Patella-pelvis Flashcards
SS:
• Subluxation of patella and patellar fx
• Allow radiologic assessment of the femoral condyle
HUGHSTON METHOD
CR AND RP OF HUGHSTON METHOD
CR: 45 deg cephalad RP: Directed through the patellofemoral joint
HUGHSTON METHOD Slowly flex the affected knee so that tibia and fibula form. what deg?
50 to 60 deg
PP: Prone
- Patella parallel with the IR
- Heel rotated 5 deg to 10 deg laterally
CR: ⊥ to mid popliteal, exiting patella
SS: Patella - Walang OID si patella pag PA
PA PROJECTION
PP:
- Pt in lateral recumbent
- Flex affected knee 5 to 10 deg
- Increasing flexion reduces patellofemoral joint space
- Adjust knee in lateral position
CR: ⊥ to IR RP: Entering knee at mid patellofemoral joint
SS: Lateral projection of patella and patellofemoral joint space
LATERALLMediolateral
P:
- From prone position medially rotate the knee 45 to 55 deg
- Flex knee approx. 5 to deg
CR: ⊥ to IR RP: Exiting the palpated patella
SS: PA oblique image of medial portion of patella free of femur
PA OBLIQUEMedial Rotation
PP:
- Flex knee 5 to 10 deg
- Externally (laterally) rotate knee 45 to 55 deg from prone position
CR: ⊥ to IR, exiting the palpated patella
SS: Oblique projection of lateral aspect of the patella free of femur
PA OBLIQUELateral Rotation
P:
- Pt in prone
- Elevate hip of affected side 2 or 3 inches
- Knee slightly flexed (appox. 10 deg) to relax
- Laterally rotate the knee to 35 to 40 deg from prone
- Rest knee on its anteromedial side
CR: 25 to 30 deg caudad RP: Directed to joint space between patella and femoral condyle
KUCHENDORF METHOD
KUCHENDORF METHOD GEST DEM.
Slightly oblique PA projection of patella,
• with most of patella free of superimposed structure
PP:
- Using axial viewer device
- Elevate pt knee approx. 2 inches to place femora parallel with tabletop
- Knee flexion 40 deg
IR: ⊥ to CR and resting on pt shins approx. 1 foot distal to the patellae
CR:
- ⊥ to IR approx. 30 deg caudad from horizontal plane
- 60 deg from vertical plane
RP: Enters midway between patellae at the level of the patellofemoral joint
SS:
- Bilateral tangential image demonstrates an axial projection of the patellae and patellofemoral joints
MERCHANT METHOD
PP:
- Pt in prone
- Flex knee slowly as much as possible or until patella is perpendicular to IR
- If pt is seated on radiographic table, hold the IR
CR:
- ⊥ to knee joint space between the patella and femoral condyles when joint is ⊥
- Degree of CR depends on degree of flexion of the knee.
- Usually, 15 to 20 deg cephalad
SS:
• Vertical fx of bone
• Articular surfaces of the patellofemoral articulation
SETTEGAST METHOD
- Projection of Distal Femur
Rotate the limb internally to place it in true anatomic position
- Bottom of IR 2 inches below the knee joint
Projection of Proximal Femur
- Place the top of IR at level of the ASIS
- Rotate limb internally 10 to 15 deg to place the femoral neck in profile
FEMUR AP CR
⊥ to the mid femur and center of the IR
PP:
- Projection of the distal femur
- draw the pt uppermost limb forward
- Adjust the pelvis in a true lateral position
- Flex the affected about 45 deg
- IR projects approx. 2 inches beyond the knee to be included
- Projection of proximal femur
- Place the top of IR at level of ASIS
- Draw the upper limb posteriorly
- Adjust the pelvis so that it is rolled posteriorly 10 to 15 deg from the lateral position is sufficient
CR: ⊥ to the mid femur and center of the IR
SS: Lateral projection of the Femur
Lateral femur
NON-TRAUMA BILATERAL:
Original Cleaves & Modified Cleaves
PP: Pt in supine
- Media rotate leg and feet 15 to 20 deg to place femoral necks parallel to IR o To avoid foreshortening
- Heels placed 8 to 10 inches apart
- Upper border of IR 1-1 ½ inches above iliac crest
CR: ⊥ midway between ASIS and symphysis pubis RP: 2” inferior to ASIS and 2” superior to
symphysis pubis
SS:
• Greater trochanter in profile
• Femoral head and neck
• Provides general survey of the bones of the entire pelvis and proximal femur.
