Positioning 2nd Year-Femur and Hip
ischial tuberosities
Which parts of the hip bones support the weight of the body when a person is in the sitting position?
Rotate the lower limb medially 10-15 degrees
Which positioning maneuver should be performed to place the femoral neck in profile for the AP projection of the proximal femur?
Rotate the lower leg medially 10-15 degrees
Which positioning maneuver should be performed to prevent the femoral neck from appearing foreshortened in the AP projection of the proximal femur?
acetabulum
Which structure of the pelvis articulates with the femur?
ilium, pubis, and ischium
Which three names refer to the major bone that makes up the right or left half of the pelvis?
greater trochanter and lesser trochanter
Which two large processes are located at the proximal end of the femur?
iliac crest and anterior superior iliac spine (ASIS)
Which two prominent structures found on the ilium are frequently used as radiographic positioning reference points?
femoral nack and intertrochanteric crest
name the two areas of the proximal femur that are common sites for fractures in elderly patients
ilium
on which bone is the ala located?
A. Acetabulum B. Femoral head C. Femoral neck D. Greater trochanter E. Lesser trochanter
Axiolateral projection Danelius-Miller Method (X-table Hip)
First, draw a line from the ASIS to the superior bor- der of the pubic symphysis. Then draw another line from a point 1 inch (2.5 cm) inferior of the greater trochanter to the midpoint of the first line. The femo- ral neck runs parallel with this second line.
Axiolateral projection Danelius-Miller Method (X-table Hip) Describe an acceptable method for locating the femoral neck
Perpendicular to the long axis of the femoral neck, entering the patient on the medial aspect of the affected thigh near the groin, and centered to the IR
Axiolateral projection Danelius-Miller Method (X-table Hip) Describe how and where the central ray should be directed.
Flex the knee and hip of the unaffected side to elevate the thigh in a vertical position, then it can be rested on some support.
Axiolateral projection Danelius-Miller Method (X-table Hip) Describe how the unaffected lower limb should be positioned
Patellar surface
On the anterior surface on the distal femur what are the 2 condyles separated by?
Intercondylar fossa
On the posterior surface on the distal femur what are the 2 condyles separated by?
True
The highest point of the greater trochanter is in the same transverse plane as the midpoint of the hip joint
10 degrees
The longitudinal plane of the femur is angled about 10 degrees from vertical
15-20 degrees 120-130 degrees
The neck of the femur projects anteriorly from the body at an angle of approximately ___________ degrees and superiorly at an angle of about ________________ degrees to the long axis of the femoral body
pelvic cavity
The region between the inlet and the outlet of the true pelvis is called the _____________________.
pelvis
The structure of the body that serves as a base for the trunk and as a girdle for the attachment of the lower limbs is known as the ____________________.
Narrow and deep heavy bony structure inlet is round outlet is narrow
What are the characteristics of a male pelvis?
Ilium, pubis, and ischium
What are the three bones that make up the hip bone?
Iliopubic and ilioischial columns
What are the two columns used to identify fractures around the acetabulum?
ASIS and superior margin of the pubic symphysis
What are the two palpable bony points of localization for the hip joint?
ischium and pubis
What bones of the hip bone form the obturator foramen
45 degrees LPO
What degree and position (LPO or RPO) would be used to demonstrate the posterior rim of the left acetabulum?
5-7 degrees
What degree difference exists between the two condyles?
5-15 degrees medially
What degree is the slant of the femur?
Evaluate foreign body
What is a lateral pelvis used for
Measured from the tip of the coccyx to the inferior margin of the pubic symphysis in the anteroposterior direction and between the ischial tuberosity is in the horizontal direction
What is the inferior aperture or outlet of the true pelvis?
Intertrochanteric line
What is the less prominent ridge connecting the trochanter anteriorly called?
Iliac crest
What is the name of the border that extends on the hip bone from the posterior superior iliac spine to the ASIS?
ischial spine
What is the name of the process that separates the greater sciatic notch from the lesser sciatic notch on the hip bone?
