Session ID =

Pelvis & Lower Limb

Helen KW Law
Assistant Professor
Health Technology & Informatics
FHSS, Hong Kong Polytechnic University
26th Oct., 2016 Week #8
1
Revision
Male pelvic cavity

2
 pubic symphasis

Ultrasonography of the Prostate gland

Urinary
Bladder
longitudinal
view
capsule of prostate gland
Ultrasound is
attenuated by
bones.
A
Ultrasound is
S I reflected by air and
fibrous structures.
P

3
Revision
Female pelvic cavity

Both uterus and vagina are midline structures. [Vagina slopes backward]
Uterus (cervix, body, fundas) bends forward on vagina [anteversion]
Uterine body bends on cervix [anteflexion] 4
Revision
Female reproductive organs

* Site of fertilisation

Check patency of tubes by

Hysterosalpingogram (HSG)

個tube冇block到，去左peritonium
5
 Ultrasound of the ovary (proliferative phase)

S I

P
Urinary many ovum
Bladder

S I

longitudinal view of the ovary 6

 Ultrasound of the uterus (proliferative phase)
A

Urinary S I

Bladder
P

longitudinal
view

Endometrium
Myometrium

7
 Ultrasound of the uterus (secretory phase)

A
Bladder
S I

longitudinal
view

Endometrium
Myometrium 8
Compartmentation of the lower limb

Pelvis

Hip

Thigh - Femur

Knee

Lower Leg – tibia & fibula

Ankle

Foot - calcaneus, toes

9
 Revision
Pelvis

1st turning point

ASIS
AIIS

Ischial spine
Pubic ramus (rami) 10
Revision
Ilium, ischium, pubis (Right)

11
Revision
Male & female bony pelvis

Male Female
Male Female
Shape of inlet heart “ ” oval “ ”
Shape iliac fossa more everted; broader
Ischial spine more inturned less pointed into outlet
subpubic arch acute angle “V” obtuse angle “ ”
dimension of pubic bone wider
12
 rim of pelvic
Iliac
crest X-Ray of the Pelvis F/20 L5

Iliac Sacrum
fossa
space Sacroiliac
joint
ASIS
PSIS
AIIS
Sacral
Femur: foramen
Head (fovea)
Neck
Acetabulum
Greater
Lesser superior Pelvic brim
Trochanter
inferior
Fat stripe
Shaft black line
(radiolucent)
Bladder
Ischium

Ischial spine Pubic rami Pubic symphysis Obturator foramen 13

 Please label
Iliac
crest X-Ray of the Pelvis F/58 L5

Iliac Sacrum
fossa
Sacroiliac
joint
ASIS
PSIS
AIIS
Sacral
Femur: foramen
Head (fovea)
Neck
Acetabulum
Greater
Lesser Pelvic brim
Trochanter
Fat stripe
Shaft trabeculuae(stress line)
⽅方向突轉可能會有fracture
Bladder
Ischium Acetabulum

Ischial spine Pubic rami Pubic symphysis Obturator foramen 14

 Please label
Iliac
crest X-Ray of the Pelvis M/21 L5

Iliac Sacrum
fossa
Sacroiliac
joint
ASIS
AIIS PSIS

Femur: Sacral
Head (fovea) foramen
Neck
Acetabulum
Greater
Lesser
Pelvic brim
Trochanter
Shaft
Ischium Fat stripe
Ischial spine
Bladder
Pubic rami
Gonad Obturator
Pubic
symphysis Shield foramen 15
 Please label
Iliac
crest X-Ray of the Pelvis M/40 L5

Iliac Sacrum
fossa
Sacroiliac
joint
ASIS
AIIS PSIS

Femur: Sacral
Head (fovea) foramen
Neck
Acetabulum
Greater
Lesser
Pelvic brim
Trochanter
Shaft Phlebolith
Ischium Fat stripe
Ischial spine
Bladder
Pubic rami Acetabulum
Gonad Obturator
Pubic
symphysis Shield foramen 16
Revision
Movement at the hip joint

• Flexion and Hyperextension

• Abduction and Adduction
• Lateral and Medial rotation

17
 Revision
Abduction & Adduction of the lower limb

Abduction Adduction

take place at the hip joint 18

Revision
Rotation of the Hip

very slight rotation at the knee 19

Femur

120

Fovea

Ligamentum
teres

Revision

20
 X-ray of the Right hip

Sacrum Acetabulum

Sacroiliac Femur:
joint Head (fovea)
Neck
Sacral
foramen Greater
Lesser
Trochanter

Fat stripe Shaft

Ischium Ischial
Pubic rami spine
Ischial
tuberosity Pubic
symphysis
Obturator
foramen 內則向外照
toes to toes 21
Anteroposterior Lateral
 Please label
X-ray of the Left hip

Sacrum Ischial
spine
Sacroiliac
joint Pubic
symphysis
Sacral
foramen Acetabulum
Femur:
Head
(fovea)
Fat stripe
Neck

Greater
Ischium Lesser
Pubic rami Trochanter
Ischial
tuberosity Shaft
Obturator
foramen calcification
22
Anteroposterior Lateral
Revision
Distal end of femur (right side) anterior

lateral

medial

Articular surfaces at the

femoral condyles

* Note the patellar surface

* 23
Revision
Distal end of femur (right side) posterior

Medial femoral condyle

Intercondylar fossa

Lateral femoral condyle

24
 X-ray of the Femur (thigh)

Fat
stripe
Cortex
LAT
Medulla Inter-
condylar
fossa

Femur:
Head
Neck

Greater
Lesser
Trochanter

Shaft
Femoral epicondyle
Femoral condyle
25
Patella
Revision
Flexion & Hyperextension of the Knee

