AP view is usually sufficient. CT scan is second line study.
widening of which joints is abnormal in the pelvis?
Widening of the symphysis pubis > 1 cm is abnormal. Observe for SI joint widening also.
what are considerations with pelvic trauma
The pelvis is a ring and fractures usually occur in more than one area.
•Pelvic fractures also cause pelvic hematomas and possible urethral and bladder injuries.
- important stxs in the obturator foramen - obturator internus and exturnus and the pudendal N.
detecting a pelvic fx: a clinical exam that reveals a stable and alert patient will be
100% sensitivity, thus rendering initial radiography unnecessary in this group of patients.
criteria is:
Age: > 3 yrs
•No impairment of consciousness
•No other major distracting injuries
•No complaint of pelvic pain •No signs of fracture on inspection
•Painless compression of iliac or pubic symphysis
•Pain free hip rotation and flexion
what is pagets disease?
– benign lesion of the pelvis. •Increased sclerosis and enlargement of the entire right hemi-pelvis.
what a types of malignat tumors in the pelvis ?
cancer like to metastasize to bone
•Child – Ewing’s sarcoma •Adult – chondrosarcomas •Metastates are also common
What is the presentation of a pelvic stress fracture ?
- History of overuse
- Relief w non-weight bearing
- Insidious in nature
- Local pain, tenderness, swelling
- Typical site in the pelvis is the pubic ramus.
- Bone scan is diagnostic early
what are 2 types of stress fractures in the pelvis?
•Two types of stress fractures;
•Abnormal stresses to normal bone
•Normal stresses to abnormal bone: insufficiency fractures
the H shape seen on a bone scan is know as a honda sign is indicative of a sacral insufficiency fx
what is Diastasis pubis
Seen c previous pregnancies. Separation of the pubis rami
what are plain films for the hip
Plain films include an
- AP view
- “frog leg” view (abducted).
When is the Hip Axial Lateral view requested?
requested if A/P or frog leg dont allow Veiw of femoral neck
What can be seen in the AP hip view ?
- Acetabulum
- Femoral head
- Femoral neck
- Greater trochanter
- Lesser trochanter
What can be seen in the frog leg hip view ?
- Iliac crest
- Ilium
- Sacrum
- SI joint
- Ischial spine
- Acetabulum
- Superior pubic ramus
- Inferior pubic ramus
- Pubic symphysis
- Ischial tuberosity
- Femoral head
- Femoral neck
- Greater trochanter
- Lesser trochanter
What can be seen in the Hip Axial Lateral view ?
- Femoral head
- Femoral neck
- Lesser trochanter
- Greater trochanter
- Ischial tuberosity
bream bypasses the crotch to get image
What are areas of typical pathology in the hip- areas of typical pathology
- Hip dislocations – usually the result of MVA’s
- Posterior dislocation most common hip dislocation. Head displaced superiorly and laterally
- Anterior dislocation. Head displaced inferiorly and medially. AIM
- Widening of joint space
- Femoral neck or intertrochanteric fractures
- Pelvis or acetabular fractures
Most hip fractures (90%)are
at the femoral neck
•Often due to osteoporosis
•Stress fx’s of the femoral neck may appear sclerotic •Fx’s of the intertrochanteric region are Often due to trauma; seen as shortened leg with IR
•Nondisplaced hip fractures are best evaluated by MRI
what is the most common cause of hip pain, and what are the findings (has to do with DJD)
-Osteoarthritis
•Patient presents with pain and loss of mobility, starting with internal rotation.
•90% of patients over 40 have some DJD of the hips •DJD changes include joint space narrowing, subchondral cysts, sclerotic borders and osteophytes.
what is the altman criteria for judgment of hip OA?
Test Cluster 1
•Hip Pain
•Hip IR < 15
•Hip flexion < 115
•Test cluster 2, if hip IR > 15 •Painful w IR
•Age > 50 yrs
•Morning stiffness less than 60 minutes and gets better with movement
Hip CPR for OA- items that comprised CPR?
- Patient reported squatting as an aggravating factor •Flexion ROM caused lateral hip pain
- Scour test with adduction caused lateral or groin pain •Extension ROM caused pain •IR less ≤ 25°
how can you tell apart RA from OA?
Ra will be bilateral and is errosive in quality
what is Aseptic necrosis of the hip?
compromised blood supply that leads to flattening of femoral head
- sclerotic changes and irrregular shape
- best study is an MRI