Intertrochanteric crest
What is the prominent ridge extending between the trochanter at the base of the neck on the posterior surface of the femoral body called?
30-45 degrees cephalad
What is the proper central ray orientation for the AP axial projection (Taylor method) for female patients?
The brim
What is the superior aperture or inlet of the true pelvis?
-triangular area superior to Intercondylar fossa on posterior femur -popliteal blood vessels and nerves pass through
What is the trochlear groove?
AP Oblique projection (Judet Method)
What projection best demonstrates suspected fractures of the acetabulum
AP axial "outlet" projection (Taylor Method)
What projection would best demonstrate the pubic and ischial rami without foreshortening
Anterior rim
What specific portion of the acetabulum is demonstrated by the AP oblique projection, external oblique position (Judet Method)?
The medial condyle is lower than the lateral
When the femur is vertical which condyle is lower than the other?
False
AP Oblique Projection (modified Cleaves method) True or False. The gonads should not be shielded for the AP oblique projection.
A. Ilium B. Acetabulum C. Superior pubic ramus D. Femoral head E. Pubic symphysis F. Obturator foramen G. Inferior pubic ramus H. Ischial ramus
AP Axial Pelvis ("Inlet" and "Outlet")
A. Ischial spines B. Pubic rami (superimposed)
AP Axial Pelvis ("Inlet" and "Outlet")
Male patients: central ray angled 20 to 35 degrees cephalad female patients: central ray angled 30 to 45 degrees cephalad
AP Axial Pelvis ("Inlet" and "Outlet") Explain how the central ray orientation for the AP axial "outlet" projection (Taylor method) differs between male and female patients.
40 degrees caudad
AP Axial Pelvis ("Inlet" and "Outlet") The superoinferior axial "inlet" projection (Bridgeman method) requires the central ray be directed _____________________________.
Taylor
AP Axial Pelvis ("Inlet" and "Outlet") To demonstrate the pubic and ischial rami without foreshortening, the ________________ method should be used.
2 inches distal to the superior border of the pubic symphysis
AP Axial Pelvis ("Inlet" and "Outlet") Where does the central ray enter the patient for the AP axial "Outlet" projection (Taylor Method)?
at the ASIS
AP Axial Pelvis ("Inlet" and "Outlet") Where does the central ray enter the patient for the superoinferior axial "inlet" projection (Bridgeman method)?
The superoinferior axial "inlet" projection (Bridgeman method)
AP Axial Pelvis ("Inlet" and "Outlet") Which projection demonstrates the superior and inferior rami of the pubic bones superimposed medially?
A. acetabulum B. Femoral head C. Greater trochanter D. Femoral neck E. Lesser trochanter F. Femoral Body
AP Femur
lesser trochanter should not be seen beyond medial border of femur or only a very small portion of lesser trochanter should be seen
AP Femur Describe how the lesser trochanter should appear in the AP projection of the proximal femur.
10-15 degrees medially
AP Femur How many degrees and in which direction should the lower limb be rotated to demonstrate the proximal femur?
not foreshortened, in profile
AP Femur How should the femoral neck appear in the AP projection of the proximal femur?
False
AP Femur True or False. Gonadal shielding should not be used because it may superimpose the femoral head.
all of it
AP Femur What portion of an orthopedic appliance should be demonstrated on the image?
to place it in true anatomic profile and to place femoral neck in profile
AP Femur Why should the lower limb be rotated?
A. Ilium B. Acetabulum C. Femoral head D. Greater trochanter E. Femoral neck F. Pubic symphysis G. Lesser trochanter H. Femoral body
AP Hip
Locate a point about 2.5 inches (6.4 cm) distal on a line drawn perpendicular to the midpoint of a line between the ASIS and the pubic symphysis.
AP Hip Describe how to find the centering point where the central ray should enter the patient
True
AP Hip True or False. An initial radiographic study of a fractured hip may include an AP projection of the pelvic girdle and proximal femora to demonstrate bilateral hip joints.
