Bontrager Chapter 7: Femur and Pelvic Girdle

the largest and strongest bone of the body

femur

a small depression located in the center of the femoral head is the

fovea capitis

the lesser trochanter is located on the ____ (medial or lateral) of the proximal femur

medial;posteriorly

Because of the alignment between the femoral head and pelvis, the lower limb must be rotated __________ degrees internally to place the femoral neck parallel to the plane of the IR to achieve a true AP projection

15 to 20 degrees

T/F The term pelvis and pelvic girdle are not synonymous

true

list the 4 bones that make up the pelvis

Right and left hip bones, sacrum, coccyx

List the two bones that make up the pelvic girdle

right and left hip bones

list two additional terms used for the bones of the pelvic girdle

ossa coxae and/or innominate bones

list the three divisions of the hip bone

ilium, ischium, pubis

all three divisions of the hip bone eventually fuse at the ____________ at the age of ______________

acetabulum, midteens

what are the two radiographic landmarks found on the ilium

crest of ilium and ASIS

Which bony landmark is found on the most inferior aspect of the posterior pelvis?

ischial tuberosity

what is the name of the joint found between the superior rami of the of the pubic bones

symphysis pubis

the ___ of the pelvis is the largest foramen in the skeletal system

obturator foramen

the upper margin of the greater trochanter is approximately __ degrees above the level of the superior border of the symphysis pubis, and the ishcial tuberosity is about __ degrees below

1 inch

1 1/2 to 2 inches

an imaginary plane that divides the pelvis region into the greater and lesser pelvis is called the

pelvic brim

List the alternate terms for the greater and lesser pelvis

greater pelvis: false

lesser pelvis: true

list the major function of the greater and lesser pelvis

support the lower abdominal organs and fetus

forms the actual birth canal

list the three aspects of the lesser pelvis, which also describe the birth route during the delivery process

inlet, cavity, outlet

match the following structures or characteristics to the correct hip bone

possesses a large tuberosity found at the most inferior aspect of the pelvis

ischium

match the following structures or characteristics to the correct hip bone

lesser sciatic notch

ischium

match the following structures or characteristics to the correct hip bone

ala

ilium

match the following structures or characteristics to the correct hip bone

posterior superior iliac spine (PSIS)

ilium

match the following structures or characteristics to the correct hip bone

possesses a slightly moveable joint

pubis

match the following structures or characteristics to the correct hip bone

anterior superior iliac spine

ilium

match the following structures or characteristics to the correct hip bone

forms the anterior, inferior aspect of the lower pelvic girdle

pubis

articulates with the sacrum to form the sacroiliac (SI) joints

ilium

in the past which radiographic exam was performed to measure the fetal head in comparison with the maternal pelvis to predict possible birthing problems

cephalopelvimetry

what imaging modality has replaced the procedure identified before this

sonography (ultrasound)

indicate whether the following radiographic characteristics apply to male or female in relation to an AP projection of the pelvis

wide, more flared ilia

pubic angle of 110 degrees

a heart shaped pelvic inlet

narrow ilia that are less flared

pubic arch angle of 75 degrees

ischial spines protruding less into pelvic inlet

female

female

male

male

male

female

joint classification, mobility type, and movement type of the hip joint

synovial, diarthrodial, ball and socket

joint classification, mobility type, and movement type of the sacroiliac joint

synovial, amphiarthrodial, limited

joint classification, mobility type, and movement type of the symphysis pubis

cartilaginous, amphiarthrodial, limited

joint classification, mobility type, and movement type of the acetabulum

cartilaginous, synarthrodial, non-moveable

Which two bony landmarks need to be palpated for hip localization?

ASIS and symphysis pubis

From the midpoint of the imaginary line created by the two landmarks (ASIS & Symphysis pubis), where would the femoral neck be located?

about 2.5 inches below the midpoint line

a second method for locating the femoral head is to palpate the __ and go ___ inches medial at the level of the ___, which is ___ inches distal to the original palpation point

1 to 2 inches, symphysis pubis and/or grater trochanter, 3 to 4 inches

To achieve a true AP position of the proximal femur, the lower limb must be rotated ___ internally.

