Femur/Pelvis/Hip

What comes out of the fovea capitis?

capitis femoris ligament

what are the attachments of the capitis femoris ligament?

fovea capitis and acetabulum

What is the longest and strongest bone in the body?

femur

The greater trochanter is located

superior and lateral to the shaft

the lesser trochanter is located

medial and posterior

The intertrochanteric crest is located on the

posterior of the femur

The intertrochanteric line is located on the

anterior femur

Intercondylar fossa AKA

popliteal surface

Intercondylar sulcus AKA

trochlear groove, and patellar surface

The anterior surface of the patella is

rough for ligament/tendon attachment

The apex of the patella is

inferior

There is a ___ angle between the neck and shaft of the femur

125

The femur sits ___ degrees from vertical

5-15

Who has more of an angle from vertical (femur)?

people with wider, shorter pelvis

Who has more of an angle between neck and shaft (femur)?

people who have a tall/narrow pelvis

The head of the femur projects

anteriorly 15-20 degrees in relation to the body

Why do we internally rotate the leg for femur x-rays? (AP)

to place the femoral neck parallel to the IR.

The pelvis is made up of

2 hip bones, sacrum, and coccyx

Pelvic girdle =

2 hip bones

pelvis girdle AKA

bony pelvis

Hip bones AKA

ossa coxae and innominate bones

What makes up a hip bone?

ilium, ischium, and pubis

Where do the ilium, ischium, and pubis fuse?

the acetabulum

When do the ilium, ischium, and pubis fuse at the acetabulum?

mid-teens

How much of the acetabulum is made up of the ilium?

2/5

What are the different parts of the ilium?

ala/wing, body, ASIS, AIIS, PSIS, PIIS, crest

How much of the acetabulum is made up of the Ischium?

2/5

What are the parts of the ischium?

upper body (articulated with the ilium), lower body, ischial tuberosity (on lower body), ramus (articulates with the pubis), ischial spine, and greater/lesser sciatic notches.

How much of the acetabulum is made up of the pubis?

1/5

What are the parts of the pelvis?

body (articulates with ilium), superior ramus, inferior ramus (articulates with ischium)

What is the largest foramen of the body?

obturator foramen

What passes through the obturator foramen?

nerves, vessels (blood and lymph), tendons, and ligaments

What bones make the obturator foramen?

ischium and pubis

Pelvic brim AKA

pelvic inlet

What is the pelvic brim/inlet?

plane between sacral promontory and superior border of the pubis

False pelvis AKA

greater pelvis

What is the false/greater pelvis?

Everything superior to the pelvic brim/inlet

True pelvis AKA

lesser pelvis

What is the true/lesser pelvis?

everything between the pelvic brim/inlet and pelvis outlet

The true/lesser pelvis forms the

birth canal

The pelvic outlet is made of

the triangle between the tip of the coccyx and the ischial tuberosities

What is cephalopelvimetry?

using colcher sussman ruler to measure babies head/birth canal/pelvis

What has cephalopelvimetry been replace by?

ultrasound

Female pelvis qualities

obtuse angle of pubic arch

wide outlet

flared, more rounded ilia

shallow front to back

Male pelvis qualities

acute angle of pubic arch

smaller inlet

ischial spines protrude into pelvic cavity more

narrow

deeper

less flared ilia

SI joints are classified as

synovial -plane/gliding (structural)

amphiarthrodial - limited movement (functional)

Pubic symphysis joint is classified as

cartilaginous - symphysis (structural)

amphiarthrodial (limited movement) - functional

Why is the pubic symphysis amphiarthrodial?

for childbirth/trauma

The acetabulum joint is classified as

cartilaginous - synchondrosis (structural)

synarthrodial (no movement) - functional

Hip joint is classified as

synovial - ball and socket/spheroidal (structural)

diarthrodial - freely movable (functional)

What movements can a ball and socket joint do?

flexion, extension, abduction, adduction, internal/external rotation, circumduction

What are the 2 methods to locate hip joint?

1. 1.5” distal to line between ASIS and pubic symphysis=head. 2.5” distal to line=neck

2. 1-2” medial and 3-4” distal to ASIS= neck. 3-4” distal to ASIS=symphysis pubis

what is the recc amount of lead for gonadal shielding?