True
AP Hip True or False. The entire pubis of the affected side should be demonstrated
False
AP Hip True or False. The exposure should be performed with the patient breathing shallowly
Place a support under the knee and a sandbag across the ankle
AP Hip What procedure should help the patient keep the affected lower leg in the required position?
Rotate the foot and lower limb medially 15-20 degrees
AP Hip Which positioning maneuver should be performed to place the femoral neck parallel with the plane on of the IR?
lesser trochanter
AP Hip Which trochanter (greater or lesser) is not usually demonstrated beyond the border of the femur?
to ensure that the pelvis is not rotated
AP Hip Why should a radiographer ensure that the distance from the ASIS to the tabletop on each side of the pelvis is the same?
A. Acetabulum B. Femoral head C. Ilioischial column D. Lesser trochanter E. Ischium
AP Oblique Judet Method
A. Iliopubic column B. Acetabulum C. Femoral head D. Pubis E. Obturator foramen F. Ischium
AP Oblique Judet Method
down
AP Oblique Judet Method The external oblique position places the affected side _____________________________.
up
AP Oblique Judet Method The internal oblique position places the affected side __________________________.
the ilioischial column (posterior) of the pelvis and the anterior rim of the acetabulum.
AP Oblique Judet Method What specific portion of the acetabulum and pelvis is demonstrated by the external oblique position of the Judet method?
iliopubic column (anterior) of the pelvis and the posterior rim of the acetabulum.
AP Oblique Judet Method What specific portion of the acetabulum and pelvis is demonstrated by the internal oblique position of the Judet method?
The central ray should enter perpendicular to the IR at the pubic symphysis.
AP Oblique Judet Method Where should the central ray enter the patient as positioned in the Figure?
The central ray should enter the patient perpendicular to the IR at a point 2 inches inferior to the ASIS of the affected side.
AP Oblique Judet Method Where should the central ray enter the patient as positioned in the Figure?
Figure B
AP Oblique Judet Method Which Figure (A or B) depicts the proper patient position to demonstrate a suspected fracture of the ilioischial column and anterior rim of the acetabulum?
Figure A
AP Oblique Judet Method Which Figure (A or B) depicts the proper patient position to demonstrate a suspected fracture of the right iliopubic column and posterior rim of the acetabulum
45 degrees
AP Oblique Projection (modified Cleaves method) After the patient's knees and hips are flexed, how many degrees from vertical should the thighs be abducted?
Perpendicular to a point on the midline of the patient about 1 inch (2.5 cm) above the pubic symphysis
AP Oblique Projection (modified Cleaves method) Describe how and where the central ray should be directed.
As much as possible to get femora to a near-vertical position
AP Oblique Projection (modified Cleaves method) How much should the hips and knees be flexed
True
AP Oblique Projection (modified Cleaves method) True or False. The AP Oblique projection should not be performed on a patient who is suspected to have a fractured femoral neck.
False
AP Oblique Projection (modified Cleaves method) True or False. The greater trochanter should be seen in profile on the lateral side of the proximal femur.
False
AP Oblique Projection (modified Cleaves method) True or False. The patient may be positioned either supine or upright.
True
AP Oblique Projection (modified Cleaves method) True or False. This projection can be modified to demonstrate only one hip area.
stop breathing during the exposure
AP Oblique Projection (modified Cleaves method) What breathing instructions should be given to the patient?
To place the long axis of the femoral necks parallel with the plane of the IR
AP Oblique Projection (modified Cleaves method) What is the purpose of abducting the thighs as required?
Bi-lateral frog leg
AP Oblique Projection (modified Cleaves method) What other name commonly refers to the AP oblique projection, modified Cleaves method?
on the medial side of the femur
AP Oblique Projection (modified Cleaves method) Where should each lesser trochanter appear in the image?
Fully extended and rotated medially 15 to 20 degrees
AP Pelvis Describe how the lower limbs were positioned in this image.
