5-PELVIC-GIRDLE.pdf

PELVIC PREPARED BY : ALDRIN LOPEZ, GIRDLE RRT, MSRT  PATHOLOGY 1.) Ankylosing Spondylitis Rheumatoid arthritis variant involving the sacroiliac joints & spine 2.) Congenital Hip Dysplasia Malformation of the acetabulum causing displacem...

PELVIC PREPARED BY : ALDRIN LOPEZ, GIRDLE RRT, MSRT  PATHOLOGY 1.) Ankylosing Spondylitis Rheumatoid arthritis variant involving the sacroiliac joints & spine 2.) Congenital Hip Dysplasia Malformation of the acetabulum causing displacement of the femoral head 3.) Legg-Calve Perthes Disease Flattening of the femoral head due to vascular disruption 4.) Slipped Epiphysis Proximal portion of femur dislocated from distal portion at the proximal epiphysis Presentation Title  PELVIS & UPPER FEMORA 9/3/20XX Presentation Title 3  AP PROJECTION PP: Supine; feet & leg rotated 15-20o medially (places femoral neck // to IR); heels 8-10 in. (20-24 cm) apart RP: 2 in. inferior to ASIS or 2 in. superior to pubic symphysis CR: ┴ SS: Greater trochanter in profile Lesser trochanter: seen if feet & leg are rotated laterally 9/3/20XX Presentation Title 4 9/3/20XX Presentation Title 5 9/3/20XX Presentation Title 6 9/3/20XX Presentation Title 7  LATERAL PROJECTION PP: Lateral recumbent: place support under lumbar spine; vertebral column // with table; pelvis in true lateral Upright: patient stand straight; weight equally distributed on feet; MSP // to IR RP: 2 in. above greater trochanter CR: ┴ SS: Lateral radiograph of lumbosacral junction; sacrum; coccyx; superimposed upper femora Berkebile, Fischer & Albrecht: Recommended dorsal decubitus lateral projection of pelvis Demonstration of “gull-wing sign” in cases of fracture dislocation of the acetabular rim & posterior dislocation of femoral head 9/3/20XX Presentation Title 8 9/3/20XX Presentation Title 9 9/3/20XX Presentation Title 10  CONGENITAL HIP DISLOCATION 9/3/20XX Presentation Title 11  MARTZ-TAYLOR METHOD Recommendations: 2 AP projections of pelvis CR: ┴ to pubic symphysis (1st projection) o To detect any lateral or superior displacement of the femoral head CR: ┴ to 45o to pubic symphysis (2nd projection) o Anterior displacement: femoral head above acetabulum o Posterior displacement: femoral head below acetabulum SS: Relationship of femoral head to the acetabulum ER: For patients with congenital hip dislocation 9/3/20XX Presentation Title 12 9/3/20XX Presentation Title 13  ANDREN-VON ROSEN APPROACH Bilateral hip projection PP: Both legs forcibly abducted 45o; femora rotated inward ER: For diagnosing congenital hip dislocation in new borns 9/3/20XX Presentation Title 14  FEMORAL NECKS 9/3/20XX Presentation Title 15  MODIFIED CLEAVES METHOD AP OBLIQUE PROJECTION Bilateral Frog Leg Position PP: Supine; ASISs equidistant from table; hips & knees flexed & feet draw up (places femora in nearly vertical position); thigh abducted 25- 45o from vertical; feet turn inward; soles against each other RP: 1 in. superior to pubic symphysis CR: ┴ SS: Acetabulum, femoral head, femoral neck & trochateric areas 9/3/20XX Presentation Title 16 9/3/20XX Presentation Title 17 9/3/20XX Presentation Title 18  Unilateral Projection PP: Supine; affected hip & knee flexed & feet draw up; soles against opposite knee; thigh abducted 45o laterally RP: 1 in. superior to femoral neck CR: ┴ SS: Acetabulum, femoral head, femoral neck & trochateric areas 9/3/20XX Presentation Title 19 9/3/20XX Presentation Title 20 9/3/20XX Presentation Title 21  ORIGINAL CLEAVES METHOD AXIOLATERAL PROJECTION PP: Same position as Modified Cleaves RP: 1 in. superior to pubic symphysis CR: 25-45o SS: Acetabulum, femoral head, femoral neck & trochateric areas 9/3/20XX Presentation Title 22 9/3/20XX Presentation Title 23 9/3/20XX Presentation Title 24  HIP 9/3/20XX Presentation Title 25  AP PROJECTION PP: Supine; ASISs equidistant from table; foot & leg rotated medially 15-20o (places