1mm

When is gonadal shielding required?

when gonads lie within 2” or 5cm of primary beam and use of shield won’t obscure anatomy of interest

Where should male shields be placed?

below ischial tuberosities and pubic symphysis

Where should female shields be placed?

above pubic symphysis and 1” medial to each ASIS

What is a shadow shield?

goes on the collimator

What is a contact shield?

goes on the pt.

what is the purpose of a grid?

improves image contrast by reducing amount of scatter that reaches the IR

When using a grid you have to

increase technique

if angling against grid lines, you have to

increase technique a lot

What images are typically done in peds?

just AP pelvis, maybe bilateral frog leg, knee with open collimation

What are routine femur images per book?

AP distal femur (long), lateral distal femur, lateral proximal femur (not frog leg)

What are routine images for femur (lab/clinic)?

AP proximal (long), AP distal (short), Lateral distal (long), Lateral proximal (short)

Where is CR for AP pelvis?

midway between ASIS and pubic symphysis (2” below ASIS) at the midline

where should the top of the light field/IR be for AP pelvis?

At the iliac crest

What should the collimation field be?

14×17, landscape

Where should the bottom of the light field/IR be for AP pelvis?

below ischial tuberosities (1.5” below pubic symphysis/greater trochanter)

Where should your marker be placed for AP pelvis

At the top in free space for smaller pt’s

At the bottom in femoral soft tissue for larger pt’s (no free space present)

If the pt’s pelvis if rotated to the right how will the iliac wing and obturator foramen look?

right iliac wing will be elongated, right obturator foramen will be closed with rotation to the right side.

When is a bilateral frog-leg projection taken?

typically only in peds

What is the name of the frog-leg projection?

modified cleaves

What does bilateral frog-leg look for in peds pt’s?

DDH (developmental dysplasia of the hip)

Where is CR for bilateral frog-leg projection?

At the midline, 3-4” below the ASIS (at the level of the femoral heads)

How much should legs be abducted for bilateral frog leg?

45 degrees

What does 20-30 degree leg abduction in bilateral frog leg look at?

femoral neck (least amount of foreshortening of the femoral neck in this position)

What is the difference between the original cleaves method and the modified cleaves method?

The original cleaves method has a cephalic CR angle to be parallel to the femoral shafts, modified cleaves does not have and angled CR

Where is CR for AP hip?

1-2”medial and 3-4” distal to ASIS

How should pt’s leg be positioned for AP hip?

internally rotated 15-20 degrees

Should iliac crest be included in AP hip?

depends on facility protocol. Best to include it

What is the name for axiolateral inferosuperior hip projection?

danelius-miller

When is danelius-miller used?

When there is trauma/suspected fx to leg being imaged and unaffected leg can be moved/abducted.

Why is it important to make sure IR and CR are perpendicular when taking a cross-table lateral?

so grid lines are not evident on the image

What is the name for modified axiolateral hip?

clements-nakayama

When is clements-nakayama used?

when leg being image has trauma/suspected fx and pt. cannot move/abduct unaffected leg.

What is CR for clements nakayama?

15-20 degrees down to the femoral neck

How should IR be positioned for clements-nakayama?

tilted to match 15-20 degree CR angle

What is the name for AP axial outlet?

taylor method

What is CR for taylor method?

angled cephalic 20-35 degrees for males, 30-45 degrees for females to midline, 1-2” distal to pubic symphysis/greater trochanters.

what breathing instructions should you give your pt. for hip/pelvis and proximal femur images?

suspend respiration

What is demonstrated by taylor method?

superior and inferior rami of the pubis as well as body and ramus of ischium

What is CR for AP axial inlet?

caudad 40 degrees to midline at the level of the ASIS

What are judet views?

posterior 45 degree oblique pt. position

What is CR for judet views?

perpendicular to 2” distal and 2” medial to the inferior border of the ASIS

What is shown in judet views?

anterior rim (iliopubic) of acetabulum and posterior ilioischial column, iliac wing

these views are specifically done to see the acetabulum

Judet views are typically done __________ , but this may vary by clinical location

bilaterally for comparison

How is the pt. rotated in judet view?

rotated into 45 degree oblique with affected side up.

What is the name for PA axial oblique acetabulum projection?

teufel

How is pt. positioned for teufel views?

35-40 degree anterior oblique with affected side down/closer to IR

What is CR for teufel?

12 degrees cephalic and 1” superior to greater trochanter as well as 2” lateral to MSP