Pelvis Positioning Flashcards by Gracie Costello

> 90 degree pubic arch

Obtuse angle

Female pelvis

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<90 degree pubic arch

Acute angle

Male pelvis

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Articulation between the right and left ilia and the sacrum

Sacroiliac (SI) joints

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Articulation of the head of the femur with the acetabulum

Hip joint

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Junction of the right and left pubic bones in the midline

Pubic symphysis

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What part of the femur is common to break due to axial loading?

Neck

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In anatomical position, how is the head of the femur positioned?

15-20 degrees anterior

*anatomical position - true AP of knee, leg, ankle but NOT hip

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T/F
In anatomical position (feet pointing forward) the lesser trochanters are visible

True

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If the hip and leg are in internal rotation, where are the greater and lesser trochanters seen?

Greater - in profile laterally
Lesser - superimposed

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If the hip and leg are in external rotation, where are the greater and lesser trochanters seen?

Greater - not in profile
Lesser - in profile medially

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What degree of internal rotation of the feet is wanted for AP projections of the pelvis/hip?

15-20 degrees to place hip in true AP

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What is asymmetric rotation of the feet an indication of?

Possible hip fracture

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What are the most common bony landmarks for palpating?

Iliac crest
ASIS

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Where is the neck of the femur located from ASIS?

1-2” medial
3-4” distal

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T/F
The highest point of the greater trochanter lies in the same horizontal plane as the midpoint of the hip joint and coccyx

True

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What is the standard SID for all pelvis/hip projections?

40” (102cm)

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What are the breathing instructions for every pelvis/hip projection?

Suspend respiration

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What projections are done for non-trauma pelvis?
Ex. OA

-AP non trauma pelvis
-bilateral frog leg
-unilateral frog leg

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What projections are done for non-trauma proximal hip/femur?
Ex. Hip pinning

-AP hip
-AP oblique (Lauenstein)

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What projections are done for trauma pelvis?

-trauma pelvis
-inlet/outlet
-judet (looking at acetabulum)

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What projections are done for trauma of proximal femur/hip?

-AP hip
-axiolateral

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What projections are done for trauma ilium?

-AP and PA

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What is the kv range for all projections, except axiolateral?

85 +-5

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What AEC cells are used for AP pelvis?

Left and right cells
IR horizontal

-patient supine -MSP centered to midline -equal ASIS to table distance on both sides, midway between symph and ASIS -medially rotate legs and feet 15-20 degrees to place femoral necks parallel with IR

AP pelvis

What AEC cell is used for an AP hip?

Center cell IR vertical

-patient supine -no rotation of pelvis -medially rotate lower limb 15-20 to place femoral neck parallel to IR -CR perpendicular to femoral neck -collimate to include ASIS

AP hip

T/F Unilateral frog leg projections should only be used for non-trauma clinical indications

True

What AEC cell is used for unilateral frog leg hip

Center cell Vertical IR

What method is contraindicated if fracture is suspected?

Unilateral frog leg

T/F Grids are used for all pelvis/hip projections

True

-flex leg 60-70 degrees -abduct thigh 45 degrees -center ASIS to midline of IR -CR perpendicular to femoral head or neck

Unilateral frog leg

What AEC cells must be used for bilateral frog leg?

Left and right IR horizontal

-flex hips/knees 60-70 degrees -abduct thighs 45 degrees -place soles of feet together -CR 3” below level of ASIS -collimate 5” below symph

AP bilateral frog leg

-method is contraindicated if fracture is suspected -commonly done for recheck hip pathologies: prosthesis, hip pinning -prevents foreshortening of distal hip

AP oblique hip (Lauenstein)

What AEC cell is used for AP oblique hip Lauenstein?

Centre cell Vertical IR

-rotate toward affected side to an oblique position until femur is in contact with the tabletop parallel to IR -CR perpendicular through hip crease (midway from ASIS and symph)

AP oblique hip Lauenstein

T/F Feet are NEVER rotated for trauma projections

True

Which projection is the only true lateral, and best for trauma?

Axiolateral Can assess the ant/post displacement of fractures

Assess medial/lateral displacement of fractures

What kv range and AEC are used for axiolateral hip

90+-5 AEC not used

-flex knee of unaffected limb to place thigh vertical -IR landscape with upper border in crease above iliac crest -CR horizontal and perpendicular to long axis of femoral neck

Axiolateral hip

Bilateral view of the bilateral pubis and ischium to allow assessment of pelvic trauma for fractures and displacement

AP axial outlet

-CR angled cephalad 20-35 degrees for males and 30-45 for females -CR directors to a midline point 1-2” distal to the superior border of the symph or GT

AP axial outlet

What AEC is used for AP axial outlet?

Centre Horizontal IR

Assessment of pelvic trauma for posterior displacement of inward or outward rotation of the anterior pelvis

AP axial inlet

-angle CR caudad 40 degrees -CR directed to a midline point at level of ASIS

AP axial inlet

What AEC cells should be used for AP axial inlet?

Left and right Horizontal IR

What projection is usually done for acetabular fractures to view upside and downside

AP oblique acetabulum (Judet)

What AEC cells should be used for AP oblique acetabulum Judet?

Unilateral - centre Vertical IR Bilateral - left and right Horizontal IR

-Recumbent 45 degree posterior oblique position with affected side down -CR perpendicular and cnetered to 2” distal and 2” medial to downside ASIS

AP oblique acetabulum Judet External rotation - affected side down

-Recumbent 45 degree posterior oblique position with affected side up -CR perpendicular and cnetered to 2” distal and 2” medial to upside ASIS

AP oblique acetabulum Judet Internal oblique - affected side up

Anterior rim and posterior ilioischial column demonstrated

Judet Downside (affected side closer)

Posterior rim and anterior iliopubic column demonstrated

Judet Upside (affected side away)

What projections are required for ilium projections?

AP and lateral Right side: RPO/RAO Left side: LPO/LAO

What AEC cell is used for ilium projections?

Centre Vertical IR

From supine position: elevate the unaffected side approx. 40 degrees to place the broad surface of the wing of the affected ilium PARALLEL with the plane of the IR -Center IR at level of ASIS

Ilium projection (AP) RPO/LPO

From a prone position: centre the Sagittal plane passing through the hip joint of the affected side to the midline of the grid Elevate the unaffected side about 40 degrees to place the affected ilium PERPENDICULAR to the plane of the IR -centre IR at level of ASIS

Ilium projection (lateral) RAO/LAO