femoral neck // to IR); RP: Femoral neck CR: ┴ SS: Hip joint 9/3/20XX Presentation Title 26 9/3/20XX Presentation Title 27 9/3/20XX Presentation Title 28  LAUENSTEIN & HICKEY METHODS LATERAL PROJECTION Mediolateral PP: Supine; patient rotated toward affected side; knee flexed & thigh draw up; opposite side extended RP: Hip joint CR: ┴ (Lauenstein); 20-25o cephalad (Hickey) SS: Hip joint Femoral neck superimposed over greater trochanter (Lauenstein) Femoral neck free of superimposition (Hickey) 9/3/20XX ER: To demonstrate hip joint & relationship of femoral head to the acetabulum Presentation Title 29 9/3/20XX Presentation Title 30 9/3/20XX Presentation Title 31  DANELIUS-MILLER METHOD AXIOLATERAL PROJECTION Cross-table/Surgical-lateral Projection PP: Supine; pelvis elevated; knee & hip of unaffected side flexed; leg of unaffected side rested on support; foot & leg of affected side rotated 15-20o; IR vertical; IR // to long axis of femoral neck RP: Femoral neck CR: Horizontal SS: Hip joint; acetabulum, femoral head & neck; trochanters 9/3/20XX Presentation Title 32 9/3/20XX Presentation Title 33 9/3/20XX Presentation Title 34  CLEMENTS-NAKAYAMA MODIFICATION MODIFIED AXIOLATERAL PROJECTION PP: Supine; limb in neutral or slightly rotated position; IR vertical & its top back tilted 15o; IR // to long axis of femoral neck RP: Femoral neck CR: 15o posteriorly SS: Lateral hip; acetabulum; femoral head & neck; trochanters ER: Useful when patient cannot be positioned in Danelius-Miller method Perform on patient with bilateral hip fractures, bilateral hip arthroplasty or limitation of movement of unaffected leg 9/3/20XX Presentation Title 35 9/3/20XX Presentation Title 36 9/3/20XX Presentation Title 37  CHASSARD-LAPINE METHOD AXIAL PROJECTION PP: Seated; patient lead directly forward; posterior surface of knee against edge of table; vertical axis of pelvis tilted 45o; patient grasp the ankles; RP: Lumbosacral region (level of greater trochanter) CR: ┴ or ┴ to coronal plane of symphysis pubis (if body flexion if restricted) SS: Relationship b/n femoral heads & acetabulum Pelvic bones Opacified rectosigmoid (Barium Enema) ER: For measuring the transverse or biischial diameter in pelvimetry 9/3/20XX Presentation Title 38 9/3/20XX Presentation Title 39 9/3/20XX Presentation Title 40  LEONARD-GEORGE METHOD PP: Supine; pelvis elevated (places greater trochanter 4 in. above table top); unaffected side hip & knee flexed; thigh abducted; foot rotated 15-20o internally (to overcome anterversion of femoral neck); IR vertical; uses curved cassette RP: Depression superior to greater trochanter CR: Medially & inferiorly perpendicular SS: Femoral head & neck; trochanteric area 9/3/20XX Presentation Title 41  FRIEDMAN METHOD AXIOLATERAL PROJECTION PP: Lateral recumbent; affected side against IR; affected limb in true lateral; unaffected limb rolled 10o posteriorly; RP: Femoral neck CR: 35o cephalad SS: Femoral head & neck; trochanteric area; proximal shaft of femur 9/3/20XX Presentation Title 42 9/3/20XX Presentation Title 43 9/3/20XX Presentation Title 44  PA OBLIQUE PROJECTION HSIEH METHOD RAO or LAO position PP: Semi prone prone position; levate the unaffected side approximately 40 to 45 degrees and have the patient support the body on the flexed CR: Perpendicular SS: PA oblique projection of the ilium, hip joint, and proximal femur Note: Urist recommended , The injured hip i elevated 60 degrees to place the posterior rim of the acetabulum in profile, and the body is adju ted to center the sagittal plane pa sing through the ASIS to the midline of the table 9/3/20XX Presentation Title 45 9/3/20XX Presentation Title 46 9/3/20XX Presentation Title 47  MEDIOLATERAL OBLIQUE PROJECTION LlLIENFELD METHOD RAO or LAO position PP: lateral recumbent position on the affected side CR: Perpendicular to the midpoint of the JR, SS: mediolateral oblique projection of