Fully extended with the feet rotated laterally into a naturally relaxed position
AP Pelvis Describe how the lower limbs were positioned in this image.
extend legs, rotate lower limbs 15-20 degrees medially
AP Pelvis Describe how the patient's lower limbs should be positioned.
a. The iliac alae should be symmetric b. The obturator foramina should be symmetric c. The ischial spines should be equally demonstrated d. The greater trochanters should be fully demonstrated e. Both ilia should be equidistant to the edge of the image f. The entire pelvis should be included along with the proximal femora g. The sacrum and coccyx should be aligned with the pubic symphysis h. The lower vertebral column should be centered to the middle of the image i. Both greater trochanters should be equidistant to the edge of the image k. The femoral necks be demonstrated in their full extent without superimposition n. If seen, the lesser trochanters should be demonstrated on the medial borders of the femora
AP Pelvis From the following list, circle the 11 evaluation criteria that indicate the pelvis was properly positioned for an AP projection. a. The iliac alae should be symmetric b. The obturator foramina should be symmetric c. The ischial spines should be equally demonstrated d. The greater trochanters should be fully demonstrated e. Both ilia should be equidistant to the edge of the image f. The entire pelvis should be included along with the proximal femora g. The sacrum and coccyx should be aligned with the pubic symphysis h. The lower vertebral column should be centered to the middle of the image i. Both greater trochanters should be equidistant to the edge of the image j. Each greater trochanter should be seen superimposed with the femoral neck k. The femoral necks be demonstrated in their full extent without superimposition l. The femoral necks should not be well demonstrated to their full extent because of superimposition m. If seen, the lesser trochanters should be demonstrated on the lateral borders of the femora. n. If seen, the lesser trochanters should be demonstrated on the medial borders of the femora
The aloe of the ilia are asymmetrical if the pelvis is rotated
AP Pelvis How is rotation of the pelvis detected in an AP projection image?
The lesser trochanters are minimally seen on the medial border of the femora; the greater trochanters are fully demonstrated; and the femoral necks are demonstrated in their full extent without anteversion.
AP Pelvis State the image characteristics that lead you to believe the patient was properly positioned for that image.
place femoral necks parallel to IR
AP Pelvis What is the rationale for positioning of the lower limbs?
7-5
AP Pelvis Which image demonstrates correct positioning of the proximal femora?
Midsagittal
AP Pelvis Which plane of the body should be positioned on the midline of the table and grid?
The proximal femora (greater and lesser trochanters and femoral neck)
AP Pelvis Which structures in these two images appear different?
midway between ASIS and pubic symphysis
AP Pelvis With reference to the patient, where should the IR be centered?
lateral projection (Lauenstein method) of the hip
All of the following projections can be used to image a patient with a suspected intertrochanteric fracture, except for the: a. AP Projection of the hip b. AP projection of the pelvis c. Lateral projection (Lauenstein method) of the hip d. axiolateral projection (Danelius-Miller method) of the hip
The IR should be placed in a vertical position with its upper border in the crease above the iliac crest and its lower border should be angled away from the body so that the IR is parallel with the long axis of the femoral neck.
Axiolateral projection Danelius-Miller Method (X-table Hip) Describe the placement of the IR
cross-table lateral surgical lateral
Axiolateral projection Danelius-Miller Method (X-table Hip) List two common names used to denote the axiolateral projection (Danelius-Miller) of the hip.
false
Axiolateral projection Danelius-Miller Method (X-table Hip) True or False. A small area of soft tissue overlap from the thigh of the unaffected lower limb is permitted.
false
Axiolateral projection Danelius-Miller Method (X-table Hip) True or False. The entire lesser trochanter should be demonstrated on the lateral surface of the femur.
False
Axiolateral projection Danelius-Miller Method (X-table Hip) True or False. The foot and lower limb should be rotated laterally 15-20 degrees.
False
Axiolateral projection Danelius-Miller Method (X-table Hip) True or False. The pelvis should be rotated approximately 15-20 degrees
Any orthopedic appliance should be completely demonstrated
Axiolateral projection Danelius-Miller Method (X-table Hip) What is the general rule concerning demonstration of any orthopedic appliance with this projection
To elevate the pelvis and provide better centering of the hip to the IR
Axiolateral projection Danelius-Miller Method (X-table Hip) Why should a firm pillow or folded blanket be placed under the pelvis
horizontally, parallel with the long axis of the femoral neck
Axiolateral projection Danelius-Miller Method (X-table Hip) With reference to the femoral neck, how should the lead strips of the grid be placed?
stop breathing for the exposure
Axiolateral projection Danelius-Miller Method (X-table Hip) what breathing instructions should be given to the patient?
Medially, superiorly, and anteriorly
Describe how the neck of the femur projects from the body.
Make a line from the ASIS to the upper margin of the pubic symphysis. At the midpoint of that line, extend a second line at a right angle and inferolater- ally toward the femur. The long axis of the femoral neck lies parallel with the second line.
Describe how to used the T-method to locate the femoral neck
Line drawn between ASIS and pubic symphysis, line drawn at right angle to the first line, parallel to long axis of femoral neck. Femoral head lies 1.5 inches and femoral neck is 2.5 inches distal for the midpoint of the 2 lines
Describe the T-method
to position the femoral necks parallel with the IR
For the AP oblique projection (modified Cleaves method), what is the purpose of abducting the femora the required number of degrees?
Perform a second exposure with another IR
For the AP projection of the femur on typical adults, what should be done to ensure that both joints of the femur are demonstrated?
true lateral
For the lateral projection of the femur, how should the pelvis be positioned to demonstrate only the knee joint with the distal femoral shaft?
AP Projection of the proximal femur
For which lower limb projection should the lower limb be rotated medially 10-15 degrees?
Lateral projection of the proximal femur
For which lower limb projection should the pelvis be rotated 10-15 degrees from true lateral?
Axiolateral projection (Danelius-Miller method)
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 method)
For which projection of the hip should the central ray be directed horizontally into the medial aspect of the affected thigh?
AP oblique projection (modified Cleaves method) for femoral necks
For which projection of the lower limbs or pelvis should the hips be flexed and the femora be abducted from the midline of the patient?
perpendicularly
How should the central ray be directed for the AP oblique projection (modified Cleaves method) to demonstrate bilateral hips?
perpendicularly
How should the central ray be directed for the AP projection of the femur?
One pubic symphysis, two hip joints (femoral head and acetabulum), and two SI joints
Identify the major articulations of the pelvis by name or abbreviation, and give the quantity for each.
about 2 inches inferior to ASIS and 2 inches superior to symphysis
In average-sized patients, where should the IR be centered for the AP projection of the pelvis?
A. ASIS B. 2" below the knee
Lateral Femur Concerning IR placement/collimated field location, (a) to what level on the patient should the upper border of an IR or collimated field be placed when demonstrating the proximal femur, and (b) to what level of the patient should the lower border of the IR or collimated field be placed when demonstrating the distal femur?
A. posterior to affected thigh B. anterior to affected thigh
Lateral Femur Concerning the placement of the unaffected (upper most) limb, (a) where should it be placed when demonstrating the proximal femur, and (b) where should it be placed when demonstrating the distal femur?
a. patella should be seen in profile c. the patellofemoral joint space should be open e. the anterior surface of the femoral condyles should be superimposed f. the inferior surface of the femoral condyles should not be superimposed
Lateral Femur From the following list, what are the four evaluation criteria that indicate the femur was correctly positioned when including the knee in a lateral projection of the distal femur. a. the patella should be seen in profile b. the patella should superimpose the femur c. the patellofemoral joint space should be open d. the greater trochanter should be seen in profile e. the anterior surface of the femoral condyles should be superimposed f. the inferior surface of the femoral condyles should not be superimposed
true lateral
Lateral Femur How should the pelvis be positioned to demonstrate the distal femur?
from true lateral, the pelvis should be rolled posteriorly about 10-15 degrees
Lateral Femur How should the pelvis be positioned to demonstrate the proximal femur?
