Pelvic radiographs

A clinico-Radiological presentation on how to systematically read pelvic/hip radiographs

1. CLINICO-RADIOLOGICAL PRESENTATION

2. HOW TO READ PELVIC/HIP RADIOGRAPHS PRESENTER: DR JOHN ABUTU JOB Resident doctor dept of surgery FMC bida . Nigeria

3. OBJECTIVES To review the radiographic anatomy of the pelvis placing emphasis on bones, body landmarks and other anatomy. Identify Basic radiographic views of the hip and pelvis. To systematically read a hip/pelvic radiographs Depict pathologies that disrupt the normal contours of the pelvic reference lines, stripes and arcs .

4. OUTLINES Introduction Relevant Radiological Anatomy Radiological Views/projections How to read hip/pelvic radiographs Normal pelvic radiograph Pathological pelvic radiograph Conclusion

5. INTRODUCTION The bony pelvis consists of the sacrum, coccyx and a pair of innominate bones, which are part of the appendicular skeleton. Pelvic Fractures account for 2-3 % of all fractures, but the mortality rate is up to 20 % The pelvic x-ray also forms an integral part in trauma imaging and as part of ATLS assessment .

6. Relevant Radiological Anatomy Pelvis = sacrum, coccyx + inominate bones Inominate bones = ilium, ischium, pubis A rticulations within the pelvis: S acroiliac joints (x2) - between the sacrum and the ilium of the innominate bones P ubic symphysis - between the pubic bodies of the two innominate bones

7. Radiological anatomy cont …

8. Radiological anatomy cont …

9. Radiological anatomy cont.. Numerous lines, arcs and stripes make up the familiar image in the pelvic radiograph. These include : I liopectineal line I lioischial line S acral arcuate line S henton arc F at stripe L ine of klein Radiographic teardrop

10. Radiological anatomy cont.. Hilgenreiner Line Perkin Line Acetabular roof Anterior acetabular wall Posterior acetabular wall Femoral head line Entheses

11. Entheses

12. Male vs female pelvis Feature Male Female Shape Narrow, deep Wide, shallow Superior aperture (inlet) Round Oval Inferior Aperture (outlet) Narrow Wide

13. Radiological views AP projections Lateral Hip projection Anxiolateral cross table Hip projection Inlet/outlet Projection Judet Projection Frog leg lateral

14. AP View

15. Lateral Hip projection

16. Axiolateral “Cross-table” Hip

17. Judet Projection

18. Reading hip/pelvic radiographs 1. Adequacy of film -Penetration -Right patient -Right part of the body -Positioning -View of structure you want to see - Atleast 2 views

19. Reading hip/pelvic radiographs cont.. 2. Soft tissues: joint effusion, fat stripes 3. Joint Space: Narrow/wide 4. Look at the bones: -cortical outline -Bony texture -Compare sides

20. Normal pelvic radiograph

21. Examples of pathological pelvic radiograph A . Congenital/Inherited -Developmental dysplasia/dislocation of the hip, a chondroplasia B . Trauma: pelvic fractures -Can be simple or complex and can involve any part of the bony pelvis. - Anteroposterior compression - result in open book or sprung pelvic fractures Lateral compression Vertical shear Combined mechanical - complex fracture pattern

22. Examples of pathological pelvic radiograph C. Infection -septic arthritis -osteomyelitis D. Metabolic – Osteonecrosis(AVN femoral head) - P aget diseease E. others eg protrucio Acetabuli

23. Pelvic fracture

24. CONCLUSION The pelvis has complex and subtle anatomy, important radiographic findings can be challenging to the clinician. A good understanding of the normal anatomy and the patterns of disease can be useful for accurate diagnosis.

25. References 1. Campbell S.E Radiography of the Hip:Lines , Signs and Patterns of Disease. Semin Roentgenol 2005; 40: 290-319. DOI:10.1053/j.ro.2005.01.016. 2. Frank Gaillard, ' Radiopedia ', http://www.radiopedia.org, 2005-2014, (accessed 6 January 2015). 3. Young JWR, Resnik CS. Fracture of the pelvis: current concepts of classification. AJR 1990; 155: 1169-75. 4. Leunig M, Beaule PE, Ganz R. The Concept of Femoroacetabular Impingement. Clin Orthop Relat Res 2009; 467: 616-22. 5. Blausen.com staff. " Blausen gallery 2014" Wikiversity Journal of Medicine.

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