RTE1513RadProceduresII

  1. Distal Femur consists of?
    • Patella & condyles
    • - part of the knee joint
  2. Proximal Femur consists of?
    • Head, neck, & trochanters
    • - part of the hip joint
  3. Image Upload 1
    • 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
  4. Image Upload 2
    Ligament Capitus Femoris
  5. Image Upload 3
    • 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
  6. Pelvis Anatomy - what are the 4 bones?
    • - R & L ossa coxae (innominates)
    • - Sacrum*
    • - Coccyx*
  7. Pelvic girdle consists of?
    only the R & L ossa coxae!

    *Sacrum & coccyx part of vertebral column
  8. Image Upload 4
    Pelvis Anatomy
  9. 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
    Image Upload 5
  10. 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
    Image Upload 6
  11. 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
    Image Upload 7
  12. 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
    Image Upload 8
  13. oval bony ridge extending from the superior portion of symphysis pubis anteriorly to the sacral promontory posteriorly
    Pelvic Brim
  14. Region inferior to the pelvic brim?
    - Forms the birth canal
    - Completely surrounded by bone
    True (lesser) pelvis
  15. Region superior to the pelvic brim
    False (greater) pelvis
  16. True & False Pelvis
    Image Upload 9
  17. 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
  18. Birth Canal
    Image Upload 10
  19. Proximal Femur Articulations (Joints)
    Image Upload 11
  20. 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
  21. 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
  22. Joint Classifications

    name the classification, movement type, and mobility type for the Acetabulum
    • Classification - Cartilaginous
    • Movement type - Non-moveable
    • Mobility type - Synarthrodial
  23. Joint Classifications

    name the classification, movement type, and mobility type for Hip
    • Classification - Synovial
    • Movement type - Spheroidal (ball and socket)
    • Mobility type - Diarthrodial
  24. Joint Classifications


    name the classification, movement type, and mobility type for Symphysis Pubis
    • Classification - Cartilaginous
    • Movement type - limited
    • Mobility type - Amphiarthrodial
  25. Joint Classifications


    name the classification, movement type, and mobility type for Sacroiliac
    • Classification - Synovial
    • Movement type - limited
    • Mobility type - Amphiarthrodial
  26. Proximal Femur
    Image Upload 12
    • 1.Greater trochanter
    • 2.Intertrochanteric crest
    • 3.Body (shaft)
    • 4.Acetabulum
    • 5.Femoral head
    • 6.Femoral neck
    • 7.Lesser trochanter
  27. Hip
    Image Upload 13
    • 1.Femoral neck
    • 2.Greater trochanter
    • 3.Intertrochanteric crest
    • 4.Lesser trochanter
    • 5.Acetabulum
    • 6.Femoral head
    • 7.Obturator foramen
    • 8.Ischial tuberosity
  28. Pelvis

    Image Upload 14
    • 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
  29. Hip Localization Methods
    Image Upload 15
    Femoral neck is 1”-2” medial & 3”-4” distal to the ASIS
  30. 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°
    • Image Upload 16
  31. The lesser trochanter is visualized & the femoral neck is foreshortened with what kind of rotation?
    • External rotation
    • Image Upload 17
  32. This x-ray has which kind of foot rotation?
    Image Upload 18
    • Internal
    • Image Upload 19
  33. This x-ray has which kind of foot rotation?
    Image Upload 20
    • External
    • Image Upload 21
  34. What are the routine and special procedures for the knee?
    • Routine:
    • - AP
    • - Medial oblique
    • - Lateral oblique
    • - Lateral

    • Special:
    • - AP Weight-Bearing
  35. Image Upload 22
    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)
  36. Image Upload 23
    AP Knee
  37. Image Upload 24
    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
  38. Image Upload 25
    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
  39. Image Upload 26
    • AP Medial Oblique Knee:
    • Head & neck of fibula not superimposedProximal tibiofibular joint openLateral condyles of femur & tibia in profile
  40. Image Upload 27
    • AP Lateral Oblique Knee:
    • Fibula superimposed over tibiaMedial condyles of femur & tibia in profile
  41. Image Upload 28
    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
  42. Image Upload 29
    Lateral Knee
  43. Image Upload 30
    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
  44. Image Upload 31
    AP Weight-Bearing Knees
  45. What are the routine views for the Patella?
    • - AP
    • - Lateral
    • - Tangential
  46. Image Upload 32
    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
  47. Image Upload 33
    PA Patella
  48. Image Upload 34
    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
  49. Image Upload 35
    Lateral Patella
  50. Image Upload 36
    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
  51. Image Upload 37
    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
  52. Image Upload 38
    Inferosuperior Tangential Patella
  53. Image Upload 39
    • Settegast tangential method
    • - Settegast – acute flexion of knee draws patella into intercondylar sulcus – patellofemoral joint not as open
  54. What are the routine views for Mid & Distal Femur?
    • - AP
    • - Lateral
  55. Image Upload 40
    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
  56. Image Upload 41
    AP Femur (Mid & Distal)
  57. Image Upload 42
    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
  58. Image Upload 43
    Lateral Femur (Mid & Distal)
  59. What are the routine and special views of the Hip?
    • Routine:
    • - AP
    • - Lateral (Frog Leg)

    • Special:
    • - Axiolateral (Denelius-Miller method)
  60. Image Upload 44
    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”
  61. Image Upload 45
    AP Hip (Proximal Femur)
  62. Image Upload 46
    Axiolateral Hip (Inferosuperior Danelius-Miller Method)
    • - Patient supine on table or bed/stretcherIR 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”
  63. Image Upload 47
    Axiolateral Hip (Inferosuperior Danelius-Miller Method)
  64. Image Upload 48
    • Orthopedic Appliances
    • Hip Replacement (Prosthesis):
    • Done for fracture, arthritis, avascular necrosis
    •    •Metal, plastic, & ceramic components
    •    •Cement (“glue”)
  65. Image Upload 49
    • Hip Pinning:
    • Done for fractures
    •    •Mostly metal components
    •    •Pins, screws, compression screw, plates,          wires
  66. What are the routine and special views for the Pelvis?
    • Routine:
    • - AP

    • Special:
    • - AP Bilateral Frog-Leg
  67. Image Upload 50
    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”
  68. Image Upload 51
    AP Pelvis
  69. Image Upload 52
    Asymmetric Rotation (Hip Fracture)

    Image Upload 53

    Fracture sign: foot in extreme lateral rotation (Fx. L hip)
  70. Image Upload 54
    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)
  71. Image Upload 55
    AP Bilateral Frog-Leg Pelvis
  72. Image Upload 56
    • Common Pathological Conditions
    • Fractured Patella
  73. Image Upload 57
    • Common Pathological Conditions
    • Knee Arthritis
    • (Arthritic Knee on Left and Healthy Knee on Right)
  74. Image Upload 58
    • Common Pathological Conditions
    • Hip Fracture
  75. Image Upload 59
    • Common Pathological Conditions
    • Hip Dislocation
  76. Image Upload 60
    • Common Pathological Conditions
    • Arthritis of the Hip
  77. Image Upload 61
    • Common Pathological Conditions
    • Bone tumor - osteosarcoma
Author
Marc817
ID
345226
Card Set
RTE1513RadProceduresII
Description
Unit 2 - Femur & Pelvic Girdle
Updated