PELVIS AP
PP:
- Pt in lateral recumbent
- Pelvis in true lateral position
CR: ⊥ to level of soft tissue depression 2” above
greater trochanter
DORSAL DECUBITUS LATERAL PROJECTION
- Best demonstrate Gull-Wing sign in cases of fracture dislocation of the acetabular rim and posterior dislocation of the femoral head.
Lateral
NON-TRAUMA UNILATERAL:
Launstein, Hickey, Friedman
TRAUMA (HIP JOINT):
Danelius Miller, Clements Nakayama, & Leonard George
SS:
• demonstrate an axial projection of the pelvic ring or inlet in its entirety.
CR: 40 deg caudad to ASIS
BRIDGEMAN METHOD
LOCATION OF FEMORAL HEAD & NECK
ASIS & Symphysis Pubis
• Determine the midpoint of a line between the ASIS and the symphysis pubis.
• The neck is approximately 2.5 inches and the head 1.5 inches distal and at right angle to the midpoint of this line.
.ASIS Only
The femoral neck is 1-2 inches medial and 3-4 inches distal to ASIS.
F-A-T-E-
F-oreshortening A-ntomy T-ube E-longation
PP: Pt in supine
- Media rotate leg and feet 15 to 20 deg to place femoral necks parallel to IR o To avoid foreshortening
- Heels placed 8 to 10 inches apart
- Upper border of IR 1-1 ½ inches above iliac crest
CR: ⊥ midway between ASIS and symphysis pubis RP: 2” inferior to ASIS and 2” superior to
symphysis pubis
SS:
• Greater trochanter in profile
• Femoral head and neck
• Provides general survey of the bones of the entire pelvis and proximal femur.
AP PROJECTION
PP:
- Pt in lateral recumbent
- Pelvis in true lateral position
CR: ⊥ to level of soft tissue depression 2” above
greater trochanter
DORSAL DECUBITUS LATERAL PROJECTION
- Best demonstrate Gull-Wing sign in cases of fracture dislocation of the acetabular rim and posterior dislocation of the femoral head.
LATERAL PROJECTION
- Often called the bilateral frog leg position
- Non-Trauma
Indication: congenital hip disease Contraindication: pt with suspected hip fx
PP:
- Pt in supine
- Abduct the thighs 45 deg from vertical
CR: 40 deg cephalad to femoral shafted
SS:
• Axiolateral projection of the femoral heads and neck
• Lesser trochanter on medial side of femur
• Femoral neck without superimposition of greater trochanter
• Lesser trochanter on medial side of femur.
• Femoral neck without superimposition of the greater trochanter.
FEMORAL NECK AP OBLIQUE PROJECTION ORIGINAL CLEAVES BILATERAL PROJECTION
- Often called the bilateral frog leg position
- Non-Trauma
Indication: congenital hip disease Contraindication: pt with suspected hip fx
PP:
- Pt in supine
- Abduct the thighs 45 deg from vertical
CR: ⊥ enter the patient’s MSP at the level 1 inch superior to symphysis pubis
SS:
• AP oblique projection of the femoral heads and neck.
FEMORAL NECK AP OBLIQUE PROJECTION MODIFIED CLEAVES BILATERAL PROJECTION
- Often called the bilateral frog leg position
- Non-Trauma
Indication: congenital hip disease Contraindication: pt with suspected hip fx
PP:
- Pt in supine
- Abduct the thighs 45 deg from vertical
CR: ⊥ enter the patient’s MSP at the level 1 inch superior to symphysis pubis
SS:
• AP oblique projection of the femoral heads and neck.
