GROUP 13

Hara Camille E. Leyba

Abigail Marie C. Remulla
Brief Anatomy
Hip Bone
Os coxae, innominate
bone
Consists of 3 bones: (1)
ilium (2) pubis (3) ischium
Fuse together to form the
acetabulum
Separated by cartilage in
children but become fused
into one bone in adults
Divided into 2 distict areas:
(1) iliopubic column (2)
ilioischial column
These columns are used
to identify fractures
around the acetabulum
NOTE: The pelvis consists of 2
hip bones, sacrum and coccyx.
Brief Anatomy
Ilium
Consists of a body and ala
Forms
2
5
th of acetabulum
Ala
3 borders: anterior,
posterior, superior
4 prominent projections:
Anterior superior iliac
spine (ASIS)
Anterior inferior iliac spine
Posterior anterior iliac
spine
Posterior inferior iliac
spine
ASIS
Important and frequently used reference point
Brief Anatomy
Pubis
Consists of a body, superior
ramus, and inferior ramus
Forms
1
5
th of acetabulum

Ischium
Consists of a body and an
ischial ramus
Forms
2
5
th of acetabulum
Projects posteriorly and
inferiorly from acetabulum to
form the ischial tuberosity.


Obturator foramen
Enclosed by the posterior union of the rami of pubis and ischium
Ischial spine
Prominent projection at the superior border of the ischial body
Lesser sciatic notch
Indentation just below the ischial spine
Hip
AP Projection
Film Size:
10 x 12 in LW

Body Position:
Supine position

Part Position:
Center the sagittal plane passing 2 inches medial to ASIS to
the midline of the table.
Place the body in a true lateral position.
Medially rotate the lower limb and foot approximately 15
degrees (15-20 degrees) to place the femoral neck parallel
with the plane of the IR.
Place a support under the knee and a sandbag across the
ankle.













Patient Instruction:
Shield gonads
Respiration suspended



Localization Point:

Immobilization Device:
Sandbag

Reference Point:
Between ASIS and pubic symphysis

Central Ray:
Perpendicular to femoral neck
Approximately 2 inches distal on a line drawn
perpendicular to the midpoint of a line between ASIS
and pubic symphysis
Center the IR to central ray



Head, neck, trochanters, and proximal one third of the
body of the femur.
Entire pelvic girdle and upper femora ( for traumatic or
pathologic)

Structures Shown:

Evidence of proper collimation
Femoral head: penetrated and seen through the
acetabulum
Regions of the ilium and pubic bones adjoining the pubic
symphysis
Any orthopedic appliance in its entirety
Hip joint
Greater trochanter in profile
Entire long axis of the femoral neck not foreshortened
Proximal one third of the femur
Lesser trochanter is usually not projected beyond the
medial border of the femur, or only a very small amount
of the trochanter is seen

Note:
Trauma patients who have sustained severe injury are
not usually transferred to the radiographic table but are
radiographed on the stretcher or bed.


Evaluation Criteria:

Lateral Position:
Lauenstein and Hickey Methods
Often called the Frog-leg position
This method is used to demonstrate the hip joint
and the realtionship of the femoral head to the
acetabulum.
This body position is not used when:
Presence of trauma
Unhealed fracture
Destructive disease
Film Size:
10 x 12 in LW

Body Position:
Supine position
Rotate the patient slightly toward the affected side to an
oblique position

Part Position:
Adjust the patients body, and center the affected hip to
the midline of the grid
Ask the patient to flex the affected knee and draw the
thigh up to a position at nearly a right angle to the hip
bone.
Keep the body of the affected femur parallel to the table


Extend the opposite limb and support it at hip level and under
the knee
Rotate the pelvis no more than necessary to accommodate
flexion of the thigh and to avoid superimposition of the affected
side

Patient Instruction:
Shield gonads
Respiration suspended

Localization Point:


Immobilization Device:

Reference Point:
midway between ASIS and pubic symphysis

Central Ray:
Perpendicular through the hip joint , which is located midway
between ASIS and pubic symphysis
Lauenstein Method: Perpendicularly
Hickey Method: Cephalic angle of 20 to 25 degrees
Center the IR to the central ray


Structure Shown:
Hip including the acetabulum, proximal end of the
femur, and relationship of the femoral head to the
acetabulum

Evaluation Criteria:
Evidence of proper collimation
Hip joint centered to radiograph
Hip joint, acetabulum, and femoral head
Femoral neck overlapped by the greater trochanter in
the Lauenstein Method
Femoral neck free of superimposition in the Hickey
Method

Axiolateral Position:
Danellus-Miller Method
Often called the Cross-table or Surgical-lateral method

Film Size:
10 x 12 in LW

Body Position:
Supine position

Part Position:
Elevate the pelvis on a firm pillow or folded sheets
sufficiently to center the most prominent point of the greater
trochanter to the midline of the IR (thin patient or who is lying
on a soft bed)
When the pelvis is elevated, support the affected limb at hip
level on sandbags or firm pillows
Flex the knee and hip of the unaffected side to elevate the
thigh in vertical position.
Rest the unaffected leg on a suitable support that does not
interfere with the central ray.
Adjust the pelvis so that it is not rotated.

Unless contraindicated, grasp the heel and medially rotate
the foot and lower limb of the affected side about 15 or 20
degrees. A sandbag may be used to hold the leg and foot in
this position, and a small support can be placed under the
knee. The manipulation of patients with unhealed fractures
should be performed by a physician

Position of IR:
Place the IR in the vertical position with its upper border in the
crease above the iliac crest.
Angle the lower border away from the body until the IR is exactly
parallel with the long axis of the femoral neck.
Support the IR in this position with sandbags or a vertical IR holder.
These are preferred methods. Alternatively, the patient may support
the IR with the hand.
Be careful to position the grid so the lead strips are in the horizontal
position.

Patient Instruction:
Shield gonads
Respiration suspended

Localization Point:


Immobilization Device:
Sandbags

Reference Point:
Mid-thigh

Central Ray:
Perpendicular to the long axis of the femoral neck
Enters at the mid-thigh and passes through the femoral neck about 2
inches below the point of intersection of the localization lines described
previously.


Acetabulum, head, neck, and trochanters of the femur
Structures Shown:

Femoral neck without overlap
from the greater trochanter
Small amount of the lesser
trochanter on the posterior
surface of the femur
Small amount of the greater
trochanter on the anterior and
posterior surfaces of the
proximal femur when the
femur is properly inverted
Soft tissue shadow of the
unaffected thigh not
overlapping the hip joint or
proximal femur
Hip joint with the acetabulum
Any orthopedic appliance in
its entirety
Ischial tuberosity below the
femoral head

Evaluation Criteria: