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Distal Femur consists of?
- Patella & condyles
- - part of the knee joint
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Proximal Femur consists of?
- Head, neck, & trochanters
- - part of the hip joint
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- Proximal Femur Anatomy
- - Head -
- Fovea capitus (small indentation)
- Ligament capitus femoris – attaches head of femur to hip socket (acetabulum)
- - Neck -
- Greater trochanter – larger, superior & lateral to femoral shaft
- Lesser trochanter – smaller, inferior to greater trochanter; projects medially & posteriorly to junction of neck & shaft
- Intertrochanteric crest – posterior thick ridge of bone that connects trochanters
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- Femur Angles
- Angulation varies with age, sex, & stature
- Angulation of the neck of the femur in relation to its shaft:
- - Average adult approximately 125° (+/- 15°)
- Angulation of the longitudinal plane of the femur to vertical:
- - Average adult approximately 10° from vertical
- Angulation of the neck & head of the femur in relation to the body:
- - Average adult approximately 15°-20° anterior angle
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Pelvis Anatomy - what are the 4 bones?
- - R & L ossa coxae (innominates)
- - Sacrum*
- - Coccyx*
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Pelvic girdle consists of?
only the R & L ossa coxae!
*Sacrum & coccyx part of vertebral column
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Hip Bones
Ossa coxae:
(1) Ilium, (2) ischium, & (3) pubis – separate in children, fused in adults
•Ossa coxae are irregular bones
Acetabulum – deep cup-shaped cavity; articulates with head of femur to form hip joint
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Ilium Anatomy
2 main parts:
Ala – thin, superior flared portion
Iliac crest – superior margin of ala
ASIS (anterior superior iliac spine)
AIIS (anterior inferior iliac spine)
PSIS (posterior superior iliac spine)
PIIS (posterior inferior iliac spine)
•Greater sciatic notch – deep indentation just inferior to PIIS (passageway for sciatic nerve to legs)
Body – thick, inferior portion near the acetabulum
Makes up superior 2/5 of acetabulum
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Ischium Anatomy
2 main parts:
Body – thick, superior portion near the acetabulum (upper body)
Makes up posteroinferior 2/5 of acetabulum
Ischial spine – posterior to acetabulum
Lower body is the thinner, inferior/medial part – ends at the ischial tuberosity
•Lesser sciatic notch – smaller indentation just inferior to ischial spine (passageway for part of sciatic nerve to legs)
Ramus – thin, inferior portion of the ischium that extends from the ischial tuberosity to join with the pubis
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Pubis Anatomy
3 main parts:
Body – thick, superior portion near the acetabulum
- Makes up anteroinferior 1/5 of acetabulum
Superior ramus – extends anteriorly & medially from body of each pubic bone to form the symphysis pubis
Inferior ramus – extends inferiorly & posteriorly from the symphysis pubis to join the ramus of each ischium
- Obturator foramen – opening formed by ramus & body of each ischium & pubis (passageway for blood vessels & nerves to the lower limbs)
•Largest foramen in the body
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oval bony ridge extending from the superior portion of symphysis pubis anteriorly to the sacral promontory posteriorly
Pelvic Brim
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Region inferior to the pelvic brim?
- Forms the birth canal
- Completely surrounded by bone
True (lesser) pelvis
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Region superior to the pelvic brim
False (greater) pelvis
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True & False Pelvis
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The 3 parts that make up the Birth Canal?
Inlet – junction between the greater & lesser pelvis that forms the superior aperture of the birth canal
Outlet – area defined by the 2 ischial tuberosities & tip of the coccyx that forms the inferior aperture of the birth canal
- Pelvic cavity – area between the inlet & outlet
- - Birth: head of fetus must pass through the inlet first, into the pelvic cavity & through the outlet
- - Size & shape of inlet/cavity/outlet & the fetuses position determines whether birth can take place naturally of via caesarean section (C-section)
- - Ultrasound used to evaluate pelvic cavity
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Birth Canal
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Proximal Femur Articulations (Joints)
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All of this makes up the what?
- Formed by ball-like head of the proximal femur & the acetabulum
- Head of femur & acetabulum has articular cartilage
- Joint surrounded by strong fibrous capsule with synovial fluid
- Strong bands of ligaments surround the capsule & joint
Hip Joint (coxofemoral)
Proximal Femur Articulation
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Name the 3 Pelvis articulations.