FEMORAL NECK AP OBLIQUE PROJECTION MODIFIED CLEAVES BILATERAL PROJECTION
NON-TRAUMA UNILATERAL:
Launstein, Hickey, Friedman
HICKEY CR
20-25 deg cephalad
FRIEDMAN CR
35 deg cephalad
LAUNSTEIN CR
⊥
TRAUMA (HIP JOINT):
Danelius Miller, Clements Nakayama, & Leonard George
- Trauma
- Unilateral
- The cross-table or surgical lateral projection of the hip joint
- Common projection for trauma, surgery, post-surgery or other patients who cannot move or rotate the affected leg for frog-leg lateral.
PP:
- Invert the leg 15-20 deg
- Unaffected side yung itataas
CR: ⊥ to the femoral neck
DANELIUSMILLER METHOD
- Trauma
- Unilateral
- The cross-table or surgical lateral projection of the hip joint
- Common projection for trauma, surgery, post-surgery or other patients who cannot move or rotate the affected leg for frog-leg lateral.
PP:
- Invert the leg 15-20 deg
- Unaffected side yung itataas
CR: ⊥ to the femoral neck
DANELIUSMILLER METHOD
- performed when both routine lateral and axiolateral are contra-indicated when a patient has bilateral hip arthroplasty.
- Usually performed when patient has limited movement in both lower limbs
- Alternative Danelius-Miller method.
PP:
- Both legs fully extended and in anatomical position
CR: 15 to 20 deg posteriorly and ⊥ to the femoral neck IR: tilted 15 deg posterior angle from the vertical and 2 inches below tabletop
CLEMENTSNAKAYAMA MODIFICATION
- The reverse Danelius Miller method.
- Bilateral
PP:
- Rotate foot 15 – 20 degrees internally
- Place cassette (special curve) in vertical position well up between thigh & center it to crease of the groin of affected side
LEONARD – GEORGE METHOD
JSK: 1. Superior aperture
• The oblique plane defined by the brim of the pelvis.
• Also known as the INLET of the true pelvis.
- Inferior aperture
• Defined by the two ischial tuberosities in the tip of the coccyx.
• Also known as the OUTLET of the true pelvis.
PELVIC OUTLET VIEW METHOD?
PELVIC INLET VIEW METHOD?
BRIDGEMAN METHOD
LILIENFIELD
STAUNIG
STAUNIG CR?
35 cephalad
PP:
- Pt in semi prone position on the affected side
- Elevate affected side, so that anterior surface of the body forms 38 degrees angle from table
CR: 12° cephalad RP: inferior level of coccyx at 2 inches lateral to MSP towards side being examined
SS: demonstrate fovea capitis particularly superoposterior wall of the acetabulum
TEUFEL METHOD
AP OBLIQUE PROJECTION
PP:
- Patient in semi supine position
- Anterior surface of the body forms a 45 deg angle from the table.
CR: ⊥to 2 inches inferior to ASIS
Two 45-degree posterior oblique positions - useful in diagnosing fractures of the acetabulum and dislocation.
JUDET METHOD
- (AFFECTED HIP UP)
- IIP (Iliopubic/ Posterior rim)
• Suspected fracture in iliopubic column and posterior rim of acetabulum.
• Obturator foramen visualized.
(JUDET METHOD)INTERNAL OBLIQUE
- (AFFECTED HIP DOWN)
- IIA (Ilioishial/ Anterior rim)
• Fracture in ilioischial column and anterior rim of acetabulum.
• Iliac wing
(JUDET METHOD)EXTERNAL OBLIQUE
- (AFFECTED HIP DOWN)
- IIA (Ilioishial/ Anterior rim)
• Fracture in ilioischial column and anterior rim of acetabulum.
• Iliac wing
(JUDET METHOD)EXTERNAL OBLIQUE