15 to 20 degrees

which structures on an AP pelvis or hip radiograph indicate whether the proximal head and neck are in position for a true AP projection

lesser trochanter should not be visible, or should only be slightly visible

which physical sign may indicate that a patient has a hip fracture

the patients foot is rotated externally

which projection should be taken first and reviewed by a radiologist before attempting to rotate the into a lateral position (if trauma is suspected)

AP pelvis

gonadal shielding should be used for all patients of reproductive, unless

it covers anatomic structures of primary interest

Should a gonadal shield be used for a hip study on a young female? If yes, describe how it should be placed on the patient

yes, use a shaped ovarian shield with top of shield at the level of ASIS and bottom at symphysis pubis

Should a gonadal shield be used for a hip study on a young male? If yes, describe how it should be placed on the patient

yes, the top of the shield should be placed at the inferior margin of the symphysis pubis

what is the advantage of using 90 kV for hip rather than a lower kV range for hip and pelvis studies with an analog imaging system on younger patients

it reduces patient dose

what is the disadvantage of using 90 kV for hip and pelvis studies with an analog imagining system, especially for older patients with some bone mass loss

it reduces radiographic contrast

which of the following conditions is a common clinical for performing pelvic and hip examinations on a pediatric (newborn) patient

a. osteoporosis

b. developmental dysplsia of hip (DDH)

c. ankylosing spondylitis

d. osteoarthritis

developmental dysplasia of hip (DDH)

T/F: Geriatric patients are often more prone to hip fractures because of their increased incidence of osteoporosis.

true

t/f the soft tissue of an obese patient is indicative of the actual size of a bony pelvis

false, the size of the bony pelvis is not proportional to the girth and dimensions of the soft tissue that surrounds it

which of the following imaging modalities can be used on a newborn to assess hip joint stability during movement of the lower limbs

a. sonography

b.CT

c. MRI

d. nuc med

sonography

which of the following imaging modalities is most sensitive in diagnosing early signs of metastatic carcinoma of the pelvis

a. sonography

b.CT

c. MRI

d. nuc med

nuc med

degenerative joint disease

osteoarthritis

most common fracture in older patients because of high incidence of osteoporosis or avascular necrosis

proximal hip joint

a malignant tumor of the cartilage of the him

chondrosarcoma

a disease producing extensive calcification of the longitudinal ligament of the spinal column

ankylosing spondylitis

a fracture resulting from a severe blow to one side of the pelvis

pelvic ring fracture

Malignancy spread to bone via the circulatory and lymphatic systems or direct invasion

metastatic carcinoma

now referred to as developmental dysplasia of the hip

congenital dislocation

which of the following devices will improve overall visibility of the proximal hip demonstrated on an axiolateral (inferosuperior) projection

a. small focal spot

b. 6:1 grid

c. compensating filter

d. shadow shield

compensating filter

which of the following modalities will best demonstrate a possible pelvic ring fracture

a. CT

b. Nuclear medicine

c. MRI

d. sonography

CT

T/F: Both joints must be included on an AP and lateral projection of the femur even if a fracture of the proximal femur is evident.

true, if an AP and lateral femur study is ordered both joints must be demonstrated on each projection

Where is the CR placed for an AP pelvis projection?

midway between the ASIS and symphysis pubis

the CR for the AP pelvis projection is approximately ___ inches inferior to the level of the ASIS

2 inches

which specific positioning error is present when the left iliac wing is elongated on an AP pelvis radiograph

rotation towards the left side

which specific positioning error is present when the left obturator foramen is more open than the right side on an AP pelvis radiograph

rotation towards the right side

indicate whether each of the following projections is used for patients with traumatic or non-traumatic injuries

axiolateral, inferiosuperior (danelius-miller)

unilateral "frog-leg" (modified cleaves method)

AP bilateral "frog-leg" (modified cleaves method)

modified axiolateral (clemets-nakayama method)

Ap axial for pelvic outlet (taylor method)

trauma

nontrauma

nontrauma

trauma

trauma

which of the following projections is recommended to demonstrate the superoposterior wall of the aceatabulum

a. AP axial inlet

b. PA axial oblique

c. axiolateral inferosuperior

d. modified axiolateral

PA axial oblique

When gonadal shielding is not used, ___(males/females) receive a greater gonadal dose with an AP pelvis projection.

females because of the location of the CR and reproductive organs

how many degrees are the femurs abducted (from the vertical plane) for the bilateral frog-leg projection

40 to 45 degrees

where is the CR placed for bilateral frog-leg (modified cleaves method) projection

3 inches below the level of the ASIS

Which size of analog image receptor should be used for an adult bilateral frog-leg projection?

14x17 landscape

where is the central ray placed for an AP unilateral frog-leg projection

midfemoral neck

which central ray angle is required for the Ap axial-outlet (taylor method) projection for a female patient

a. 15 to 25 degrees caudad

b. 30 to 45 degrees cephalad

c. 20 to 35 degrees cephalad

d. none central ray is perpendicular

30 to 45 degrees cephalad

proper name of an axiolateral (inferosuperior) projection

danelius-miller

proper name of a modified axiolateral projection

clements-nakayama

proper name of AP bilateral or unilateral frog-leg

modified cleaves

proper name of posterior axial oblique for acetabulum

teufel

proper name of AP axial for pelvic "outlet" bones

taylor

posterior oblique for acetabulum

Judet