Acetabulum – fused bodies of ilium, ischium, & pubis
Symphysis pubis – superior rami of each pubic bone separated by a fibrocartilaginous disk
Sacroiliac (SI) joints – formed by articulation of the sacrum & the ala of the ilium
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Joint Classifications
name the classification, movement type, and mobility type for the Acetabulum
- Classification - Cartilaginous
- Movement type - Non-moveable
- Mobility type - Synarthrodial
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Joint Classifications
name the classification, movement type, and mobility type for Hip
- Classification - Synovial
- Movement type - Spheroidal (ball and socket)
- Mobility type - Diarthrodial
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Joint Classifications
name the classification, movement type, and mobility type for Symphysis Pubis
- Classification - Cartilaginous
- Movement type - limited
- Mobility type - Amphiarthrodial
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Joint Classifications
name the classification, movement type, and mobility type for Sacroiliac
- Classification - Synovial
- Movement type - limited
- Mobility type - Amphiarthrodial
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Proximal Femur
- 1.Greater trochanter
- 2.Intertrochanteric crest
- 3.Body (shaft)
- 4.Acetabulum
- 5.Femoral head
- 6.Femoral neck
- 7.Lesser trochanter
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Hip
- 1.Femoral neck
- 2.Greater trochanter
- 3.Intertrochanteric crest
- 4.Lesser trochanter
- 5.Acetabulum
- 6.Femoral head
- 7.Obturator foramen
- 8.Ischial tuberosity
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Pelvis
- 1.Sacrum
- 2.Ischial spine
- 3.Acetabulum
- 4.Greater trochanter
- 5.Ischial tuberosity
- 6.Symphysis pubis
- 7.Iliac crest
- 8.ASIS
- 9.Superior ramus of pubis
- 10.Femoral head
- 11.Femoral neck
- 12.Obturator foramen
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Hip Localization Methods
Femoral neck is 1”-2” medial & 3”-4” distal to the ASIS
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The lesser trochanter is not visible or barely visible & the femoral neck is visualized (“true” AP projection of hip & proximal femur) with what kind of rotation?
- Internal rotation 15°-20°
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The lesser trochanter is visualized & the femoral neck is foreshortened with what kind of rotation?
- External rotation
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This x-ray has which kind of foot rotation?
- Internal
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This x-ray has which kind of foot rotation?
- External
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What are the routine and special procedures for the knee?
- Routine:
- - AP
- - Medial oblique
- - Lateral oblique
- - Lateral
- Special:
- - AP Weight-Bearing
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AP Knee
- - Patient supine or seated on table
- - Leg fully extended
- - Rotate leg internally 3°-5° until interepicondylar line is parallel to IR
- - CR to knee joint; a point ½” distal to apex of patella
Optional: CR angled 3°-5° caudal for a small patient (thin thighs & buttocks); 3°-5° cephalad for a large patient (thick thighs & buttocks)
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AP Medial Oblique Knee
- - Patient supine or seated on table
- - Leg fully extended
- - Rotate leg internally until interepicondylar line is 45° to IR
- - CR to knee joint; a point ½” distal to apex of patella
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AP Lateral Oblique Knee
- - Patient supine or seated on table
- - Leg fully extended
- - Rotate leg externally until interepicondylar line is 45° to IR
- - CR to knee joint; a point ½” distal to apex of patella
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- AP Medial Oblique Knee:
- Head & neck of fibula not superimposedProximal tibiofibular joint openLateral condyles of femur & tibia in profile
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- AP Lateral Oblique Knee:
- Fibula superimposed over tibiaMedial condyles of femur & tibia in profile
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Lateral Knee
- - Patient in lateral recumbent on table
- - Knee flexed 20°-30°
- - Epicondyles superimposed & plane of patella perpendicular to IR
- - Mediolateral projection
- - CR angled 5°-7° cephalad to 1” distal to medial epicondyle
Optional: cross table mediolateral or lateromedial projection with no CR angle; knee may be flexed or leg extended
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AP Weight-Bearing Knees
- - Bilateral exam
- - Patient erect with no shoes or socks – weight evenly distributed on both feet
- - Feet pointed straight ahead
- - CR to midpoint between both knees at level of knee joint – ½” distal to apex of patellae
Done to demonstrate femorotibial joint spaces & possible cartilage degeneration under full body weight
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What are the routine views for the Patella?
