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S2 Proc Unit 1
SJC Zerbe Procedures Semester 2 Unit 1
| Ummmmmm.... | Ok, yeah |
|---|---|
| Pelvis consists of: | 2 hip bones Sacrum Coccyx |
| Pelvis Girdle consists of: | 2 hip bones |
| Pelvis Function: | Serves as base for trunk Serves as girdle for attachment of the lower limbs |
| Other names for the hip bones: | Innominate bone Ox Coxae |
| The hip bone consists of: | Ilium Ischium Pubis Separate at birth and in youth Fuse in adulthood |
| Pelvis is divided into 2 distinct areas to identify fractures of the Acetabulum. What are those divisions | Iliopubic column Ilioischial column |
| The Ilium consists of two main parts. They are the: | The body The ala (wing) |
| The body of the ilium forms what portion and how much of the acetabulum? | Superior 2/5 |
| There are 3 borders of the ala of the Ilium; they are: | Superior border Anterior border Posterior border |
| There are 4 prominent projections on the anterior and posterior borders of the ala of the Ilium; they are: | Anterior Superior Iliac Spine Anterior Inferior Iliac Spine Posterior Superior Iliac Spine Posterior Inferior Iliac Spine |
| Which of the 4 prominences is a palpable landmark? | Anterior Superior Iliac Spine ASIS |
| Where is the Iliac crest? | Superior border of the ALA, extends from the ASIS to the PSIS |
| Iliac Fossa | Fossa on the medial surface of the wing/ala |
| Arcuate Line | Arc-shaped ridge that separates the fossa and the body Forms a part of the circumference of the pelvic brim |
| Rough surface on the inferior and posterior portions of the wing: | Auricular surface Articulates with sacrum Forms and interlock |
| Inward curve of the ilium just below the auricular surface: | Greater Sciatic Notch Formed by the angle of the wing and body of the Ilium |
| The 3 main parts of the Pubis: | Body Superior Ramus Inferior Ramus |
| The body of the pubis makes up how much and what portion of the acetabulum | Anterior 1/5 |
| Superior Ramus of the pubis (location) | Projects inferiorly and medially from the acetabulum |
| Inferior Ramus location: | Extends from the superior ramus inferiorly and posteriorly |
| 2 main portions of the ischium: | Body Ramus |
| The Body of the ischium makes up what portion and how much of the acetabulum. | Posterior 2/5 |
| The expanded portion of the ischium that extends posteriorly and inferiorly from the body | (acetabulum) Ischial tuberosity |
| When seated upright the body rests on the: | 2 Ischial tuberosities |
| Ischial Ramus: | Projects anteriorly and medially from the ischial tuberosity (meets the inferior ramus of the pubis) |
| Obturator Foramen is made up by: | Superior and inferior rami of the pubis and the ischial ramus |
| Where is the ischial spine? | On the superoposterior border of the body of the ischium |
| Where is the lesser sciatic notch? | Indentation on the ischium just below the ischial spine |
| The largest and strongest bone in the body? | Femur |
| Proximal end of femur consists of: | Head Neck Greater and lesser trochanter |
| Fovea capitus? | Small depression at the center of the head for the liagmentum capitis femoris |
| Greater tachanter? | At the junction of the body and the base of the neck on the superolateral part of the body |
| Lesser trochanter? | At the junction of the body and the base of the neck on the posteromedial border of the body |
| Intertrochanteric Crest? | prominent ridge extending between the trochanters at the base of the neck on the posterior surface of the body |
| Intertrochanteric Line | less prominent ridge connecting the trochanters on the anterior surface of the body at the base of the neck |
| Femoral Neck projects anteriorly from the femoral body at an angle of: | 15 to 20 degrees |
| Femoral Neck projects superiorly from the femoral body at an angle of: | 120-130 degrees |
| The longitudinal plane of the femur is angled how much from vertical? | 10 degrees Children – angle is wider with more vertical neck Wider patient – angle is narrower with more horizontal neck |
| Hip Joint type? | Synovial, ball and socket, freely movable |
| Pubic Symphysis Joint type? | Cartilaginous, Symphysis, slightly movable |
