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PELVIC GIRDLE

PATHOLOGY  Demonstration of “gull-wing sign” in cases


1.) Ankylosing Spondylitis of fracture dislocation of the acetabular rim
 Rheumatoid arthritis variant involving the & posterior dislocation of femoral head
sacroiliac joints & spine
2.) Congenital Hip Dysplasia B.) CONGENITAL HIP DISLOCATION
 Malformation of the acetabulum causing
displacement of the femoral head MARTZ-TAYLOR METHOD
3.) Legg-Calve Perthes Disease  Recommendations: 2 AP projections of
 Flattening of the femoral head due to pelvis
vascular disruption  CR: ┴ to pubic symphysis (1st projection)
4.) Slipped Epiphysis o To detect any lateral or superior
 Proximal portion of femur dislocated from displacement of the femoral head
distal portion at the proximal epiphysis  CR: ┴ to 45o to pubic symphysis (2nd
projection)
A.) PELVIS & UPPER FEMORA o Anterior displacement: femoral
head above acetabulum
AP PROJECTION o Posterior displacement: femoral
PP: Supine; feet & leg rotated 15-20o medially head below acetabulum
(places femoral neck // to IR); heels 8-10 in. (20-24  SS: Relationship of femoral head to the
cm) apart acetabulum
RP: 2 in. inferior to ASIS or 2 in. superior to pubic  ER: For patients with congenital hip
symphysis dislocation
CR: ┴
SS: Greater trochanter in profile ANDREN-VON ROSEN APPROACH
Lesser trochanter: seen if feet & leg are rotated  Bilateral hip projection
laterally  PP: Both legs forcibly abducted 45o; femora
rotated inward
LATERAL PROJECTION  ER: For diagnosing congenital hip
PP: dislocation in new borns
 Lateral recumbent: place support under
lumbar spine; vertebral column // with table; C.) FEMORAL NECKS
pelvis in true lateral
 Upright: patient stand straight; weight MODIFIED CLEAVES METHOD
equally distributed on feet; MSP // to IR AP OBLIQUE PROJECTION
RP: 2 in. above greater trochanter Bilateral Frog Leg Position
CR: ┴ PP: Supine; ASISs equidistant from table; hips &
SS: Lateral radiograph of lumbosacral junction; knees flexed & feet draw up (places femora in
sacrum; coccyx; superimposed upper femora nearly vertical position); thigh abducted 25-45o
Berkebile, Fischer & Albrecht: from vertical; feet turn inward; soles against each
 Recommended dorsal decubitus lateral other
projection of pelvis RP: 1 in. superior to pubic symphysis
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PELVIC GIRDLE
CR: ┴  Femoral neck free of superimposition
SS: Acetabulum, femoral head, femoral neck & (Hickey)
trochateric areas ER: To demonstrate hip joint & relationship of
Unilateral Projection femoral head to the acetabulum
PP: Supine; affected hip & knee flexed & feet
draw up; soles against opposite knee; thigh DANELIUS-MILLER METHOD
abducted 45o laterally AXIOLATERAL PROJECTION
RP: 1 in. superior to femoral neck Cross-table/Surgical-lateral Projection
CR: ┴ PP: Supine; pelvis elevated; knee & hip of
SS: Acetabulum, femoral head, femoral neck & unaffected side flexed; leg of unaffected side rested
trochateric areas on support; foot & leg of affected side rotated 15-
20o; IR vertical; IR // to long axis of femoral neck
ORIGINAL CLEAVES METHOD RP: Femoral neck
AXIOLATERAL PROJECTION CR: Horizontal
PP: Same position as Modified Cleaves SS: Hip joint; acetabulum, femoral head & neck;
RP: 1 in. superior to pubic symphysis trochanters
CR: 25-45o
SS: Acetabulum, femoral head, femoral neck & CLEMENTS-NAKAYAMA MODIFICATION
trochateric areas MODIFIED AXIOLATERAL PROJECTION
PP: Supine; limb in neutral or slightly rotated
D.) HIP position; IR vertical & its top back tilted 15o; IR //
to long axis of femoral neck
AP PROJECTION RP: Femoral neck
PP: Supine; ASISs equidistant from table; foot & CR: 15o posteriorly
leg rotated medially 15-20o (places femoral neck // SS: Lateral hip; acetabulum; femoral head & neck;
to IR); trochanters
RP: Femoral neck ER:
CR: ┴  Useful when patient cannot be positioned in
SS: Hip joint Danelius-Miller method
 Perform on patient with bilateral hip
LAUENSTEIN & HICKEY METHODS fractures, bilateral hip arthroplasty or
LATERAL PROJECTION limitation of movement of unaffected leg
Mediolateral
PP: Supine; patient rotated toward affected side; CHASSARD-LAPINE METHOD
knee flexed & thigh draw up; opposite side AXIAL PROJECTION
extended PP: Seated; patient lead directly forward; posterior
RP: Hip joint surface of knee against edge of table; vertical axis
CR: ┴ (Lauenstein); 20-25o cephalad (Hickey) of pelvis tilted 45o; patient grasp the ankles;
SS: Hip joint RP: Lumbosacral region (level of greater
 Femoral neck superimposed over greater trochanter)
trochanter (Lauenstein)

