Imaging - Radiologic Evaluation Pelvis and Hip

AP pelvis (pelvis, sacrum, coccyx)

AP hip

Lateral frog-leg

What are the routine x-ray views of the pelvis and hip?

AP pelvis

What view does this show?

AP pelvis

What view does this show?

AP hip

What view does this show?

AP hip

What view does this show?

Lateral frog leg

What view does this show?

Lateral frog leg

What view does this show?

Angle of inclination

angle from the head of the femur to the neck of the femur

AP pelvis

How is the angle of inclination best imaged?

coxa valga and genu varum

What does this image show?

caxa vara and genu valga

What does this image show?

femoral anteversion

What does this image show?

femoral retroversion

What does this image show?

Bilateral sides of pelvis and hips

L5 vertebra

sacrum and coccyx

SI joints

hip joints

Femoral Necks and their angles of inclination

What do you see on a AP pelvis radiograph view?

Proximal femur and acetabulum

Unilateral Femoral Neck

Angle of Inclination femoral neck to shaft

Greater & Lesser Trochanter Intertrochanteric Crest

Cortical outline of femur

What do you see on a AP hip radiograph view?

Lateral frog leg

Femoral head

neck and proximal shaft

Greater & Lesser Trochanters from

medial aspect

lateral frog leg

What radiograph view has the best view of the lesser trochanter?

femoral head in acetabular fossa

medial wall of acetabulum

anterior and posterior rims of acetabulum

Sacrum

Pubic rami

greater and lesser trochanters

What do you see in a CT axial view of the pelvis?

anterical inclination of acetabular cup

acetabular roof

iliopsoas muscle anterior to hip

sacroiliac joints

pubic symphysis

What do you see in a CT saggital view of the pelvis?

bilateral comparison of hip joints

acetabulum

femoral heads, necks, shafts

greater and lesser trochanter

Sacrum, ilia, sacroiliac joints

What do you see in a CT coronal view of the pelvis?

cartilage

Labrum

Presence of FAI

What is an arthrography used to evaluate?

arthrography

contrast material injected into joint space for imaging

Acetabulum

Labrum

Femoral head and neck

Greater and lesser trochanters

Scrum, ilium, sacroiliac joints

pubic symphysis

What do you see in an MRI axial view of the pelvis?

Sphericity of femoral head

Superior aspect of acetabulum and cartilage

What do you see in an MRI sagittal view of the pelvis?

gluteus maximus

hamstrings

What do you see in an posterior MRI axial view of the pelvis?

iliopsoas

sartorius

rectus femoris

vastus medialis

What do you see in an anterior MRI axial view of the pelvis?

Hip joints

Proximal femurs

Sacroiliac joints

ilium

Gluteal muscles

abductors

adductors

What do you see in an MRI coronal view of the pelvis?

avulsions of the ASIS, AIIS, or ischial tuberosity

What does A show?

iliac wing frature

What does B show?

sacral fracture

What does C show?

ipsilateral pubic rami fracture

What does D show?

contralateral pubic rami fracture

What does E show?

sartorius

TFL

Which muscles attach to the ASIS?

Unstable pelvic injury

disruption of 2 or more sites on pelvic ring

internal hemorrhage

What are unstable pelvic injuries associated with?

Vertical shear/Malgaigne fractures

Straddle fractures

Bucket handle fractures

Examples of unstable pelvis injuries

Vertical shear/Malgaigne fractures

lateral fractures of the superior and inferior pubic rami and disruption of the ipsilateral sacroiliac

Straddle fractures

all for ischiopubic rami fractured

Bucket handle fractures

ischial ramus, ipsilateral pubic ramus, and the contralateral sacroiliac joint

SIJ

pubic symphysis

Where do dislocations of the pelvis occur?

Acetabular fracture

from femoral head impacting into acetabulum

CT or advanced imaging

What imaging is used for acetabular fractures?

70% female

40% >85 years old

What is the population that hip fractures occur in?

14%

What percentage of fractures are hip fractures?

Femoral neck

Intertrochanteric

Trochanteric

What are the three types of hip fractures?

intracapsular

What type of hip fractures are femoral neck fractures?

avascular necrosis due to blood supply limitations

What is there a risk of with femoral neck fractures?

AP hip in maximal internal rotation and lateral view (comparison with the uninvolved hip through AP pelvis view)

What imaging is used to diagnose a femoral neck fracture?

ORIF

arthroplasty

How are femoral neck fractures treated?

Trochanteric fracture

isolated fractures of greater and lesser trochanters are typically avulsion fractures caused by forceful muscle contraction

AP and other views

What imaging is used to diagnose a trochanteric fracture?

AP view with LE in ER

What imaging is used to diagnose a lesser trochanteric fracture?

non surgical unless significant displacement

How are trochanteric fractures treated?

gluteus max and min

Triceps coxae

Piriformis

What muscles attach to the greater trochanter?

iliopsoas

What muscles attach to the lesser trochanter?

Subtrochanteric fracture

Proximal femur fracture located from the lesser trochanter to 5cm distal to it that may occur in low energy (elderly) or high energy (young patients) mechanisms

AP and other views

What imaging is used to diagnose a subtrochanteric fracture?

cephalomedullary nail fixation

How are subtrochanteric fractures treated?

joint space narrowing

sclerotic subchondral bone

osteophyte at joint margins

cyst/pseudocyst

How does degenerative joint disease/osteoarthritis appear on imaging?

symmetrical joint space narrowing

loss of bone density in periarticular bone density

articular erosions

synovial cysts

joint effusion

periarticular swelling

How does rheumatoid arthritis appear on imaging?

joint narrowing with sclerosis

osteophyte formation

large subchondral cysts

What are characteristics of OA?

Avascular necrosis of the femoral head

Interruption of blood supply to the femoral head that causes deformities and collapse of the head

intracapsular fracture or displaced fracture interrupt blood supply

What causes Avascular necrosis of the femoral head?

Glucocorticoids

ETOH

post-transplantation

SLE

post-trauma

genetic disorders

What are risk factors of Avascular necrosis of the femoral head?

Legg Calve Perthes

Idiopathic epiphyseal ischemic necrosis at femoral head

hip pain

antalgic gait

What are characteristics of Legg Calve Perthes?

children ages 3-12

What is the population that Legg Calve Perthes occurs in?

standard radiographs

MRI - bone marrow

What is the imaging used to diagnose Legg Calve Perthes disease?

conservative revascularization

core decompression

grafting

THA

What are possible treatments for Legg Calve Perthes disease?

Slipped capital femoral epiphysis (SCFE)

femoral epiphysis slips posteriorly

lateral frog leg to view amount of displacement

What type of imaging is used to diagnose SCFE?

blurring/widening of physis on AP

How is SCFE seen on an image?

surgically

How is SCFE treated?

Femoral acetabular impingement (FAI)

Pathological contact between femoral head-neck junction and acetabular rim during hip movement

CAM

aspherical femoral head - femoral head can not clear the acetabular rim

Pincer

Over-coverage of the femoral head by the acetabulum

Capital

What type of fracture is 1?

Subcapital

What type of fracture is 2?

transcervical

What type of fracture is 3?

Intertrochanteric

What type of fracture is 4?

Subtrochanteric

What type of fracture is 5?

intracapsular

What type of fracture is a capital fracture?

intracapsular

What type of fracture is a subcapital fracture?

intracapsular

What type of fracture is a transcervical fracture?

extracapsular

What type of fracture is a intertrochanteric fracture?

extracapsular

What type of fracture is a subtrochanteric fracture?