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What serves as the base of the trunk of the body?
the pelvis
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What forms the connection between the vertebral column and the lower limbs?
the pelvis
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What bones make up the pelvis?
- two hip bones
- sacrum
- coccyx
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what bones make up the pelvic girdle?
two hip bones
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Give two alternate names for the hip bone:
- ossa coxae
- innominate bone
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Name the three divisions of the hip bone:
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What bones do we "sit on"?
the ischium
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What bone is inferior and anterior to the acetabulum?
the pubis
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What bone is inferior and posterior to the acetabulum?
the ischium
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At what vertebral level is the ASIS located?
S2
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At what vertebral level is the iliac crest located?
L4-L5
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What is the name of the "wing" of the ilium?
the ala
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How are the margins of the ala located in relation to each other?
the lateral margin is anterior to the medial margin
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What part of the pelvis makes up the upper 2/5 of the acetabulum?
the ilium
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Of the pubis, is the superior ramus or the inferior ramus more anterior?
the superior ramus
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Label:
- A. Posterior Superior Iliac Spine (PSIS)
- B. Posterior Inferior Iliac Spine
- C. Greater Sciatic Notch
- D. Ischial Spine
- E. Lesser Sciatic Notch
- F. Ischial Tuberosity
- G. Ischium
- H. Ischial Ramus
- I. Ala of Ilium
- J. Iliac Crest
- K. Anterior Superior Iliac Spine (ASIS)
- L. Anterior Inferior Iliac Spine
- M. Body of Ilium
- N. Acetabulum
- O. Peclineal Line
- P. Superior Ramus of the Pubis
- Q. Obturator Foramen
- R. Pubis
- S. Inferior Ramus of the Pubis
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Label:
- A. Iliac Crest
- B. Anterior Superior Iliac Spine (ASIS)
- C. Anterior Inferior Iliac Spine
- D. Acetabulum
- E. Ischium
- F. Obturator Foramen
- G. Ala of Ilium
- H. Auricular Surface
- I. Posterior Superior Iliac Spine
- J. Posterior Inferior Iliac Spine
- K. Ischial Spine
- L. Body of Pubis
- M. Peclineal Line
- N. Superior Ramus of Pubis
- O. Inferior Ramus of Pubis
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- A. iliac crest
- B. ASIS
- C. ischial spine
- D. greater trochanter
- E. lesser trochanter
- F. inferior ramus of pubis
- G. pubic symphysis
- H. obturator foramen
- I. ischium
- J. acetabulum
- K. sacrum
- L. sacroiliac (SI) joints
- M. Ala of ilium
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What is the small indention on the head of the femur that is a ligament attachment site?
fovea capitis
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What is the part of the femur that runs between the greater and lesser trochanters, anteriorly?
intertrochanteric line
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What is the part of the femur that runs between the greater and lesser trochanters, posteriorly?
intertrochanteric crest
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Describe how the width of the pelvis influences the angle of the neck of the femur:
- a wide pelvis will decrease the angle of the femoral neck
- a narrow pelvis will increase the angle of the femoral neck
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Describe how the width of the pelvis influences the longitudinal angle of the femur:
- a wide pelvis will mean more longitudinal angulation of the femur
- a narrow pelvis will mean less longitudinal angulation of the femur
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At the neck, the femur projects _______ anteriorly and _______ superiorly. The longitudinal plane is angled ________________.
- 12-20°
- 120-130°
- 10° from vertical
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What type of joint is the hip joint?
- synovial
- diarthrodial
- spheroidal (ball & socket)
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What type of joint is the SI joint?
- synovial
- amphiarthrodial
- gliding/plane (irregular)
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What is the name of the medial surface of the ilium which articulates with the sacrum to form the SI joint?
auricular surface
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What is the slight ridge of bone that runs medially and anteriorly forming the brim of the pelvis?
aurculate line
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What is the degree of angulation of the SI joints?
25-30° to the midsagittal plane
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What is the most anterior joint of the the pelvis?
the pubic symphysis
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What type of joint is the pubic symphysis?
- cartiliginous
- amphiarthrodial
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Describe the differences between the male and female pelvis:
- the female pelvis is wider, more flared, with the fossa being more shallow
- the female bony structures appear lighter and thinner
- the female pubic arch is an obtuse angle (>90°)
- the male pubic arch is an acute angle (<90°)
- the female inlet is more oval shaped & male is more rounded
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What follows the medial shape of the ilium around to the superior border of the pubis and to the top of the sacrum?
the pelvic brim
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What is the name for the top aspect of the sacrum?
the sacral promontory
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The region above the pelvic brim is the _________ and the region below the pelvic brim is the __________.
- false (greater) pelvis
- true (lesser) pelvis
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The brim (from the sacral promontory to the superior margin of the pubic symphysis) forms the ________, while a measurement from the tip of the coccyx to the inferior margin of the pubic symphysis forms the ___________.
- superior aperture (inlet)
- inferior aperture (outlet)
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The region between the inlet and the outlet is the __________.
pelvic cavity
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How do you find the location of the femoral head?
1 1/2" distal to the midpoint of an imaginary line from the ASIS to the superior margin of the pubic symphysis
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How do you find the location of the femoral neck?
