pelvis radiology ( modified)

8/6/2019 Pelvis Radiology ( Modified)

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Radiology in pelvis


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HIP JOINT

-It is a ball & socket joint formed by the head ofthe femur &

acetabulum ofthe hip bone

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Movements : Flexion

Iliopsoas ,rectus femoris ,sartorius & adductor muscles

Extension

Gluteus maximus & hamstring muscles

Abduction

Gluteus minimus & medius, assisted by sartorius,tensor fascia

lat

ae & piriformis

Adduction

Adductor longus & brevis , assisted by pectineus & gracilis


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Medial Rotation

Anterior fibers of gluteus medius & minimus, & thetensor fascia latae

Lateral Rotation

Piriformis,obrurator internus & externus,superior and

inferior gemelli,quadratus femoris , asssited by gluteus

maximus

Circumduction

A combination of previous movements

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Articulations :

-The hip joint is the articulation between the hemispherical head offemur & the acetabulum.

-The articular surface ofthe acetabulum is horse shoe shaped & is

deficient inferiorly atthe acetabular notch

-The acetabulum cavity is deepen by the presence of acetabular

labrum.

-The labrum bridges across the notch and is here called the

transverse acetabular ligament

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The hip joint is reinforced by the following ligaments:

1.Iliofemoral ligament (limits overextension during standing )

2.Pubofemoral ligament (limits extension & abduction)

3.Ischiofemoral ligament (limits extension)

4.The transverse acetabular ligament (blood vessels & nerves enter

the joint)

5.Ligament of the head of femur(lies within the joint)


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The centers appear in the following order:

- lower ilium at aboutthe 8th - 9th week of fetal life

- in the superior ramus ofthe ischium, aboutthe 3rd month;

- in the superior ramus ofthe pubis, between the 4th

- 5th

months.- At birth, the 3 primary centers are quite separate.

- The secondary ossification centers are still cartilaginous.

- By 7th -8th year, the inferior rami ofthe pubis & ischium are almost

completely united by bone.


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- Aboutthe 13rd / 14th y.o, the 3 primary centers have extended

their growth into the bottom ofthe acetabulum.

- They are separated from each other by a Y-shaped portion of

cartilage, which now presents traces of ossification, often by 2

centers.

- During puberty, ossification takes place in each ofthe remaining

portions, & they join withthe rest ofthe bone between the 20th

25th years.


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-Plan of ossification ofthe hip

bone.

-The 3 primary centers unite

through a Y-shaped pieceabout puberty.

-Epiphyses appear about

puberty, and unite about

twenty-fifth year.


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Basic X-ray Interpretation

All x-rays :

Correct patient

Correct date & time

Determine if supine, upright or decubitus

A normal x-ray is VERY variable

Read an x-ray the same way all the time

Read x-rays withthe radiologist


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Views for a pelvis:

1. A-P view.

2. Inlet view ( cauded projection)

3. Outlet view (cephalad projection)4. Judet view

-Internal (obturator) oblique view

-External ( iliac ) oblique view

Ifthere continues to be doubt, it is appropriate to order a CT scan of

the pelvis


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A-P view ofPelvis


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There are 6 lines that one should evaluate when looking at an AP

radiograph ofthe Pelvis:

1. The iliopectional line to evaluate the anterior column.

2. The ilioischial line to evaluate the posterior column.

3. The dome ofthe acetabulums.

4. The 'tear drop' to evaluate the anteroinferior portion ofthe

acetabular fossa.

5. The anterior rim ofthe acetabulum.

6. The posterior rim ofthe acetabulum.


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-acetabular roof (red),

-posterior rim ofthe

acetabulum (yellow),

-anterior rim oftheacetabulum (blue),

-iliopectineal line (white),

teardrop (black),

-ilioisc

hial line (green do

ts).


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H=Hilgenreiner's Line

P=Perkin's Line

S=Shenton's Line.

U= uncovering. That's theamount ofthe femoral

head thathas no boney

coverage.


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Shentons line

-is an imaginary line drawn along

the inferior border ofthe

superior pubic ramus & the

inferomedial border ofthe

femur neck.

-This line should be continuous &

smooth.

-Interruption of Shenton's line

indicate (in the correct clinical

scenario) :1.DDH

2.# femur neck.


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Hilgenreiners line.

-a horizontal line drawn between

the two triradiate cartilage

centers ofthe hips defines a

horizontal planne & an

approximation to flexion axis

ofthe hips.

-mainly used as a reference for

Perkin's line and

measurement ofthe

acetabular angle.


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Perkins Line

-a perpendicular line to the

horizontal line drawn atthe

edge ofthe boney part ofthe

socket


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- the upper femoral epiphysis

should be seen in the

inferomedial quadrant: it

should lie below

Hilgenreiner's line, &medial

to Perkin's line.

- Lateral displacement occurs

in DDH.


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The acetabular index:

-is the angle betw. Hilgenreinerline & a line drawn from thetriradiate epiphysis to the lateraledge ofthe acetabulum.

normal value:-


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It is also, of course, importantto evaluate the rest ofthe bony

structures visible on the radiograph, including :

1.the pubic rami

2.the SI joints

3.the neck of each femur

4.the visualized lumbar spine & sacrum,

5.the pubic symphysis.


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Pelvic Inlet View

- Shows the pelvic ring

configuration.

-narrowing/ widening of

ring diameter is

immediately apparent.

-evaluates for posterior

displacement of pelvic

ring / pubic symphysis

opening.


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Pelvic Outlet View

-Both iliac crests are not

entirely included on the film;

making this radiograph an

incomplete view;

-however, the pelvic outlet iscompletely demonstrated.

-the degree ofvertical

displacement could be

determined from this

radiograph.


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Internal (obturator View)

- shows iliopectineal line

(anterior column) of

pelvis & posterior wall.

-

pt

is supinew

/ involvedside of pelvis rotated

anteriorly 45 & beam

directed vertically toward

affected hip.


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External (iliac) oblique view

- Shows ilioischial line

(posterior) column &

anterior wall.

-

pt

is supinew

/ uninvolvedside of pelvis rotated ant. 45

degrees;


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Reference

1. Apleys concise system of orthopaedic fracture.

2. Netters concise radiologic anatomy.

3. http://www.wheelessonline.com/ortho/radiology_of_pelvic_fract

ures.

4. http://emedicine.medscape.com/


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THANK YOU

pelvis radiology ( modified)

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