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Imaging II > Pelvis > Flashcards

Pelvis Flashcards

1
Q

What are the recommended views for the hip?

A

AP and lateral

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2
Q

What lines represents the anterior and posterior columns?

A 
Anterior = iliopectineal
Posterior = ilioischial
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3
Q

What do the anterior and posterior lip of the acetabulums represent?

A

Anterior and posterior walls of the acetabulum

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4
Q

What is AVN?

A

an interruption of blood supply to the femoral head causing bone tissue death

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5
Q

What are the 2 different presentations of AVN?

A

Osteochondritis dissecans is local infaraction, most often in weight bearing bones
Epiphyseal ischemic necrosis affects entire epiphysis in a growing child, proximal femur most common location for this

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6
Q

How does AVN develop?

A

1) idiopathically
2) compression or disruption near bone (trauma, infection, steroid administration)
3) conditions that cause blood vessel occlusion (radiation, lupus, giant cell arteritis)
4) conditions that cause blood vessel blockage (alcoholism, diabetes, sick cell disease)

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7
Q

Legg Calve Perthes Disease

A

young boys with average age 6 yo

idiopathic AVN, or associated with subtle trauma, synovitis, infection or metabolic bone disease

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8
Q

What are the signs and symptoms of AVN?

A
  • synovitis or inflammatory response of hip
  • non specific dull pain in joint, thigh, leg
  • limited joint motion and progressive painful limp (adults)
  • painless, slow evolving lump (children)
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9
Q

What type of gait is seen in children with bilateral AVN?

A

waddling type gait

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10
Q

What is the first radiographic sign of AVN?

A

Radiolucent crescent image (represents collapse of necrotic subchondral bone of femoral head)
Sclerosis and cyst formation at femoral head (can be distinguished from OA by normal joint space)

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11
Q

What occurs with advanced AVN?

A

Femoral head collapses or appears flattened because of structural weakness and inability to withstand weight-bearing forces

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12
Q

Does the femoral head become more radiolucent or radiodense in AVN?

A

radiodense because of new bone attempting to heal microfractures of trabeculae and calcification of necrotic marrow

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13
Q

Does the joint space ever change in AVN?

A

Yes, during advanced stages it will become compromised. Once the femoral head collapses, it alters the joint surface congruity and involves the acetabulum

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14
Q

What advanced imaging can be done for AVN?

A

Bone scans = identify increased uptake at site of lesion soon after lesion

MRI considered MOST appropriate for early sensitivity and specificity

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15
Q

What is the treatment for AVN in children?

A

Successful healing with conservative treatment in younger patients (avoiding weight-bearing, traction, bracing, casting, exercise)

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16
Q

What is the prognosis for AVN? (children and adults)

A

Good for children because they possess healthier, more adaptable blood supply
Prognosis in adults more variable, may or may not need surgical intervention (may take several years to heal)

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17
Q

What type of surgical intervention is used for AVN?

A

Drilling into femoral head to hasten revascularization
Grafting healthy bony into drill holes to repair process
Varus derotation osteotomy to provide weight-bearing surface for femoral head
Osteotomy and replacement arthroplasty

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18
Q

Where is Klein’s Line drawn?

A

Along the lateral femoral neck intersecting the femoral head (SHOULD intersect the head, if not, slipped femoral head)

19
Q

What is the normal femoral neck angle? Coxa vara? Coxa valga?

A

normal = 130~
coxa vara = < 130
coxa valga = >130

20
Q

Where is Shenton’s Line?

A

Medial and superior surface of obturator foramen to medial aspect of femoral neck

21
Q

Where is the iliofemoral line?

A

outer surface of ilium that extends inferiorly along femoral neck

22
Q

What is DJD of the hip?

A

Osteoarthritis, most common disease affecting hips

23
Q

What are the 2 major etiologies of DJD?

A 
Primary = without clear precursor
Secondary = directly related to some predisposing trauma or pathological condition
24
Q

What are some of the causes of Secondary DJD?

A

fracture, paget’s disease, epiphyseal disorders, congenital dislocation, AVN, inflammatory arthritides

25
Q

How is DJD presented?

A

Progressive pain and loss of ROM

Abulation becomes impaired from loss of joint congruity and increased pain upon weight beaing

26
Q

What are the major radiological findings for DJD?

A

Joint space narrowing, sclerotic subchondral bone, osteophyte formation at joint margins, (pseudo)cyst formation, migration of femoral head

27
Q

How are cysts seen on radiographic images? (density)

A

Radiolucent lesions

28
Q

What are cysts called that are in the acetabulum?

A

Egger’s cysts

29
Q

How do cysts from in DJD?

A

Degeneration of articular cartilage. The loss of buffering effected by articular cartilage results in microfractures in the subchondral bone. These fractures permit joint synovial fluid into the periarticular bone

30
Q

What causes the femoral head to migrate in DJD?

A

The destruction of articular cartilage alters normal joint congruity between the femoral head and the acetabulum

31
Q

Where does the femoral head typically migrate in DJD?

A

superomedial position relative to normal position

32
Q

What are the goals for conservative treatment for DJD?

A

decreased pain, restoration of flexibility and strength, preserving functional activities and ambulation with AD to unload joint from full weight bearing stresses

33
Q

Surgical options for DJD include…

A
  • wedge osteotomy
  • femoral head resection
  • hemiarthroplasty
  • THA
  • hip resurfacing
34
Q

Who is a good candidate for a hip resurfacing?

A

younger patients with good bone density

35
Q

What is RA?

A

progressive, systemic, autoimmune inflammatory disease primarily affecting synovial joints

36
Q

Who gets RA?

A

3x greater in women

most common in young adulthood

37
Q

What is the clinical presentation for RA?

A 
morning joint stiffness
bilateral and symmetrical swelling of joints
pain and functional disability
Rheumatoid nodules
positive rheumatoid factor test
radiographic changes consistent with RA
38
Q

What are the radiological findings for RA?

A

Osteoporosis of periarticular areas
Symmetrical and concentric joint space narrowing
Articular erosions centrally or peripherally in joint
Synovial cysts location within nearby bone
Periarticular swelling and joint effusions
Axial migration of femoral head
Acetabular protrusion

39
Q

What articular erosions occur in RA?

A

Femoral head loses spherical shape and acetabulum loses cuplike appearance

40
Q

What is the biggest difference between RA and DJD?

A

RA has minimal or absent reparative processes, sclerotic subchondral bone and osteophytes not evident

41
Q

Difference in clinical signs (RA and DJD)

A

RA has swelling

42
Q

Difference in ABCS (RA and OA)

A 
A = RA is bilateral synovial joint; OA is unilateral synovial or cartilaginous
B = RA acetabular protrusion, dislocations, swan-nec and boutoniere deformities; OA herberdens nodes, bouchards nodes, valgus/varus
C = RA osteoporosis; OA does not
S = RA is symmetrical, OA asymmetrical, osteophytes, sclerotic subchondral cysts
43
Q

What is the treatment for RA?

A 
Pharmacological treatment (NSAIDs, corticosteroids, gold salts, immunosuppressive drugs)
Conservative treatment for pain and disability (pain relief modalities, splinting, adaptive functional and ambulatory devices, exercise to promote strength/ROM)
Surgical in advanced cases (THA)

Imaging II (9 decks)

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