Hip and Pelvis RADT 1512

Tiera Rigby MS, RT(R)(MR) Additional slides provided by Weber Faculty

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Hip Joint

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AP Hip

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10X12 lengthwise

Medially rotate toes (15-20 degrees)$

CR between ASIS and greater trochanter or 2 inches above the fold of the leg

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Correct Feet Placement for AP

Hips

AP Hip

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Lateral Hip (Lauenstein & Hickey Methods)

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Do not do this projection with a suspected fracture of the hip.

10X12 crosswise

CR midway between ASIS and pubic symphysis-perpendicular to hip joint

Axiolateral “Cross-table” Hip (Danelius-Miller Method)

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Cassette parallel with long axis of femoral neck, upper border placed in crease above iliac crest

CR perpendicular to the long axis of the femoral

neck

10X12 lengthwise

Axiolateral Hip (Clements-Nakayama Modification)

$ If a patient has bilateral hip fractures, bilateral hip arthroplasty, or limited movement of the unaffected hip, the

Danelius-Miller method CANNOT be used.

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Pt is supine and film placed as for cross-table lateral. Limb remains in neutral or slightly

externally rotated position.

CR 15 degrees posterior and

aligned perpendicular to the femoral neck

and cassette

Lateral Hip

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Crosstable Lateral Hip with Fracture

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Review – What would you do?

Complication$

1. Patient unable to lie flat.$

2. Patient unable to move affected leg or fracture is suspected$

3. Both legs are affected and patient cannot move either legs.

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Intertrochanteric Fracture(Extracapsular)

◆ Fracture between the greater and lesser trochanters on the

intertrochanteric line.$!

◆ Commonly repaired with internal fixation utilizing a

metal plate and screws. $!

◆ If blood supply is interrupted, a hip replacement may be

required.$

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Transcervical Fracture(Intracapsular)

◆ Break in the femoral neck$– Divisions according to level of

fracture in neck:$◆ Subcapital $◆ Transcervical$◆ Basal$

!!Surgical Treatment:$

$ Anatomical reduction$$ Internal fixation$

Complications:$$ Non-union$

$ Avascular Necrosis

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Hip ReconstructionCauses:$

$ 1. Osteoarthritis$$ 2. Rhematoid $ $$ arthritis$

$ 3. Avascular Necrosis$$ 4. Abnormalities$$ 5. Trauma$

!Complications:$$ 1. Dislocation$$ 2. Blood Clots$$ 3. Infection$

Pelvis

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Lateral Pelvis Anatomy

Joints of Pelvis

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Slightly movable

Slightly movable

Hip$(synovial ball & socket joint)$

Freely movable

Male vs. Female Pelvis

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Feature Male Female

Shape Narrow, deep Wide, shallow

Bony Structure Heavy Light

Superior Aperture (inlet) Round Oval

Inferior Aperture (outlet) Narrow Wide

Divisions of Pelvis

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True Pelvis

False Pelvis

Superior aperature = Inlet Inferior aperature = Outlet(Brim of the Pelvis)

AP Pelvis

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CR midway between ASIS & pubic symphysis

Upper border of cassette is 1-1.5

inches above the crest

Toes internally rotated 15-20 degrees

Perfect Pelvis Xray

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Congenital Dislocation

Two AP Projections Required:$

1. CR Perpendicular to Pubic Symphysis$

$ (Lateral or Superior displacement of femoral head)$

$

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2. CR 45 degrees cephalic directed at Pubic Symphysis (Posterior or Anterior displacement of femoral head)$

Lateral Pelvis

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Lateral Pelvis

14X17 film lengthwise$Adjust pelvis in true lateral, extend thighs, & support L-spine to place vertebral column parallel$Iliac Crest 1-1.5 in below the top of film.$If pt cannot turn- complete cross table lateral.