2 1/2" distal to the midpoint of an imaginary line from the ASIS to the superior margin of the pubic symphysis
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When localizing the hip joint, what is palpated?
only the ASIS
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How do you get the proximal femur and hip joint to be projected in a true AP projection?
internally rotate the leg 15-20°
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what are the two most common fracture sites, concerning the hip?
- the femoral neck
- the intertrochanteric crest
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What is a clinical sign of a fractured hip (at femoral neck)?
external rotation of the involved foot so that it's at a 90° angle
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Where should the shield be placed for a male, for pelvis?
top of shield at inferior margin of pubic symphysis
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Where should the shield be placed for a female, for pelvis?
- only if it will not cover pertinent anatomy
- Prone is an option to reduce exposure, sometimes
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- A. greater trochanter
- B. neck of femur
- C. head of femur
- D. lesser trochanter
- E. body/shaft of femur
- F. fovea capitis
- G. intertrochanteric crest
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What cassette size and orientation do you use for pelvis projections?
14x17CW
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Where do you center for an AP pelvis?
midway between ASIS and pubic symphysis (leg crease)
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- AP Hip
- blah blah. you know this one.
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What is the easiest way to tell on a hip/pelvis radiograph if a positioning error is present where legs/feet were not rotated in 15-20°?
the lesser trochanters are easily seen medially
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What is the method used for an AP oblique pelvis?
- Modified Cleaves Method
- (bilateral "frog leg")
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For the Modified Cleaves Method, by how much should the femurs be angled?
abducted 40-45°
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Where do you center for the Modified Cleaves Method of the pelvis?
3" below the ASIS, on the mid-sagittal plane
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How should the greater trochanters appear for a Modified Cleaves pelvis?
overlapping the neck of the femur
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What cassette size and orientation is used for hip projections?
10x12LW (to part)
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For the Unilateral Frog Leg (Modified Cleaves), what should be centered to the midline of the grid?
the ASIS of the affected side
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- Modified Cleaves Method (AP oblique)
- no rotation (symmetrical appearance)
- lesser trochanter on medial side
- femoral neck without superimposition by greater trochanter
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For the lateral hip projection, the ___________ Method uses a 20-25° cephalic CR, and the ___________ Method uses a perpendicular CR.
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What is the angulation used for the Hickey method for a lateral hip projection?
20-25° cephalic
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What positioning change is made if moving from a unilateral frog leg to a lauenstein/hickey method?
- for the unilateral frog, the thigh is abducted 45° laterally
- for both the hickey and lauenstein methods, the leg of the affected side is flat on the table (bent at knee) with unaffected hip elevated
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What pelvis/hip projection should never be done on a suspected fracture?
A Frog Leg position
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When viewing radiographs of a Lauenstein and a Hickey projection, what is a major noted difference?
- lauenstein - greater trochanter overlaps femoral neck
- hickey - greater trochanter does not overlap femoral neck
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Between Lauenstein and Hickey, which is the better view of the neck of the femur?
Hickey
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- Lauenstein Method (lateral)
- hip joint centered
- femoral neck overlapped by greater trochanter
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- Hickey Method (lateral)
- hip joint centered
- femoral neck free of superimposition
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- Axiolateral inferiosuperior projection (used for trauma hip)
- Danelius-Miller Method
- no overlap of neck and greater trochanter
- small amount of lesser trochanter, posteriorly
- small amount of greater trochanter, anterior and posterior
- ischial tuberosity below femoral head
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For the Danelius-Miller Method, explain the alignment of the tube, part, and IR:
- tube is perpendicular to both the neck of the femur and the IR
- neck of femur is parallel to the IR
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- AP axial "outlet" projection
- Taylor Method
- pubic & ishial bones magnified
- pubic bones superimposed over sacrum & coccyx
- pubic & ishial rami near center
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What is specific to the Taylor Method, when taking an AP projection of the pelvis?
- for males: angle CR 20-35° cephalic
- for females: angle CR 30-45° cephalic
- (AP axial "outlet" projection, mostly for trauma pts)
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- Judet Method (AP Oblique)
- an RPO or LPO position (45° from table)
- internal oblique - suspected fx of iliopubic column (anterior) and posterior rim of acetabulum; affected hip UP
- external oblique - suspected fx of ilioischial column (posterior) and anterior rim of acetabulum; affected hip DOWN
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- Clements-Nakayama Modification Method
- modified axiolateral projection
- for when unaffected leg cannot be raised to complete a danelius-miller method
- 15° posterior angulation of CR
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Which method would you most likely use to image a suspected fractured hip?
- AP, as is
- cross table lateral (Danelius-Miller Method)
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Which two bones form the obturator foramen?
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Where's the CR for a unilateral hip?
the neck of the femur
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What method is being used for an axiolateral projection of the hip?
Danelius-Miller
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Greater trochanters can be used as a palpable landmark for the same plane as what other landmark?
pubic bone/pubic symphysis
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For positioning, on an AP pelvis, if the left ilium is flared and the right obturator foramen is open, in which direction is the patient rotated?
- to the left
- (the side of pelvis closer to IR, ilium flared, foramen closed)
- (elevated side, ilium foreshortened, foramen open)
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What methods would the CR enter the medial aspect of the proximal femur?
- lauenstein
- hickey
- modified cleaves
- danelius-miller
- (all frog legs, all laterals)
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