when the femur is vertical, which condyle is considered lower
medial condyle
anteriorly, what are the distal condyles of the femur separated by
patellar surface (trochlear groove)
the hip bone is made up of what 3 bones
ischium, ilium, & pubis
what is the name of the cup shaped socket that receives the head of the femur on the hip bone
acetabulum
the body of the ilium forms how much of the acetabulum
2/5th superiorly
list the four prominent projections found on the ilium
ASIS, AIIS, PSIS, PIIS
what three parts does the pubis consist of
body, superior ramus, inferior ramus
when the body is in a seated upright position, the weight of the body rests on what structures
ischial tuberosities
what is the prominent ridge between the trochanters on the posterior surface of the body named
intertrochanteric crest
the two common fracture sites in the elderly
femoral neck, intertrochanteric crest
two other names for the hip bone
ossa coxae & innominate bones
where does the iliac crest set on vertebrae
L4 - L5 interspace
the pelvis consists of which 4 bones
2 hip bones, sacrum, & coccyx
what is the name of the small depression located on the head of the femur
fovea capitis
the pubic of the hip bones articulate with each other at the anterior midline of the body, forming a joint called ?
pubic symphysis
the largest foramen in the body
obturator foramen
for which projection of an individual hip should the unaffected hip be flexed and the thigh be raised out of the way of the central ray
axiolateral projection (danelius - miller)
how many degrees should the feet & lower limbs be internally rotated for an AP pelvis radiograph
15-20 degrees
the CR for an AP pelvis is directed perpendicular to the center of the IR , what is the entrance point
2’’ superior to the pubic symphysis
2’’ inferior of the ASIS
what will be shown in profile of the lower limbs are in correct position for an AP pelvis
greater trochanter
what is the CR angle for an AP projection of the hip
perpendicular
unless suspected fracture, the lower limb and leg should be internally rotated for an axiolateral projection of the hip (danelius - miller) how many degrees of rotation are required
15 - 20 degrees
what is the respiration phase for the AP projection of the pelvis
suspended respiration
which of the following is an important and frequently used radiographic positioning reference point
anterior superior iliac spine (ASIS)
the strongest bone in the body
femur
where is the IR centered for an AP pelvis
midway between the ASIS and pubic symphysis
T/F : a grid is recommended for hip radiography
true
T/F : it is important to include the entire prosthesis when examining a patient with a total hip replacement
true
true pelvis is also
lower, actual birth canal, “lesser” pelvis
the false pelvis is also
higher, “greater” pelvis, inlet part of pelvis
where baby “cooks”
the trochanters are joined by a ridge called the
interchrochanter crest
the ilium makes up the ___ part of the acetabulum
superior (2/5th)
the area superior to the oblique plane through the pelvis brim is the greater or ___
false pelvis
a severe blow or trauma to one side of the pelvis that results in a fracture on the opposite side from the injury
pelvic ring fracture
general differences between the male and female pelvis
shape, angle of pubic arch, position of ischial spines
between right and left pubic bones , cartilaginous and is very limited movement or ampiarthrodial
symphysis pubis
between sacrum & ilium , synovial joint & irregular gliding
sacroiliac joints (SI)
the symphysis pubis is ___ inferior to the ASIS
3-4 inches
typical sign for a broken hip
leg turned external
pelvic ring fracture is best seen on
CT scan
good for joint abnormalities & can look at muscles and soft tissue in addition to x rays
MRI
best to demonstrate newborn hip dislocation and joint stability during movement of lower limbs
ultrasound
good for early evidence of bony pathology processes, infections, mets, or other primary malignancies. More sensitive and asses the physiologic aspect rather than the anatomic aspect
nuclear medicine
AP pelvis evaluation criteria
greater trochanters are visible & in profile , the lesser trochanters should not be visible at all or only the tips
AP axial outlet projection (taylor method) CR
males - 20-35 degrees cephalic
females - 30-45 degrees cephalic
posterior oblique acetabulum (judet method) clinical indications
acetabulum fractures & pelvic ring fractures
posterior oblique acetabulum (judet method) CR for pelvic ring
perpendicular 2’’ inferior from the ASIS and 2” medial to upside ASIS
ilium posterior inferior part ends in the
greater sciatic notch
ischium consists of
body & ischial ramus
ischium body forms what of acetabulum
posterior 2/5 of acetabulum
the pubis consists of
body, superior ramus, inferior ramus
the pubis body forms what of acetabulum
1/5th of anterior acetabulum
the obturator foramen is formed by what
junction of ischial ramus & pubis inferior ramus
heavier, narrower, deeper
angle at pubic symphysis is acute
heart shaped inlet
male pelvis
wider, shallower, lighter
angle at pubic symphysis is obtuse
more oval or wide inlet
female pelvis
which palpable landmark is at the same level as the pubic symphysis
greater trochanter
the weakest part in the pelvis is the
symphysis pubis
CR angulation and direction for AP axial inlet
40 degrees caudal to level of the ASIS
striking sclerosis of the bones of the hand and wrist, generalized increased bone density of the lower spine, pelvis, and hips
osteopetrosis
when looking for congenital hip dislocation what projection is the most commonly performed
the bilateral modified cleaves
hip dislocations caused by conditions present at birth, causes repeated dislocations
hip dysplasia also called developmental dysplasia of the hip (DDH)
bilateral symmetric obliteration of the sacroiliac joints by way of fusing together, works it’s way up the spine also called “bamboo spine” , most common in males
ankylosing spondylitis
also called DJD (degenerative joint disease) sclerotic bone formation in the acetabulum is seen, most common type of arthritis and considered normal aging
osteoarthritis of the hip
aseptic or ischemic necrosis , first presents as a lip mostly in 5-10 year old boys. the head of the femur becomes flat, then fragments
legg- calve- perthes disease
the most common type of primary bone cancer , looks like punched out bone, lytic lesions of lucency
multiple myeloma
intertrochanteric fractures happen between
the greater & lesser trochanter along the ridge
resembles cotton wool on a radiograph, it is from an overproduction of bone that is very dense but also pliable
paget’s disease
joint movement type of the symphysis pubis
ampharthrodial
how much is the affected side rotated for the PA axial oblique projection (teufel method)
35-40 degrees
what projection is best suited for the patient with limited movement of both lower limbs to demonstrate a lateral perspective of the proximal femur
clements - nakayama method
SI joint are classified as what type of mobility
amphiarthrodial
hip joints are classified as
diarthrodial
which pathology usually occurs in 10 to 16 year old patients during rapid growth
slipped capital femoral epiphysis
where is the CR directed for the PA oblique projection - judet method for acetabulum with affected side down
perpendicular and centered 2 inches distal and 2 inches medial to downside ASIS
where is the CR directed for the PA axial oblique projection - teufel method for the acetabulum with the affected side down
perpendicular and centered 1 inch superior to the level of the greater trochanter , approximately 2 inches lateral to the MSP, CR angled 12 degree cephalad
what topographic landmark is most frequently used for positioning the pelvis
ASIS