45 degrees
Lateral Femur When demonstrating the distal femur and including the knee, how many degrees should the knee be flexed?
A. Acetabulum B. Femoral head C. Femoral neck D. Lesser trochanter E. Ischial tuberosity
Lauenstein and Hickey Method for Lateral Projection (Frog Hip)
Acetabulum
Lauenstein and Hickey Method for Lateral Projection (Frog Hip) A lateral projection image obtained by the Lauenstein method or the Hickey Method is used to demonstrate the hip joint and the relationship of the head of the femur with the ____________________.
Flex the affected knee and draw the thigh up to a nearly right-angle position relative to the affected hip centered to the midline of the table.
Lauenstein and Hickey Method for Lateral Projection (Frog Hip) Describe how the affected thigh and leg should be positioned for lateral projections of the hip.
The unaffected leg should be extended and supported at the level of the hip.
Lauenstein and Hickey Method for Lateral Projection (Frog Hip) Describe how the unaffected lower limb should be positioned
cephalically 20-25 degrees
Lauenstein and Hickey Method for Lateral Projection (Frog Hip) How should the central ray be directed for the Hickey method of a lateral hip projection?
perpendicularly
Lauenstein and Hickey Method for Lateral Projection (Frog Hip) How should the central ray be directed for the Lauenstein method of a lateral hip projection?
AP Axial Outlet Projection (Taylor Method) patient supine Men: CR directed 20-35 degrees cephalad and enters midline at point 2 inches inferior to superior border of symphysis Women: CR directed 30-45 degrees cephalad and enters midline at a point 2 inches inferior to superior border of symphysis Evaluation Criteria: -pubic and ischial bones magnified with pubic bones superimposed over coccyx -symmetric obturator foramina -pubic and ischial rami near center of radiograph -includes hip joints
Name projection, how to position, and evaluation criteria
AP Distal Femur epicondyles parallel to IR bottom of IR 2 inches below the knee joint CR perpendicular to midfemur Evaluation Criteria -both Joints, may need 2 images -no knee rotation -include all of orthopedic appliance in its entirety
Name projection, how to position, and evaluation criteria
AP Hip medially rotate leg 15-20 degrees to place femoral neck parallel with IR CR about 2.5 inches distal on a line drawn perpendicular to midpoint of a line between ASIS and symphysis Evaluation Criteria -regions of ilium and pubic bones adjoining symphysis -hip joint -proximal one third of femur -femoral head, penetrated and seen through acetabulum -entire long axis of femoral neck not foreshortened -greater trochanter in profile -Lesser trochanter usually not projected beyond medial border of femur or only a very small amount of trochanter visible -show all orthopedic appliances in their entirety
Name projection, how to position, and evaluation criteria
AP Oblique Judet Method External Oblique Affected hip down Anterior surface of body forms a 45 degree angle with the table CR perpendicular to IR, enters at pubic symphysis Evaluation Criteria -acetabulum centered to IR -ilioschial column and anterior rim of acetabulum on external oblique
Name projection, how to position, and evaluation criteria
AP Oblique Judet Method Internal Oblique Affected hip up Anterior surface of body forms a 45 degree angle with the table CR perpendicular to IR, enters 2 inches inferior to ASIS of affected side Evaluation Criteria -acetabulum centered to IR -iliopubic column and posterior rim of affected acetabulum on internal oblique
Name projection, how to position, and evaluation criteria
AP Oblique Projection (Modified Cleaves Method) frog leg both legs CR perpendicular to midsagittal plane at level 1 inch superior to pubic symphysis Evaluation Criteria -no rotation of pelvis -acetabulum, femoral head, and femoral neck -lesser trochanter on medial side of femur -femoral neck without superimposition by greater trochanter; excess abduction causes the greater trochanter to obstruct neck -femoral axes extended from the hip bones at equal angles
Name projection, how to position, and evaluation criteria