- - AP
- - Lateral
- - Tangential
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PA Patella
- - Patient prone on table
- - Leg fully extended
- - Rotate leg internally 5° until interepicondylar line is parallel to IR
- - CR to midpopliteal crease (back of knee); exits midpatella
Optional AP patella done more often due to patient discomfort – same positioning as AP knee with CR entering the midpatella
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Lateral Patella
- - Patient in lateral recumbent on table
- - Knee flexed 5°-10°
- - Epicondyles superimposed & plane of patella perpendicular to IR
- - Mediolateral projection
- - CR to mid patellofemoral joint
Optional: cross table lateromedial with leg fully extended
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Tangential Patella
- Inferosuperior -
- - Patient supine on table
- - Knee flexed 40°-45° with support underneath
- - IR on mid-thigh tilted perpendicular to CR
- - CR at 10°-15° angle from lower leg tangential to patellofemoral joint
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Tangential Patella
- Settegast method -
- - Patient prone on table
- - Knee flexed 90°
- - CR at 15°-20° angle from lower leg tangential to patellofemoral joint
*More common if Fx. suspected
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Inferosuperior Tangential Patella
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- Settegast tangential method
- - Settegast – acute flexion of knee draws patella into intercondylar sulcus – patellofemoral joint not as open
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What are the routine views for Mid & Distal Femur?
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AP Femur (Mid & Distal)
- - Patient supine on table
- - Leg fully extended
- - Rotate leg internally 5° until interepicondylar line is parallel to IR
- - CR to femur & midpoint of IR – be sure to include entire knee joint
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Lateral Femur (Mid & Distal)
- - Patient in lateral recumbent on table (may need to cross unaffected leg over to get a true lateral)
- - Knee flexed 45°
- - Epicondyles superimposed & plane of patella perpendicular to IR
- - Mediolateral projection
- - CR to femur & midpoint of IR – be sure to include entire knee joint
Optional cross table lateromedial projection with leg fully extended
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Lateral Femur (Mid & Distal)
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What are the routine and special views of the Hip?
- Routine:
- - AP
- - Lateral (Frog Leg)
- Special:
- - Axiolateral (Denelius-Miller method)
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AP Hip (Proximal Femur)
- - Patient supine on table
- - Leg fully extended
- - Rotate leg internally 15°-20° medially*
- - CR to femoral neck – 1”-2” medial & 3”-4” distal to ASIS
*Do not attempt to rotate leg medially if Fx. or dislocation suspected – take AP “as is”
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Axiolateral Hip (Inferosuperior Danelius-Miller Method)
- - Patient supine on table or bed/stretcherIR placed against iliac crest parallel to femoral neck
- - Raise unaffected leg out of the way (place on leg holder or other support)
- - CR directed horizontally to femoral neck & IR (enters groin)
Done for trauma or post-surgical – commonly called a “cross-table lateral hip”
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Axiolateral Hip (Inferosuperior Danelius-Miller Method)
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- Orthopedic Appliances
- Hip Replacement (Prosthesis):
- Done for fracture, arthritis, avascular necrosis
- •Metal, plastic, & ceramic components
- •Cement (“glue”)
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- Hip Pinning:
- Done for fractures
- •Mostly metal components
- •Pins, screws, compression screw, plates, wires
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What are the routine and special views for the Pelvis?
- Special:
- - AP Bilateral Frog-Leg
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AP Pevis
- - Patient supine on table
- - Legs fully extended
- - Separate legs & rotate internally 15°-20° medially*
- - Top of IR placed 1” above iliac crest
- - CR to IR – enters midway between level of ASIS & symphysis pubis (about 2” inferior to level of ASIS)
*Do not attempt to rotate leg medially if Fx. or dislocation suspected – take AP “as is”
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Asymmetric Rotation (Hip Fracture)
Fracture sign: foot in extreme lateral rotation (Fx. L hip)
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AP Bilateral Frog-Leg Pelvis
- - Patient supine on table
- - Legs fully extended
- - Flex both knees 90°
- - Place the plantar surfaces of both feet together & abduct both femora 40°-45° from vertical
- - CR to IR – enters 3” inferior to level of ASIS
Often done with infants & children to rule out developmental dysplasia of hip (DDH) also known as CHD (congenital hip dislocation)
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AP Bilateral Frog-Leg Pelvis
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- Common Pathological Conditions
- Fractured Patella
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- Common Pathological Conditions
- Knee Arthritis
- (Arthritic Knee on Left and Healthy Knee on Right)
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- Common Pathological Conditions
- Hip Fracture
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- Common Pathological Conditions
- Hip Dislocation
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- Common Pathological Conditions
- Arthritis of the Hip
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- Common Pathological Conditions
- Bone tumor - osteosarcoma
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