Pelvis/Hip/Femur

Question 1

Abnormal symphysis pubis

Answer 1

> 1cm is abnormal

Look for SI joint widening

Question 2

Pelvis Fx

Answer 2

• Pelvis fxs usually occur in more than 1 area
  o Fxs can also cause pelvic hematoma and urethral and bladder injuries
• Ex) widening of pubic symphysis can also lead to secondary fx and sudden widening of R SI

Question 3

Paget’s disease

Answer 3

Benign lesion of the pelvis

- Increased sclerosis and enlargement of the entire R hemi pelvis

Question 4

Pelvis Stress Fx

Answer 4

• History of overuse
• Relief w/ Non WBing
• Insidious in nature
• local pain, tenderness, swelling
• Typical site = pubic ramus
• Bone scan is diagnostic early

Question 5

Insufficiency Fx

Answer 5

• Abnormal stresses to normal bone
• Normal stresses to abnormal bone: insufficiency Ex) Osteoporosis
• HONDA Sin = sacral insufficiency fx

Question 6

Frog Leg View

Answer 6

(abducted view)
o	Iliac crest
o	Ilium
o	Sacrum
o	SI joint
o	Ischial spine 
o	Acetabulum
o	Superior/Inferior pubic ramus
o	Pubic symphysis 
o	Femoral Head/Neck 
o	Greater/Lesser troch

Question 7

AP View

Answer 7

o Supine NWB
 Acetabulum
 Femoral head/neck
 Greater/lesser troch

Question 8

Hip Axial View

Answer 8

o Femoral Head/neck
o Lesser/Greater trochanter
o Ischial tuberosity

Question 9

Posterior Hip Dislocation

Answer 9

o POSTERIOR dislocation most common (Head displaced SUPERIOR and LATERAL on film)
 Dash board injury

Question 10

Anterior Hip Dislocation

Answer 10

o ANTERIOR dislocation (Head displaced INFERIOR and MEDIAL)

Question 11

Most common fracture?

Answer 11

Femoral Neck
- due to OP
Intertrochanteric  region 
-Trauma
Shorted Leg w. IR

Question 12

Osteoarthritis of hip

Answer 12

Hip pain most common cause
o Pt presents w/ pain and -mobility, starting with IR
o DJD of hip most patients
o DJD includes joint space narrowing, subchondral cysts, sclerotic borders and osteophytes

Question 13

Altman Criteria Test 1

Answer 13

Hip pain + IR <15 + Flexion < 115

Question 14

Altman Criteria Test 2

Answer 14

if hip IR > 15 + pain w/ IR + 50yrs plus + morning stiffness

Question 15

Aseptic Necrosis

Answer 15

• Femoral head flattened, irregular, sclerotic
• Use MRI
• Acronym
  o A-nemia (sickle cell)
  o S teriods
  o E thenol
  o P ancreatitis
  o T rauma
  o I idiopathic
  o C asisson’s disease (deep sea diver or pressure change occupation)

Question 16

SCFE

Answer 16

• Line drawn along superior border of femoral neck + should intersect w/ femoral head
• Complaints of knee pain + hip

Question 17

Femoral Stress Fx

Answer 17

• History of overuse
• Relief w/ non WB
• Insidious in nature
• Local pain, tenderness, swelling
• Compression vs tension side
• Bone scan is diagnostic early
• MRI 100% sensitive

Question 18

Femur Benign Tumors

Answer 18

fibrous cortical defects, fibrous dysplasia, non ossifying fibroma

Question 19

Femur Malignant Tumors

Answer 19

chondrosarcoma, mets

Question 20

Femur Periosteal reactions

Answer 20

o	Benign or malignant 
o	Typically in long bone
o	Causes
	Infections
	Osteomyelitis 
	Ewing’s tumor – young 5-20yo
	Osteogenic sarcoma – around knee joint
	Sunburst pattern – malignancy

Question 21

Benign lesions

Answer 21

o Small
o No associated periosteal reaction
o Narrow transition zone between bone and lesion
o Thing + well defined sclerotic white margins

Question 22

Malignant Lesions

Answer 22

o Lytic lesion w.o sclerotic margins is considered malignant until proven otherwise
o Breast and lung cancer produce lytic lesions
o Chondrosarcomas
 Destructive in nature
 Vary in appearance
 Occur in femur pelvis ribs