AP Pelvis Heels separated 8-10 inches, medially rotate legs 15-20 degrees, femoral necks parallel to IR Center of IR is halfway between ASIS and symphysis (2 inches inferior to ASIS and 2 inches superior to symphysis) Top of IR is 1-1.5 inches above crest CR perpendicular to midpoint of IR Evaluation Criteria -entire pelvis along with proximal femora -both ilia and greater trochanter equidistant to edge of radiograph -lower vertebral column centered to middle of radiograph -no rotation of pelvis *both ilia symmetric in shape *symmetric obturator foramina *ischial spines equally seen *sacrum and coccyx aligned with symphysis -proper rotation of proximal femora *femoral necks are not foreshortened *greater trochanter in profile *lesser trochanter, if seen, visible on medial border of femora
Name projection, how to position, and evaluation criteria
AP Proximal Femur must include hip joint top of IR at level of ASIS rotate limb internally 10-15 degrees to place femoral neck in profile CR perpendicular to midfemur Evaluation Criteria -both joints, may need 2 images -femoral neck not foreshortened on proximal femur -lesser trochanter not seen beyond the medial border of femur or only a very small portion seen on proximal femur -include all orthopedic appliance in its entirety
Name projection, how to position, and evaluation criteria
Axiolateral Projection (Original Cleaves Method) frog hip both legs CR parallel with femoral shafts, CR maybe angled between 25-45 degrees depending on how vertical femera can be placed Evaluation Criteria -no rotation of pelvis -Axiolateral projections of femoral necks -femoral necks without overlap from greater trochanters -small parts of lesser trochanters on posterior surfaces of femora -small parts of greater trochanters on posterior and anterior surfaces of femora -both sides equidistant from edge of radiograph -greater amount of proximal femur on unilateral examination -femoral neck angles approximately 15-20 degrees superior to femoral bodies
Name projection, how to position, and evaluation criteria
Axiolateral Projection (X-table) Hip Danelius-Miller Method Flex knee and hip of unaffected leg Rest unaffected leg in support Medially rotate foot and lower limb of affected side about 15-20 degrees IR in vertical position, upper border above the crest Angle IR away from body so it is parallel with long axis of neck CR perpendicular to long axis of neck; enters groin area at point midway between anterior and posterior surfaces of upper thigh, passes through femoral neck, which is about 2.5 inches between point of intersection of T method Evaluation Criteria -hip joint with acetabulum -femoral neck without overlap from greater trochanter -small amount of lesser trochanter on posterior surface of femur -small amount of greater trochanter on anterior and posterior surfaces of proximal femur when femur is properly inverted -ischial tuberosity below femoral head and neck -include all orthopedic appliances
Name projection, how to position, and evaluation criteria
Lateral Distal Femur lateral position, bring uppermost limb forward Pelvis in true lateral flex knee about 45 degrees IR 2 inches below the knee CR perpendicular to midfemur Evaluation Criteria -superimposed anterior surface of femoral condyles -patella in profile -open patellofemoral space -include all orthopedic appliances in its entirety
Name projection, how to position, and evaluation criteria
Lateral Projection (Mediolateral) Hip (FROG HIP) Hickey Method Rotate toward affect side to an oblique position Flex affected knee, draw thigh up to a position at about 90 degrees to hip bone Affected femur parallel to table CR angled 20-25 degrees and 1 inch inferior from the midpoint between ASIS and symphysis Evaluation Criteria -hip joint centered on radiograph -hip joint, acetabulum, and femoral head shown on image -femoral neck free of superimposition
Name projection, how to position, and evaluation criteria
Lateral Projection (Mediolateral) Hip (FROG HIP) Lauenstein Method Rotate toward affect side to an oblique position Flex affected knee, draw thigh up to a position at about 90 degrees to hip bone Affected femur parallel to table CR perpendicular to hip joint (midway between ASIS and symphysis Evaluation Criteria -hip joint centered on radiograph -hip joint, acetabulum, and femoral head shown on image -femoral neck overlapped by greater trochanter
Name projection, how to position, and evaluation criteria
