image interpretation : pelvis & lower limbs...image interpretation : pelvis & lower limbs...
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Image Interpretation : Pelvis & Lower limbs
Imelda Williams
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Radiographic interpretation of the pelvis
▪ Anatomical radiographic lines to assess for trauma.
▪ Shenton’s line: gentle curve of the lower border of superior pubic
ramus & inferior border of femoral neck.
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The pelvis contains 3 bony ring structures
which indicates careful scrutiny to exclude
additional fractures or dislocations.
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▪ Alignment:
– Examine the 3 bony rings : one fracture in a bony ring is frequently associated with another.
– Look at Shenton’s line– Sacro-iliac joints- compare their
widths, they should be equal– Symphysis pubis- superior
border of the pubic rami should align, the width of the joint should be approx 5mm
– Look at acetabulum-compare sides
ABCs Pelvic Search Strategy
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▪ Bone- trace outline of each bone for signs of fractures
▪ Cartilages – are joint spaces uniform?
▪ Soft tissues- look for
– calcifications, foreign bodies, avulsion fractures.
▪ Satisfaction of search: if you find one abnormality, search for
possibility of another.
Bone, Cartilage, Soft tissues
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Pelvic fractures
▪ Pelvic fractures are relatively uncommon,
▪ Fractures are classified as minor (stable) isolated fractures or major
(unstable) displaced fractures
▪ Fractures involving bony ring
– Widened SI-joint
– Diastasis of pubic symphysis represents fracture of main ring
– Double pathology e.g. fracture(s) / dislocation = unstable fracture
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Stable fractures
▪ Fractures around the “ring” which do
not break into the ring
▪ Usually the result of moderate forces
▪ Isolated sacrum fractures
▪ Mechanism is usually fall onto sacrum
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Unstable Pelvic fractures
▪ Consist of fractures to both arches.
▪ High risk of hemorrhage
▪ Classified by: Mechanism of injury
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Lateral Compression fractures
▪ Most common unstable fracture
▪ Affected iliac wing folds inwards
▪ Tension in SI-joint
▪ Fractures of pubic rami, sacral
foramina
Monash Image
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HIP: Range & Significance of Radiographic Appearances
▪ Intracapsular
▪ Reduce the blood supply to femoral head
▪ High risk of delayed union, non-union or avascular necrosis
▪ Extracapsular
– Intertrochanteric
▪ Do not interfere with
femoral head blood supply
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Hip fractures associated with high morbidity & mortality in
elderly population
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Hip dislocations
▪ Traumatic: Anterior or posterior
▪ Slipped capital (upper) femoral
epiphysis (SUFE)
– Patients prone to AVN &
degenerative arthritis
▪ Complications of hip
dislocations
▪ SUFE
– AVN femoral head
– Osteoarthritis
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Hip: Posterior dislocation
▪ Patient presents with
internal rotation of knee
▪ 90% of cases may have
acetabular posterior rim
fracture
▪ 20% can result in
avascular necrosis
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Monash Image
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Apophyses: sites of muscle insertion
www.learningradiology.com
Ischial tuberosity avulsion following hamstring injury
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Fractures of Femoral Shaft
▪ Open or Closed
▪ Spiral
▪ Comminuted
▪ Supracondylar
▪ Pathological
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Monash Image
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Tibial Plateau Fractures▪ Check condyle
alignment:
– Line drawn
perpendicular to
tibial plateau from
lateral margin of
the femur
– Should be no more
than 5mm of tibia
outside of it
Normal kneeLateral femoral condyle does not
align to lat tibial margin
Slight cortical
disruption and lucent
line of fracture
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Normal Variant
▪ Bipartite or Multipartite
patella common normal
variants
▪ Distinguish from patella
fracture:
– Smooth margins
– Uni / Bilateral
– Most common location:
supero-lateral corner
of patella
Bipartite patellaMultipartite patella
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Monash Image
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Avulsion fracture▪ Inversion injury –
result of pull of the
calcaneofibular
ligament
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Monash Image
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The Danis-Weber classification system uses the position
of the level of the fibular fracture with its relationship to
its height at the ankle joint.
Type A: fracture below the ankle joint
Type B: fracture at the level of the joint, with the
tibiofibular ligaments usually intact
Type C: fracture above the joint level which tears the
syndesmotic ligaments.
Danis-Weber Classification
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Calcaneal injuries
▪ Usually associated with a fall from a height
▪ Associated with T12/L1 compression fractures
▪ Most fractures are visible on the lateral projection
▪ Look for cortical disruption, a sclerotic line and check Bohler’sangle which should be between 30-40 degrees
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Monash Image
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Stress fractures
▪ Normally affect one metatarsal,
usually the second or third
▪ Early signs – fine incomplete
fracture line with a fluffy callus
formation
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Missed stress fracture
Monash Image
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Base of the fifth metatarsal
Avulsion fracture:
▪ Most common fracture of this
area – an inversion injury
▪ Occurs at the most proximal tip
of the 5th metatarsal where the
peroneus brevis tendon
attaches
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Monash Image
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Phalanx fractures are common
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Crushed fracture
Monash Image
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Take home principles
▪ Always consider the mechanism of injury.
▪ Apply a search strategy.
▪ Know the common pelvis and lower limb fractures and dislocations.
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