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PELVIC GIRDLE
CR: ┴ or ┴ to coronal plane of symphysis pubis (if SS: Fovea capitis; superoposteior wall of
body flexion if restricted) acetabulum
SS:
 Relationship b/n femoral heads & JUDET METHOD
acetabulum AP OBLIQUE PROJECTION
 Pelvic bones Judet & Letournel: described two 45o posterior
 Opacified rectosigmoid (Barium Enema) oblique position
ER: For measuring the transverse or biischial PP:
diameter in pelvimetry  Internal Oblique: semisupine; LPO (places
hip in internal oblique); affected hip up;
LEONARD-GEORGE METHOD MSP 45o from table
PP: Supine; pelvis elevated (places greater  External Oblique: semisupine; RPO
trochanter 4 in. above table top); unaffected side hip (places hip in external oblique); affected hip
& knee flexed; thigh abducted; foot rotated 15-20o down; MSP 45o from table
internally (to overcome anterversion of femoral RP:
neck); IR vertical; uses curved cassette  Internal Oblique: 2 in. inferior to ASIS of
RP: Depression superior to greater trochanter affected side
CR: Medially & inferiorly perpendicular  External Oblique: pubic symphysis
SS: Femoral head & neck; trochanteric area CR: ┴
SS: Acetabular rim
FRIEDMAN METHOD ER:
AXIOLATERAL PROJECTION  Useful in diagnosing fxs of acetabulum
PP: Lateral recumbent; affected side against IR;  Internal Oblique: For patient with
affected limb in true lateral; unaffected limb rolled suspected fx of iliopubic column (anterior)
10o posteriorly; & posterior rim of acetabulum
RP: Femoral neck  External Oblique: For patient suspected fx
CR: 35o cephalad of ilioischial column (posterior) & anterior
SS: Femoral head & neck; trochanteric area; rim of acetabulum
proximal shaft of femur Rafert-Long Modification:
 Modified Judet Method
E.) ACETABULUM  Same position as Judet Method
 CR: Horizontal (for external oblique) &
TEUFEL METHOD
Perpendicular/Vertical (for internal oblique)
PA AXIAL OBLIQUE PROJECTION
PP: Semiprone; RAO/LAO; unaffected side
F.) ANTERIOR PELVIC BONES
elevated; MSP 38o from table; knee of elevated side
flexed
PA PROJECTION
RP: Acetabulum or inferior level of coccyx (2 in. PP: Prone; IR center to greater trochanter (level of
lateral to MSP toward side of interest)
pubic symphysis)
CR: 12o cephalad RP: Distal coccyx
CR: ┴
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PELVIC GIRDLE
SS: Pubic symphysis & ischia; obturator foramina  Symphysis pubis

TAYLOR METHOD G.) ILIUM


AP AXIAL “OUTLET” PROJECTION
PP: Supine; ASISs equidistant from table; knee AP OBLIQUE PROJECTION
flexed slightly PP: Supine; RPO/LPO; unaffected side elevated
RP: 2 in. distal to superior border of pubic 40o (places broad surface of the wing of affected
symphysis ilium // to IR); shoulder, hip & knee elevated
CR: 20-35o cephalad (males); 30-45o (females) RP: Level of ASIS
SS: Pelvic outlet CR: ┴
 Superior & inferior rami without SS:
foreshortening  Unobstructed projection of ala & sciatic
notches
BRIDGEMAN METHOD  Profile image of acetabulum
SUPEROINFERIOR AXIAL “INLET”  Broad surface of the iliac wing without
PROJECTION rotation
PP: Supine; ASISs equidistant from table; knee
flexed slightly; IR center at level of greater PA OBLIQUE PROJECTION
trochanters PP: Supine; RAO/LAO; unaffected side elevated
RP: level of ASISs 40o (places affected ilium ┴ to IR); patient rested on
CR: 40o caudad forearm; knee of elevated side flexed
SS: Pelvic ring/inlet RP: Level of ASIS
CR: ┴
LILIENFELD METHOD SS:
SUPEROINFERIOR PROJECTION  Ilium in profile
PP: Seated-erect; knees slightly flexed; patient lean  Femoral head within acetabulum
backward 45-50o; arch the back (places pubic arch
in vertical position)
RP: 1.5 in. superior to symphysis pubis  THE END 
CR: ┴ “BOARD EXAM is a matter of PREPARATION. If
SS: Pelvic ring/inlet you FAIL to prepare, you PREPARE to fail”
 Anterior pubic & ischial bones 03/26/14
 Symphysis pubis

STAUNIG METHOD
INFEROSUPERIOR PROJECTION
PP: Prone
RP: Symphysis pubis
CR: 35o cephalad
SS: Pelvic ring/inlet
 Anterior pubic & ischial bones
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