x-ray anatomy pelvis and hip

Question 1

femoral neck fractures are subtle, what are the 5 areas to assess for fracture

Answer 1

• capital
• subcapital
• transcervical
• intertrochanteric
• subtrochanteric

Question 2

fractures in which 3 areas of the femoral head leads to risk of avascular necrosis and why

Answer 2

capital, subcapital and transcervical

• because they are intracapsular had have no other blood supply besides from the head

Question 3

what is a typical radiographical sign of the common sub capital fracture of the femoral head

Answer 3

the femoral neck looks shortened and femur may be superiorly displaced

• clinically the patients leg looks shortened and externally rotated

Question 4

mind that an undisplayed NOF can be subtle and missed on initial radiograph.

ensure to deeply scrutinise the lateral hip xray for NOF fractures

Question 5

a pubic rami fracture can be mistaken for a femoral NOF fracture.

Question 6

if there is a pubic rami fracture, what 2 other areas should be scrutinised

Answer 6

iliac wing or sacrum

Question 7

what is the normal pubic symphysis width in children and adults, otherwise indicating disruption

Answer 7

10mm in children
5mm in adults

Question 8

what should you look for in the pubic rami to ensure no injury

Answer 8

that the superior pubic rami align otherwise (if one is higher than the other) it indicated disruption

Question 9

the ischial-pubic synchondrosis (cartilaginous junction) may present as irregular and asymmetric during development. can be mistaken for healing fractures or lesions

Question 10

what method can be used to identify if there is any injury to the sacrum as it is hard to identify due to obstruction by bowel gas?

Answer 10

use the arcuate lines (formed fro the edge of the sacral foramina)

• should be smooth and unbroken
• asymmetry indicated injury to sacrum

Question 11

an L5 transverse process may suggest an occult sacral fracture in absence of obvious fracture of iliac crest

Question 12

what should the average width of SI joints be in adults?

Answer 12

2-4mm (normally wider in kids)

Question 13

a double break in the pelvis ring is regarded as unstable injury

Question 14

if there is anterior compression of the pelvis, what 3 things can be seen radiographically

Answer 14

• widening of SI joints
• diastasis (widening) of pubic symphisis
• extrenal rotation of semi pelvis

Question 15

if there is lateral compression of pelvis, what 3 things can be seen radiographically

Answer 15

• oblique fractures of pubic rami bilatereally
• fracture to sacral foramina
• infolding of hemipelvis

Question 16

how can you tell between posterior and anterior dislocation of the femoral head

Answer 16

posterior = looks more superior and outwards

anterior = looks more inferior and towards midline

Question 17

where are the 5 apophyses found in the pelvis/hip region

Answer 17

• crest of illeum
• ASIS
• AIIS
• ischial tuberosity
• lesser trochanter

Question 18

what will you see radiographically on a slipped upper femoral epiphysis (SUFE) and what view is done to view this

Answer 18

• widened physeal growth plate
• frog lateral view
• a line drawn along the lateral femoral neck should intersect a portion of the femoral epiphysis, if not then there is a medials lip

Question 19

what is perths disease

Answer 19

osteochondritis of femoral head

• an uncommon condition that affects children between the ages of 3 and 11 years. Blood supply to the head of the thigh bone is disrupted which causes the bone to deteriorate.

Question 20

what is an irritable hip + radiographic indications

Answer 20

• transient synovitis (inflammation fo hip joint)
• can be indicated by joint effusion

Question 21

what is pagets disease

Answer 21

• 3 main features: bone expands, cortex thickened and trabecular is coarse

often pelvis and proximal femur is affected

Paget’s disease of bone is a chronic (long-lasting) disorder that causes bones to grow larger and become weaker than normal.