the ilium, acetabulum, and proximal femur Note: Lilienfeld projection is not used with patients who have an acute hip injury 9/3/20XX Presentation Title 48 9/3/20XX Presentation Title 49 9/3/20XX Presentation Title 50  ACETABULUM 9/3/20XX Presentation Title 51  TEUFEL METHOD PA AXIAL OBLIQUE PROJECTION PP: Semiprone; RAO/LAO; unaffected side elevated; MSP 38o from table; knee of elevated side flexed RP: Acetabulum or inferior level of coccyx (2 in. lateral to MSP toward side of interest) CR: 12o cephalad SS: Fovea capitis; superoposteior wall of acetabulum Presentation Title 9/3/20XX Presentation Title 53 9/3/20XX Presentation Title 54  JUDET METHOD AP OBLIQUE PROJECTION Judet & Letournel: described two 45o posterior oblique position PP: Internal Oblique: semisupine; LPO (places hip in internal oblique); affected hip up; MSP 45o from table External Oblique: semisupine; RPO (places hip in external oblique); affected hip down; MSP 45o from table RP: Internal Oblique: 2 in. inferior to ASIS of affected side External Oblique: pubic symphysis CR: ┴ SS: Acetabular rim 9/3/20XX Presentation Title 55  ER: Useful in diagnosing fxs of acetabulum Internal Oblique: For patient with suspected fx of iliopubic column (anterior) & posterior rim of acetabulum External Oblique: For patient suspected fx of ilioischial column (posterior) & anterior rim of acetabulum 9/3/20XX Presentation Title 56 9/3/20XX Presentation Title 57 9/3/20XX Presentation Title 58  Rafert-Long Modification: Modified Judet Method Same position as Judet Method CR: Horizontal (for external oblique) & Perpendicular/Vertical (for internal oblique) 9/3/20XX Presentation Title 59  ANTERIOR PELVIC BONES 9/3/20XX Presentation Title 60  PA PROJECTION PP: Prone; IR center to greater trochanter (level of pubic symphysis) RP: Distal coccyx CR: ┴ SS: Pubic symphysis & ischia; obturator foramina 9/3/20XX Presentation Title 61 9/3/20XX Presentation Title 62 9/3/20XX Presentation Title 63  TAYLOR METHOD AP AXIAL “OUTLET” PROJECTION PP: Supine; ASISs equidistant from table; knee flexed slightly RP: 2 in. distal to superior border of pubic symphysis CR: 20-35o cephalad (males); 30-45o (females) SS: Pelvic outlet Superior & inferior rami without foreshortening 9/3/20XX Presentation Title 64 9/3/20XX Presentation Title 65  BRIDGEMAN METHOD SUPEROINFERIOR AXIAL “INLET” PROJECTION PP: Supine; ASISs equidistant from table; knee flexed slightly; IR center at level of greater trochanters RP: level of ASISs CR: 40o caudad SS: Pelvic ring/inlet 9/3/20XX Presentation Title 66  LILIENFELD METHOD SUPEROINFERIOR PROJECTION PP: Seated-erect; knees slightly flexed; patient lean backward 45-50o; arch the back (places pubic arch in vertical position) RP: 1.5 in. superior to symphysis pubis CR: ┴ SS: Pelvic ring/inlet Anterior pubic & ischial bones Symphysis pubis 9/3/20XX Presentation Title 67 9/3/20XX Presentation Title 68 9/3/20XX Presentation Title 69  STAUNIG METHOD INFEROSUPERIOR PROJECTION PP: Prone RP: Symphysis pubis CR: 35o cephalad SS: Pelvic ring/inlet Anterior pubic & ischial bones Symphysis pubis 9/3/20XX Presentation Title 70 9/3/20XX Presentation Title 71  ILIUM AP OBLIQUE PROJECTION PP: Supine; RPO/LPO; unaffected side elevated 40o (places broad surface of the wing of affected ilium // to IR); shoulder, hip & knee elevated RP: Level of ASIS CR: ┴ SS: Unobstructed projection of ala & sciatic notches Profile image of acetabulum Broad surface of the iliac wing without rotation 9/3/20XX Presentation Title 72 9/3/20XX Presentation Title 73 9/3/20XX Presentation Title 74  PA OBLIQUE PROJECTION PP: Supine; RAO/LAO; unaffected side elevated 40o (places affected ilium ┴ to IR); patient rested on forearm; knee of elevated side flexed RP: Level of ASIS CR: ┴ SS: Ilium in profile Femoral head within acetabulum 9/3/20XX Presentation Title 75 9/3/20XX Presentation Title 76 9/3/20XX Presentation Title 77