Pelvic Girdle Imaging Flashcards

Question

Modified Lateral Hip Technique- To Consider

Answer 1

* Only required in situations where both neck of femurs are suspected to be fractured * Usually in such an extreme case a CT scan is more than likely going to be performed * However, this is the heavily modified lateral hip technique * SID 100-180 (whatever works but keep it smaller where possible) * The tube needs to be angle approximately 25° downLook out for the sides of the stretcher * Angling the patient as much as possible or to 45° will reduce greater trochanter superimposition with the femoral head but means more of the stretcher could appear on the image

Answer 2

* The frog leg lateral view is a special radiograph of the pelvis to evaluate the hip in paediatrics. * It helps clinicians determine if a patient has a: * Slipped upper femoral epiphysis (SUFE) * Perthes Disease * Cerebral Palsy Integrated Pathway (CPIP) * Any hip dysplasia

Answer 3

* IR Size/Orientation dependent on patient habitus * Radiographic Marker * Examination mainly done out of Bucky however it depends on size of patient * SID 110cm * Suggested exposure factors; CR: 63-70 kV and 2-5 mAs DR: 63 - 70 kV and 1-4 mAs Older children may require an exposure in the bucky, check the local rules

Answer 4

*The patient starts supine with no rotation of hips * Both limbs are bent at the knee and the hip is abducted 45◦ * Centring point= midway between the anterior superior iliac spine (ASIS) and the pubic symphysis * Collimation; * Superior to the iliac crest * Inferiorly to the proximal third of femur * Lateral to the skin margins

Answer 5

Judet Views Used for acetabular fracture assessment. Inlet/ Outlet Views Inlet- caudal angulation to visualise pelvic rim Outlet- cranial angulation for obturator foramen

Answer 6

Shenton’s line is an imaginary curved line drawn along the inferior border of the superior pubic ramus (superior border of the obturator foramen) and along the inferior- medial border of the neck of femur. This line should be continuous and smooth. * Interruption of the Shenton line can indicate: Neck of Femur Fracture DDH

Answer 7

* There are several different types of dislocations: * Posterior Dislocation (most common 85%) * Anterior Dislocation (10%) * Inferior * Superior * Central hip dislocation * Dislocations are normally associated with: * RTC’s * High Speed Trauma * Falls * Degeneration of Hip replacements * They are managed by applying traction and using the “closed reduction” method (applying force correctly so that the hip is moved back into the correct position)

Answer 8

Posterior Dislocation of Prosthesis Posterior Dislocation Anterior Dislocation

Answer 9

* Femoral Neck is the weakest part of the Femur * NOF’S can affect the blood supply to the femoral head so need to be classified correctly. * There are three types: Subcapital (femoral head/neck junction) Transcervical (mid-part of femoral neck) Basicervical (base of femoral neck) * Most commonly occur:  Falls  High Speed Trauma

Answer 10

* They are managed by different surgical methods: Arthroplasty (total hip replacement or hemi arthroplasty) for patients with a displaced intracapsular hip fracture. Dynamic Hip Screw (DHS) which can only be used when the fracture is non-displaced. Cannulated screws also limited to non-displaced fractures but can be removed.

Answer 11

Sub-capital Transcervical Basicervical Inter-trochanteric Sub-trochanteric

Answer 12

Comminuted intertrochanteric fracture Subtrochanteric fracture

Answer 13

* Is a Type I Salter-Harris growth plate injury due to repeated trauma and hormonal factors * During growth, there is a widening of the physis/ physeal plate which is pronounced during a growth spurt. * The force across the growth plate can result in a fracture and as a result there is slippage.

Answer 14

Acetabular Fracture Pubic Rami - Fracture Iliac wing Fracture Avulsion Fracture

Answer 15

* Open Book Fracture * It is a combination of ligamentous rupture and/or fractures to both the anterior and posterior arch

Answer 16

It occurs when blood supply to the head of the femur is interrupted. As a result of this there is death of marrow and osteocytes.

Answer 17

* It is a chronic bone disorder which causes abnormal bone re-modelling. It is not understood entirely but we understand that it occurs due to a disease of osteoclasts * osteoclasts – cells that absorb old bone * osteoblasts – cells that make new bone * In Paget's disease of bone, the osteoclast cells start to absorb bone at a faster rate * The osteoblasts then produce new bone quicker, but the new bone is larger and weaker than normal

Answer 18

* It occurs when cartilage in the hip joint gradually wears away over a period of time. This results in the bone surfaces rubbing against each other. To compensate for the loss of cartilage the bones start growing outwards causing bone spurs (osteophytes). * Mainly caused by; Age, obesity and family history

Answer 19

* It is a chronic inflammatory disease that affects the joints. * Auto-immune condition that mistakes the body’s cells for foreign invaders and releases inflammatory chemicals that attack the synovium. The inflamed synovium gets thicker and makes the joint area feel painful and tender and look red and swollen. * Joints become painful, swollen and stiff * Usually occurs later in life, the age of 50 or so It can begin as early as the 30’s * More prevalent in females * Family history increases likelihood

Answer 20

* It results from an abnormal relationship between the femoral head and the acetabulum * It occurs:* Mainly in females * Due to Lax of ligaments and abnormal position in utero

Answer 21

* Perthes is considered an idiopathic condition, and there are no clear predisposing factors * Boys are five times more likely to be affected than girls * Occurs generally between ages of 3-12 * Presents as a flattened and sclerotic femoral epiphysis