| Sacroiliac Joint type? | Synovial, Irregular gliding, slightly movable |
| Female Pelvis Characteristics: | Lighter Wider More shallow Oval shaped inlet Wide outlet Wider sacrum with steeper curve Flattened sacral promontory Obtuse angle of pubic arch |
| Male Pelvis Characteristics | Heavy Narrow Deep Inlet Round Outlet Narrow Acute angle of pubic arch |
| Pelvic Brim? | Oblique plane extending from sacral promontory to superior pubic symphysis. Divides the pelvis into greater and lesser pelvis. |
| Region above the pelvic brim? | Greater of False Pelvis |
| Region below the pelvic brim? | True or lesser pelvis Pelvic cavity |
| Superior aperture?? | Inlet Formed by the pelvic brim |
| Inferior aperture???? | Outlet Measured from the tip of the coccyx to the inferior margin of the pubic symphysis |
| The neck of the femur projects anteriorly at an approximate angle of: | 15º-20 |
| In order to accurately position the patient for hip radiographs, one has to localize two bony points on the pelvis. | Superior margin of the symphysis and the ASIS |
| The ilia articulate with the sacrum posteriorly at the: | sacroiliac joint |
| How many degrees should the feet and lower limbs be internally rotated for an AP pelvis radiograph? | 15º-20º to place the femoral necks parallel to the IR |
| The CR for an AP pelvis is directed perpendicular to the center of the IR. The CR entrance point will be about: | On the MSP and Midway between the ASIS and Pubic Symphysis (2 inches superior to the pubic symphysis) |
| What structures will be shown "in profile" if the lower limbs are in correct position for an AP pelvis? | greater trochanters |
| Which of the following methods will demonstrate the femoral necks in the AP oblique projection? | Modified Cleaves |
| For the AP oblique femoral necks (Modified Cleaves method), the CR is directed: | CR is perpendicular directed to the Midsagital plane at a level 1” superior to the symphysis pubis or @ 2 ½ to 3” inferior to the ASIS |
| How much should the thighs be abducted for the AP oblique projection of the femoral necks (modified Cleaves method)? | 45 degrees |
| Which body plane should be positioned to the midline of the grid for an AP hip? | a sagittal plane 1 to 2 inches medial to the ASIS |
| Which of the following methods demonstrate the hip in an axiolateral projection? | Danelius-Miller |
| Which projection of the hip is shown in the figure? | Axiolateral: Daneulius-Miller |
| Is the affected limb rotated for the axiolateral projection (Danelius-Miller method) | Yes @ 15-20 degrees unless contraindicated |
| How is the CR directed for the Axiolateral Projection (Danelius-Miller method)? | Perpendicular to the IR and femoral neck |
| Where is the IR placed for the axiolateral projection (Danelius-Miller method) | In a vertical position with its upper border in the crease above the crest and the lower border tilted away to be place it parallel with the long axis of the femoral neck. |
| How far apart should the heels be placed in order to internally rotate the lower limbs for an AP pelvis? | 8-10 inches |
| Where is the IR centered for an AP pelvis? | midway between the ASIS and the pubic symphysis Roughly 2” below the ASIS |
| Where is the central ray directed for the AP oblique projection (modified Cleaves) of the femoral necks? | 1 inch superior to the pubic symphysis |
| What is the name of the large foramen in the innominate bone? | Obturator foramen |
| The most proximal rounded end of the femur is termed what? | The head |
| What are the two most common fracture sites of the hip in the elderly? | Femoral Neck Intertrochanteric Crest |
| What makes up the acetabulum? | 2/5 ilium superiorly 2/5 ischium posteriorly 1/5 pubis anteriorly |
| The AP Projection of the hip should demonstrate: | The greater trochanter in profile and the femoral neck parallel to the IR. The lesser trochanter should line the medial border of the femur |
| IR size and direction for AP and modified cleaves Pelvis | 14 x 17 CW |
| Respiration phase for pelvis and hip imaging: | Suspend respiration |
| Patient position for AP Pelvis | Supine |
| What projection is commonly referred to as “Frog Legs” | AP Oblique Projection femoral necks Modified Cleaves Method |
