Pelvis Hip & Femur Flashcards
What findings & type of joint disease is demonstrated here?
- Non-uniform loss of joint space on left (at superior femoral-acetabular joint space)
- Subchondral sclerosis & subchondral cysts
- Osteophyte at the acetabular margin
Degenerative arthritis (OA or DJD)
(Recommend for possible ortho referral)
Degenerative joint disease of the hip is termed ____
Malum coxa senilis
T/F: There is a good correlation between radiographic features of DJD in the hip & clinical picture
F
Non-uniform joint loss is common in the hip, specfically MC where
Superior femoral-acetabular joint space
Collar type ____ around femoral head/neck junction is a common radiographic feature in DJD of hip
Osteophytes
______ aka cortical thickening along medial femoral neck is a common radiographic feature in DJD of hip
Buttressing
A common radiographic feature in DJD of hip is ____ which demonstrates one medial joint space >2mm vs. the opposite side
A nonspecific sign
Waldenstrom’s sign
What findings are demonstrated here in this case of DJD of the hip?
Subchondral sclerosis & collar osteophyte around femoral neck
Also buttressing
What findings are demonstrated here?
- Bilateral & symmetric distribution
- Decreased joint space at axial portion of femoral-acetabular joint. decreases medial & superior → uniform loss of joint space
- Periarticular osteopenia (yellow)
Infammatory disease process (Rhuematoid Arthritis)
Protrusio acetabuli in the hip is MC caused bilaterally by what disease process
RA
Bilateral, symmetric narrowing of axial joint space in the hip is associated with what disease process?
RA
What disease process is likely the cause of the findings here?
RA
DDX = bone softening diseases such as osteomalacia, padgets
What findings are demonstrated here?
- Normal subchondral bone, normal joint spacing at the hip
- Ill-defined, irregular margins at pubic symphysis
- Monoarticular inflammatory arthritis → septic arthritis (until proven otherwise) or osteitis pubis
- Recommend medical referral, CBC w/ blood culture to r/o septic arthritis
(Osteitis pubis common in young athletes, women post-childbirth)
15 y.o male
What type of disease process is demonstrated here & what is the likely cause?
Inflammatory arthritis in kids → juvenile idiopathic arthritis or hemophilia
_____ (malunion/nonunion) of pelvic fractures is uncommon; _____ (malunion/nonunion) is common
Nonunion; Malunion
Stable or unstable fracture
Stable
Stable or unstable fracture
Unstable
What kind of stable fracture
Duyerney fraction
What kind of unstable fracture
Straddle fx
What kind of unstable fracture
Malgaigne fx
What kind of unstable fracture
Sprung pelvis
What kind of unstable fracture
Bucket handle fx
What hip pathology is demonstrated here?
AIIS avulsion fx on the left (normal growth plate on right)
What findings are outlined here in an adolescent patient
What findings are seen here?
- Extra bone on femur = post-traumatic heterotopic ossification
- Disruption of arcuate line of sacrum on left side (pink)
- Disruption of cortex in superior & inferior pubic ramus (yellow)
- Unstable pelvic fx → Malgaigne fx (fx thru sup & inf pubic rami w/ fx or dislocation posteriorly around SI jt)
- Refer for CT for further eval
What type of pelvic fx is demonstrated here?
What type of pelvic fx is demonstrated here?
What findings are demostrated here?
Abnormal Klein’s line on the left
Slipped Femoral Capital Epiphysis AKA Salter Harris Type 1 fx
(Red = growth plates)
What are 3 major pediatric hip disorders?
Slipped Femoral Capital Epiphysis
Legg-Calves Perthes Disease aka AVN
Developmental Dysplasia
_____ (intracapsular/extracapsular) femoral neck fx has a worse prognosis due to AVN
Intracapsular
MC type of intracapsular fx; usually impacted, easily missed =
Subcapital fx
What type of intracapsular femoral neck fx is shown here?
Subcapital fx
Transverse fx through mid-neck = what type of intracapsular femoral neck fx
Midcervical fx
Transverse fx @ base of neck; pathologic fx’s occur here = what type of intracapsular femoral neck fx
Basicervical fx
What type of femoral neck fx is demonstrated here?
Subcapital fx
What type of femoral neck fx is demonstrated here?
Midcervical fx
What type of femoral neck fx is demonstrated here?
Basicervical fx
What type of femoral neck fx’s raises alarm bells for thinking there may be an underlying pathology for this fx?
Basicervical (intracapsular) & Subtrochanteric (extracapsular)
What are the 2 types of extracapsular femoral neck fxs?
Intertrochanteric
Subtrochanteric
What type of extracapsular femoral neck fx is demonstrated here?
What type of extracapsular femoral neck fx is demonstrated here?
Subtrochanteric
What pathology is demonstrated here
Posterior hip dislocation (refer out for CT)
What are the 3 ddx based on the age & aggressive appearence of the lesion in this case?
- Ewing’s Sarcoma
- Osteosarcoma
- Osteomyelitis
MC cause & location of osteomyelitis/septic arthritis?
Staph Aureus
Femur
This case demonstrates a chronic case of ____
Phemister’s triad consists of:
And is associated with what condition
- Gradual loss of joint space (key for diff. from other inflamm processes)
- Juxta-articular osteoporosis
- Articular erosions
Tuberculous Arthritis
What condition is demonstrated here?
An oval lucency (greater than 1cm) surrounded by sclerosis
(due to ankylosing of the joint, think infection therefore brodies vs. osteoid osteoma or osteoblastoma)
What are the most likely differentials of this aggressive process in the left ilium of this 65 y.o pt?
- Metastasis
- Myeloma
- Lymphoma
_____ seen below can be a ddx for blastic metastasis
Enostoma (“bone island”)
What condition is associated with the findings seen here?
- Increased density, accentuated & enlarged trabeculae patterns on right
- Filled in Kohler’s teardrop
→ likely Paget’s disease
What condition is likely the cause of the findings seen here?
red = blade of glass or flame sign (well demarcated border between normal & affected bone)
What condition is likely the cause of the findings seen here?
Fibrous Dysplasia
Usually leave me alone lesion, may want ortho referral
What condition is likely the cause of the findings seen here?
Polyostotic fibrous dysplasia
What are the possible differentials associated with these findings?
- Small lucency (aka lucent nidus) surrounded by area of sclerosis
- Osteoid Osteoma (usually smaller lucency therefore most likely)
- Brodie’s Abcess
- Osteoblastoma
These findings are likely caused by what condition
Osteoid Osteoma
What condition is likely the cause of the findings seen here?
DDX: Osteosarcoma, Ewing’s Sarcoma & Osteomyelitis
What condition is likely the cause of these findings?
AVN of femoral head bilaterally
What is the gold standard for dx of AVN?
MRI
Features of ____ include:
- Sclerosis with cystic areas w/ generalized osteopenia of all surrounding osseus features
- Linear subchondral lucency of femoral head known as crescent sign
- Femoral head deformity
AVN
What condition is likely the cause of these findings?
Crescent sign outlined
What condition is likely the cause of these findings?
- Smaller, flattened, fragmented, sclerotic femoral head
Legg-Calve-Perthes disease
What condition is likely the cause of these findings?
Widening of SI joints = hyperparathyroidism
What condition is likely the cause of these findings?
Putti’s Triad:
- Small femoral head
- Laterally displaced femoral head
- Increased acetabular angle
DX: Developmental dysplasia of the hip
What condition is likely the cause of these findings?
Developmental dysplasia of the hip
What condition is likely the cause of these findings?
Tri-radiate pelvis → osteogenesis imperfecta
