Trauma Pelvis

What are three differences from a male vs female pelvis?

• Male is more narrow and heart shape

• Female is more wider and round

• Female pelvis has obtuse 80-85 angle

• Male pelvis has acute 50-60 angle

What is the angle and centering for inlet pelvis image?

• 40 degrees caudal

• Level of ASIS

• MSP

What is the angle and centering for outlet pelvis image?

• 20-35 cephaled for males

• 30-45 cephaled for females

• MSP and 2 in below pubic symphysis

What is demonstrated in Inlet projection?

• Ischial spines are fully

demonstrated and equal in size

and shape

• Superimposed superior pubic

ramus and ischium

What is demonstrated in outlet projection?

• Obturator foramina and bilateral

  ischia are equal in size and

  shape (symmetric)

What is the angle and centering for trauma judet projection

• 45 degrees medial lateral

• 2 in below and 2 in medial from asis

What must be done for trauma judet projections?

• Off center the IR to the left (when

  angling to the left). Place left hip

  joint in the center of the IR.

What is shown on upside and downside judets?

Upside: Posterior rim and anterior iliopubic column, open obturator foramen

Downside: Anterior rim and posterior ilioischial column and elongated iliac wing

What is the angle and centering for LEONARD-GEORGE PROJECTION?

• Place IR in between the patients legs

• Rotate the tube to the IR so the CR is perpendicular to the femoral neck

• CR should be parallel to a line drawn from ASIS and pubic symphysis

What does the LEONARD-GEORGE PROJECTION demonstrate?

• Lateral view of hip

• Acetabulum, hip joint, head,

  neck, and trochanters of the

  femur are visible.

What is the angle and centering of the clement-nakayama projection?

• 30-40 degrees mediolaterally and 15-20 degrees down

• Center perpendicular to femoral neck

What must be demonstrated for the clement’s nakayama projection?

• Lateral view of hip

• acetabulum, head and neck

  in profile, and the trochanters.

What is the clement’s nakayama good for?

• Bilateral hip fractures or arthroplasty

What is the angle and CR centering for the sanderson projection?

• Place IR underneath the hip to be parallel with the long axis of foot

• CR is angled medio-lateral as needed to be perpendicular to long axis of foot or IR.

• Support is placed under affected hip, 20-30 degrees from supine

What does sanderson method demonstrate?

Lateral view showing

the entire head, neck,

acetabulum, and

trochanters.

What are some pathology of the hip?

• Legg Calve´ Perthes

• developmental dysplasia

  of the hip (DDH)

During a repeat study of the

AP axial (Taylor) outlet projection, both obturator foramina are symmetric but foreshortened. Which of the following positioning modifications must be performed to correct this error?

Increase the cephalic CR angulation

A radiograph of an AP axial (Taylor) "outlet" projection reveals that the obturator foramina are not symmetric.

What type of positioning problem is present on this radiograph?

Rotation of the pelvis

A patient enters the ER having sustained trauma to the pelvis.

The patient's main complaint is about her left hip. Which of the following projections should be taken first to rule out fracture or dislocation?

AP Pelvis

A radiograph of an axiolateral (inferosuperior) projection of the hip reveals a soft tissue artifact seen across the affected hip. This artifact prevents a clear view of the femoral head and neck. What must the technologist do to eliminate this artifact or its effect during the repeat exposure?

Increase the elevation and flexion of the patient's unaffected leg

Which one of the following projections will best demonstrate a lateral oblique view of the femoral head and

neck for the patient with limited movement in both lower limbs?

1. Teufel

2. Axiolateral (inferosuperior)projection

3. AP axial (Taylor)

4. Modified axiolateral (Clements-Nakayama)

Modified axiolateral (Clements-Nakayama)

Which of the following positions will best demonstrate the posterior

(ilioischial) column and anterior (iliopubic) column of the pelvis?

Posterior oblique(Judet method)

Which of the following positions will best demonstrate signs of developmental dysplasia of the hip?

Bilateral frog method

Which of the following conditions will produce shortening of the epiphyses but widening of the epiphyseal plate?

Slipped capital femur

Which of the following pathologic conditions is a common type of aseptic or ischemic necrosis?

Legg-Calvé-Perthes disease

A common condition of the femur that develops in elderly patients, leading to frequent fractures of the hip (proximal femur):

Avascular Necrosis

Select the correct gender to correspond with the following pelvic characteristics. Obtuse angle of pubic arch:

Female

Select the correct gender to correspond with the following pelvic characteristics. More oval or heart-shaped pelvic inlet:

Male

Using the hip localization method, the femoral head can be located:

b. 1 1/2 inches (4 cm) below the midpoint of the imaginary line between the two bony landmarks

The two bony landmarks that are palpated using the hip localization method are the:

ASÍS AND Pubic Symphysis

The sacroiliac joints are classified as ____joints with ____mobility.

synovial; amphiarthrodial

Which bone of the pelvic girdle forms the anterior inferior aspect?

Pubis

Which bones fuse to form the acetabulum?

Ischium, pubis, and ilium

What is DDH?

Developmental dysplasia of the hip

• Condition present at birth

• Congenital dislocation of the hip is the older term

What is Legg-Calvé-Perthes disease?

• Most common type of aseptic or ischemic necrosis

• Lesions of just one hip(head and neck of femur)

• 5-10 year old boys

What parts do the Ilium, Ischium and pubis make up of the acetabulum?

Ilium - largest and superior

Ischium - Inferior and posterior

Pubis - Inferior and anterior

What makes up the inlet?

Superior portion of pubic symphysis and sacral promontory

What forms the false pelvis?

Tip of coccyx and two ischial tuberosities

Describe the von rosen hip projection

• A test for DDH

• The baby is lying supine

  with the CR perpendicular

  to the mid-pelvis

  The legs are abducted at

  least 45 degrees with an

  inward rotation of the

  femora at the knees (legs

  are straight