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Modified Cleaves Method “Frog Leg Position”

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14x17 crosswise

Brace soles of feet against

each other for support

Abduct thighs about 45 degrees from vertical, assure both legs equally abducted

CR 1.5 in superior to pubic symphysis

Original Cleaves Method (Axiolateral Projection)$• CR parallel with femoral shafts $

(25-45 degrees cephalic)

PA Projection (Anterior Pelvic Bones)

Use an 8 X10 inch film crosswise. Pt is prone.$Center the film at the greater trochanters (pubic symphysis). CR perpendicular to midpoint of the cassette.$This shows the pubic symphysis and ischia, including the obturator foramina.

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AP Axial “Outlet” projection (Taylor Method)

10X12 crosswise (14X17 for entire pelvis) Pt supine without rotation$

!Males: 20-35 degree cephalad$Females: 30-45 degree cephalad

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CR 2 inches distal to the superior border

of the pubic symphysis

AP Axial “Outlet” Projection

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Elongated pubic and ischial rami

• Evaluates vertical shift or migration of hemipelvis$

• Shows superior & inferior rami without

foreshortening & shows anterior pelvic bones$

• Proximal/distal displacement of anterior/posterior portion of ring

Anterior and Posterior Ring Superimposed

Superoinferior Axial “Inlet” Projection (Bridgeman Method)

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10X12 crosswise (14X17 if entire pelvis is routine)$

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Demonstrates axial projection of pelvic ring, or inlet, in its entirety

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CR 40 degrees caudad centered @ level ASIS

“Inlet” Projection

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Near superimposition of pubis and ischia

• Demonstrates ring configuration$

• Evaluates narrowing or widening of diameter of

ring$• Shows posterior

displacement of ring or opening of pubic

symphysis

“Inlet” Projection

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Routine AP Pelvis

Inlet Projection$

AP Oblique Projection Acetabulum

(Judet Method)

RPO and LPO Positions @ 45 degrees$

CR directed perpendicular through the acetabulum$

Useful in diagnosing fractures of the acetabulum.

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Pelvic Fractures!

Classification:$Degree of Stability$

Stable (2/3): fracture of single bone or single breaks in the pelvic ring$Unstable (1/3): 2 or more fractures of pelvic ring$!

Direction of Force$Anteroposterior$Lateral $Vertical

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Pelvic Fractures account for 2-3 % of all fractures, but the mortality rate is up to 20%. Significant force is typically required to fracture a normal healthy pelvis

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Pelvic Fractures

Complications:$Life threatening hemorrhage$Sitting imbalance$Leg length discrepancy$

!

Radiography: (note: do not move pt with suspected fx)$Minimum AP projection$Inlet and Outlet projections (anteroposterior displacement)

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Duverney’s FractureStable fracture at the lateral margin of the iliac wing (just below the anterior inferior spine) caused by vertically directed forces

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Complications: Possible

hemorrhage from the internal iliac arterial system.

“Open Book” Injury

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diastasis of > 2.5 cm = ligament damage at the SI joint

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SI Joint Dislocation

Surgery

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In surgery, AP and lateral views will be expected. Remember, patient

positioning is the same regardless if accomplished with a C-arm or regular

radiographs.

Remember: DO NOT break the sterile field. You must have proper sterile drapes placed prior to moving in on

the patient.

Osteoporosis “Porous Bone”

!Risk Factors: Low bone mass, genetics, anorexia$

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Females have a 40% lifetime risk of fractures from osteoporotic bone at the age of 50

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Bone DensitometryThe purpose of bone densitometry is to facilitate the diagnosis of osteoporosis by detecting low bone mass. $

DEXA (spine, hip, forearm) most common$QCT (spine, forearm)$SXA (heel, forearm)$RA (hand)

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Normal bone: T-score better than -1. $Osteopenia: T-score between -1 and -2.5 $

Osteoporosis: T-score less than -2.5 $

T-SCORE: number of standard deviations below the average for a young adult at peak bone density.