Module 8 Pelvis And Hips Flashcards
PELVIC GIRDLE
Composed of right and left hip bones AKA =
- Os coxae
- Innominate bones
A S I S
Anterior Superior Iliac Spine
A I I S
Anterior Inferior Iliac Spine
P S I S
Posterior Superior Iliac Spine
ARTICULATIONS RELATED TO THE PELVIS
- Hips
- Pubic symphysis
- Sacroilliac Joints
HIP JOINT CLASSIFICATION
- Synovial diarthrosis joint classification, ball and socket joint
PUBIC SYMPHYSIS CLASSIFICATION
Cartilaginous amphiarthosis classification
SACRO ILIAC JOINT CLASSIFICATION
Synarthroses or Amphiarthoses
MALE PELVIS FEATURE
Shape=. Narrow and deep
Body structure = Heavy
Pelvic inlet. =. Round
Pelvic outlet =. Narrow
Pubic Arch =. Less than 90 deg
FEMALE PELVIS FEATURE
Shape=. Wide , shallow
Bony Structure=. Light
Pelvic inlet=. Oval
Pelvic outlet = Wide
Pubic arch. = Greater than 90 deg
AP PELVIS PROJECTION
- Patient supine with MSP centred to midline of table
- Centre MSP with the centre f the grid
- Adjust shoulders to be in the same transverse plane
- Internally rotate feet15-20 deg
- CR. I’d point of IR
AP PELVIS STRUCTURES DEMONSTRATED
- Entire pelvis along with proximal femora
- Greater trochanter sin profile
- Lesser trochanters if seen must be demonstrated on the medial border of femora
AP PELVIC OUTLET PROJECTION
Demonstrates fractures of the pubis and ischium
- Patient supine with legs extended
- Align MSP to CR and to the midline of table
- Ensure No rotation of pelvis
- CR 20-35 deg cephalad for males and 30-45 for females 3-5 cm distal to the superior border of symphysis pubis
AP PELVIC OUTLET PROJECTION STRUCTURES DEMONSTRATED
Superior and inferior rami of pubes and body and ramus of ischium with minimal foreshortening or superimposition
AP AXIAL PELVIC INLET PROJECTION
= Provides assessment of pelvic trauma for posterior displacement or inward or outward rotation of the anterior pelvis
- Position patient supine with legs extended
- Align MSP to CR and to midline of the table with No rotation of pelvis
- CR 40 deg caudal at the level of ASIS
AP AXIAL PELVIC INLET PROJECTION STRUCTURES DEMONSTRATED
Demonstrates the pelvic inlet in its entirety
AP OBLIQUE HIP JUDET METHOD
= Useful-to evaluate acetabulum fractures or hip dislocation. Both hips done for comparison
- Place patient semi supine with affected side rotated towards the IR and away from the IR
- Place patient 45 deg posterior oblique
- Align femoral head and acetabulum of interest to midline of the table
- CR perpendicular 5cm distal and 5 cm medial to downside ASIS
…when anatomy of interest is upside CR must be perpendicular and centred 5 cm directly distal to elevated ASIS
AP OBLIQUE HIP JUDET METHOD STRUCTURES DEMONSTRATED
- When centred to the down side acetabulum= the ilioischial column and anterior rim of acetabulum
- When centred to the upside acetabulum= the iliopubis column and posterior rim of the acetabulum and obturator foramen is open
AP HIP PROJECTION
- Patient is in a supine position with the Sagittal line 5 cm medial to the ASIS centred to the midline of the table
- The body is in true AP position
- Adjust the shoulders to lie in the same transverse plane
- Use gonadal shielding and f possible
- Internally rotate the feet 15deg to overcome the ante version of the femoral necks
- CR perpendicular entering 6;4 cm distal to the midpoint between the ASIS and symphysis pubis
AP HIP PROJECTION STRUCTURES DEMONSTRATED
Head , neck, trochanter, and proximal one third of the femur
LATERAL HIP PROJECTION ( LAUENSTEIN METHOD)
- From supine position, patient turns on to affected side near lateral
- Centre affected hip on to the centre of the table
- Flex affected knee almost right angle to the hip
- Extend the opposite thigh and support it at hip level
- Avoid superimposition with the unaffected hip
- CR perpendicular and mid way ASIS and the symphysis pubis
LATERAL HIP PROJECTION ( LAUENSTEIN METHOD) STRUCTURES DEMONSTRATED
- Hip joint, acetabulum and femoral head
- Greater trochanter overlaps the femoral neck
AP PROJECTION BILATERAL HIPS PROJECTION
- Patient is in supine position with mid sagittal line centred to table
- Patient in true supine position
- Internally rotate feet
- CR- IR at the top of the ASIS and centre the CR to IR
AP PROJECTION BILATERAL HIPS PROJECTION STRUCTURES DEMONSTRATED
- Both hips and upper femora
- Greater trochanters in profile, femoral neck parallel to IR
- Lesser trochanters should not be seen
AP OBLIQUE PROJECTION: BILATERAL FROG LEG PROJECTION
Modified Cleaves Method
- Patient is in a supine position with the mid sagittal line centred to the table
- Patient in supine position
- Patient shoulders in the same transverse plane
- Have the patient flex hips and knees and draws feet up as much as possible
- abduct the thighs 45 deg if possible
- Have the patient place plantar surfaces of the feet together
- CR perpendicular to enter 2,5 cm superior to the symphysis pubis
AP OBLIQUE PROJECTION: BILATERAL FROG LEG PROJECTION
( Modified Cleaves Method ) STRUCTURES DEMONSTRATED
- Acetabulum,
- femoral head
- Lateral femoral neck
- Lesser trochanters on the medial side of the femur
AXIOLATERAL PROJECTION: CROSS TABLE LATERAL
Danelius- Miller Method
In cases where the patient is unable to move
- Patient is in supine position
- Elevate pelvis on a non- opaque pad
- Place grid with IR in it above iliac crest vertically
- Invert affected foot 15-20deg if possible
- Position cassette parallel to long axis of the femoral neck
- Flex and elevate the unaffected knee and rest it on support
- CR Directly horizontal at right angles of the femoral neck
AXIOLATERAL PROJECTION: CROSS TABLE LATERAL
( Danelius- Miller Method ) STRUCTURES DEMONSTRATED
- Femoral head
- Neck
- Trochanters
- Acetabulum
DEVELOPMENTAL HIP DYSPLASIA
Conditions more common in first born females,
- An incomplete acetabular formation
- Femoral head is displaced in relation to the acetabulum
Diagnosed by the extra folds of the gluteal tissue on the infant
Imaged with the. AP lateral frog leg projection
Treated with immobilisation
LEGG- CALVE-PERTHES
Ischemic necrosis leading to the flattening of the head of the femur caused by vascular interruption
- Largely affects boys between the ages of 4 and 10
- Diagnosed with a persistent worsening limp
- Imaged with AP and lat both hips
- Treatment = Immobilisation with monitoring of physical activities
ANKYLOSING SPONDYLITIS
A rheumatoid variant involving the sacroiliac joints and spine