| Which projection will demonstrate the lesser trochanters in profile medially? | Modified cleaves Pelvis |
| AP Hip IR size and direction | 10 x 12 LW |
| CR location for AP hip projection | Perpendicular to the femoral neck Using the hip localizing method approximately 2½ inches (6.4 cm) distal on a line drawn perpendicular to the midpoint of a line between ASIS and pubic symphysis |
| IR size and direction for the axio-lateral hip (Danelius-Miller) | 10x12 LW Grid cassette |
| CR location and direction for axiolateral hip (Danelius Miller) | Horizontal Perpendicular to IR and femoral neck |
| IR size and direction for modified axiolateral hip (Clements-Nakayama) | 10 x 12 LW Grid cassette |
| CR direction and location for modified axiolateral hip (Clements-Nakayama) | Angled 15 degrees posteriorly from horizontal Perpendicular to the femoral neck and IR |
| How is the limb positioned for the modified axiolateral hip (Clements-Nakayama) | Neutral or slightly externally rotated |
| When is the modified axiolateral hip (Clements-Nakayama) performed | Trauma and when the patient is unable to lift the unaffected leg for Danelius Miller |
| IR size and direction for AP Oblique Acetabulum (Judet) | 10 x12 LW |
| How should the patient be positioned for the internal AP oblique of the Left acetabulum | 45 degree RPO Oblique |
| How should the patient be positioned for the AP external oblique of the left acetabulum? | 45 degree LPO |
| The AP Oblique of the Acetabulum in internal rotation demonstrates: | Iliopubic column and the posterior rim of the acetabulum |
| The AP Oblique of the Acetabulum in external rotation demonstrates: | Ilioischial column And Anterior rim of the acetabulum |
| CR location for AP oblique acetabulum in internal rotation | Perpendicular to the IR Entering 2” inferior to the elevated ASIS |
| CR Location for the AP Oblique Acetabulum in external rotation | Perpendicular to IR Entering pubic symphysis or 2” medial and 2” inferior from the ASIS closest to the IR |
| Patient position for the AP Axial Outlet Projection | Taylor Method supine |
| CR direction and location for the AP Axial Outlet/Taylor Method | 20 to 45 degrees cephalic angle 2” inferior to the superior border of the pubic symphysis (20-35 men) (30-45 women) |
| Taylor Method is what projection of the pelvis? | AP Axial Outlet |
| Patient position for the AP Axial “inlet” projection | supine |
| CR direction and location for the AP Axial “inlet” Bridgeman Method | 40 degree caudal angle at the level of the ASIS |
| Projection | AP Axial “inlet” Bridgeman Method |
| Pelvic Sacral Foramina | Four pairs of openings throughout the sacrum for transmission of nerves and blood vessels |
| Ala of the Sacrum | Wing-like masses of the sacrum |
| Auricular surface of sacrum | Superoanterior surface for articulation with the pelvis |
| Sacral cornu | 2 processes that project inferiorly from posterolateral aspect of the last sacral segment to join coccygeal cornu |
| How many vertebrae are there in the sacrum? | 5 |
| On each side of the sacral base is a large wing-like mass called the: | ala |
| The angle of the articulation between the sacrum and the ilia (the sacroiliac joints) | 25º-30º |
| How much must the body be rotated for the oblique projection of the sacroiliac joints? | 25-30 degrees The SI joints project 25-30 degrees medially from the anterior surface. To open the joints, the patient is obliqued 25-30 degrees from the AP position which will place the SI joint farthest from the IR perpendicular (open) to the IR. |
| What structure is demonstrated in a 25 to 30 Degree RPO position with the central ray entering 1” medial to the elevated ASIS? | Left sacroiliac joint. The SI joints angle posteriorly and medially 25 degrees to the MSP. The 25 degree oblique will open the joint. In APO projection the side furthest from the IR is demonstrated; In the PAO the side nearest the IR is demonstrated. |
| CR angle and location for AP Axial SI Joints (Ferguson Method) | 30 (male) to 35 (female) degrees cephalic 1 ½” superior to the pubic symphysis |
| CR location for the AP Oblique SI joint? | 1”medial to the elevated ASIS |
Created by:
paigeduh
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