Lateral Proximal Femur Top of IR at level of ASIS draw upper limb posteriorly to support it adjust pelvis so that it is rolled posteriorly to prevent superimposition, 10-15 degrees from lateral position Evaluation Criteria -opposite thigh not over proximal femur and hip joint -greater trochanter superimposed over distal femoral neck - lesser trochanter visible on medial aspect of proximal femur -include all orthopedic appliances in its entirety
Name projection, how to position, and evaluation criteria
Modified Axiolateral Projection Clements-Nakayama Modification patient supine grid parallel to axis of femoral neck and tilt is top back 15 degrees CR angled 15 degrees posteriorly and aligned perpendicular to femoral neck and grid IR Evaluation Criteria -hip joint with acetabulum -femoral head, neck and trochanters -include all orthopedic appliances
Name projection, how to position, and evaluation criteria
Superoinferior Axial Inlet Projection Bridgeman Method patient supine CR directed 40 degrees caudad, entering midline at level of ASIS Evaluation Criteria -medially superimposed superior and inferior rami of pubic bones -nearly superimposed lateral two thirds of pubic and ischial bones -symmetric pubes and ischial spines -hip bones -anterior pelvic bones
Name projection, how to position, and evaluation criteria
greater (false) pelvis lesser (true) pelvis
Name the two parts a pelvis is divided into by the brim of the pelvis
True
True or False In the seated position, the weight of the body rests on two ischial tuberosities.
False
True or False The greater sciatic notch is located on the anterior border of the ilium
Wide and shallow light bony structure inlet is oval outlet is wide
What are the characteristics of a female pelvis?
Femoral neck and intertrochanteric crest
Where are the two most common sites on the femur for fractures in elderly adults
it forms part of the acetabulum
Where in the pelvis is the body of the pubis located?
On medial condyle, on posterolateral
Where is the adductor tubercle located on the femur?
Superolateral part of the femur
Where is the greater trochanter located?
Posteromedial part of the femur
Where is the lesser trochanter located?
2 inches above the pubic symphysis
Where on the midline of the patient should the central ray enter for the AP projection of the pelvis?
Pubis
Which bone/portion of the hip bone consists of a body and two rami?
ischium
Which bone/portion of the hip bone extends inferiorly from the acetabulum and joins with the inferior ramus of the pubic bone?
two hip bones, sacrum, and coccyx only
Which bones form the pelvis?
pubis, ischium, and ilium
Which bones of the pelvis compose the acetabulum?
female
Which gender (male or female) has a pelvis with a larger and more rounded outlet?
Greater pelvis: above Lesser pelvis: below
With reference to the brim of the pelvis, identify the location of the greater (false) pelvis and the lesser (true) pelvis as either "above" or "below".
anteriorly
in a typical adult, in which direction (anterior or posterior) does the femoral neck project away from the long axis of the femur?
ilium
what part of the hip bone forms the broad, curved portion called the ala?
acetabulum
what structure of the hip bone is formed by the fusion of the three hip bones?
sacrum and coccyx
what structures form the posterior part of the pelvis
1 inch above pubic symphysis
where on the midline of the patient should the central ray be directed for the AP oblique projection (modified Cleaves method)
Male
which gender (male or female) has a broader and shallower pelvis?
ischial spine
which of the following pelvic structures is not used as a positioning palpation point? a. iliac crest b. ischial spine c. pubic symphysis d. ASIS
pubis and ischium only
which portions of the hip bone joint to form the obturator foramen?
Rotate the lower limbs medially 15-20 degrees
which positioning maneuver should be performed to place the femoral necks parallel with the IR for an AP projection of the pelvis?
greater trochanter
which process is located at the superolateral aspect of the proximal femoral shaft?
ASIS
which structure should be centered to the midline of the table when the AP oblique projection (modified Cleaves method) is adapted to demonstrate only one hip?