HEAD
&
NECK

26
 Revision
Femoral & Tibial condyles

patellar
surface

lateral of patella is larger

lateral
tibial medial
condyle tibial
condyle

Tibial Superior
tuberosity tibio-
fibular
joint 27
 X-ray of Both Knees (Anteroposterior)

Femur
Femoral
epicondyle

Femoral
condyle Patella
lateral
tibial
condyle Tibia

Fibular
medial Head
tibial
Superior condyle Fibula
tibio-
fibular Fat stripe
joint Intercondylar eminence
28
 X-ray of Both Knees (Lateral)

lateral
femoral Femur
condyle seasomoid bone(fabella)

anterior+posterior

⽂文字
Patella Tibia
inferior
Infrapatella Fibular
fat pad Head

tibial tuberosity Fibula

Superior tibio-
fibular joint Intercondylar eminence 29
 X-ray of Both Knees (Anteroposterior)

Total Knee
Replacement
Femur
Femoral
epicondyle

Femoral
condyle Patella
lateral
tibial
condyle Tibia

Fibular
medial Head
tibial
Superior condyle Fibula
tibio-
fibular Fat stripe
joint 30
 X-ray of Both Knees (Skyline view)

Patellofemoral
joint
Lateral
medial femoral
femoral condyle
condyle

Intercondylar fossa
Why keeping the patella?

keep ligaments and atriculations

31
 Revision
Knee joint is a synovial joint

femur Patella within the quadriceps tendon

Medial collateral ligament

Lateral
collateral
ligament Patellar ligament inserts into tibial
tuberosity

Note: Quadriceps femoris is a

powerful extensor of the leg at the
knee joint.

32
 Revision
Knee joint cavity

Anterior cruciate Posterior cruciate

ligament ligament

Lateral meniscus Medial meniscus

33
 Revision
Sagittal section of the knee joint

Supra-patellar bursa

Pre-patellar bursa Femur

Cruciate ligaments
are extra-synovial
Fat
Joint capsule
Infra-patellar bursa
Tibia
Meniscus not shown

34
 Tibia & Fibula

(Lower leg)

Superior tibiofibular joints

A synovial plane joint

Revision
Inferior tibiofibular joints
A fibrous joint with negligible
movement

35
 X-ray of the Tibia & Fibula (Lower leg)

Femoral epicondyle
Femoral condyle Tibial tuberosity
Patella
addapted
tubercle

Fibula
Head
Neck

Tibia AP

Growth Plate
fracture line
(Epiphyseal)
LAT
Medial malleolus Talus
Lateral malleolus Calcaneus
36
 Please label
X-ray of the Tibia & Fibula (Lower leg) F/20

Femoral epicondyle
Femoral condyle
Patella
Fibula
Head Tibial tuberosity
Neck

Tibia

AP
Growth Plate
(Epiphyseal)

LAT
Medial malleolus Talus
Calcaneus
Lateral malleolus
Navicular 37
 Revision
Articular surfaces of the ankle joint

fibula

tibia
*

talus

Dorsi-flexion and plantar flexion of

the foot at the ankle joint.

: articular surface lined by hyaline cartilage 38

Revision
Inversion & Eversion of the Ankle

Inversion Eversion

take place at the intertarsal joint

39
Revision
Foot & toes

fused

7
most posterior,
inferior

40
 Ureply (Show ID)

Q.1 Name this bone.

 Ankle joint & Medial collateral (deltoid) ligament

Medial malleolus

Cun. N T
I

C
sustentaculum tali

Medial longitudinal arch of foot:

Calcaneus, Talus, Navicular,
Cuneiform I, II, III
Metatarsal I, II, III Revision
42
Right Ankle joint & Lateral collateral ligament

(lateral view)
Revision

Lateral longitudinal arch:

Calcaneus, Cuboid, Metatarsal IV & V
43
 Revision
Arches of the Foot

Phalanges

Metatarsal I - V
Transverse
arch

N
Lateral longitudinal arch
7 tarsal bones: Cu
• calcaneus (Ca)
• talus (T) T
• navicular (N)
• cuneiform I, II, III
• cuboid (Cu) Ca Medial longitudinal arch
44
Revision
Plantar surface of Right foot

Transverse arch (From medial to lateral):

45
Base of metatarsals, Cuneiform I, II, III, Cuboid
 X-ray of the Ankle

Fibula
Tibia
Fibular
notch

Growth
Plate Talus
Achilles Navicular
tendon Cuniform
cunuform 1
Medial 最離地
malleolus
AP
Trochlea 5th metatarsal
最貼地
Talus
Lateral Cuboid
Navicular malleolus Calcaneus
LAT Calcaneal spur?
46
 X-ray of the Ankle

The radiolucent triangle Fibula

seen posteriorly on lateral
radiographs of the ankle is Fibular
the Kanger Triangle. It is notch
bounded anteriorly by the
flexor hallucis longus Growth
muscle and tendon, Plate Talus
posteriorly by the Achilles Navicular
tendon, and inferiorly by
Cuniform
the calcaneus. It is used for
the diagnosis of Achille’s
tendon rupture.
AP

Lateral Cuboid
malleolus Calcaneus
Sustentaculum tali LAT
45
 Please label
X-ray of the calcaneus (calcaneum) Lateral

Talus
Navicular
Cuniform

Achilles tendon
Cuboid
Fat Pad
Calcaneus
Calcaneal spur?
48
 X-ray of the calcaneus (calcaneum) Axial

Talus
Sustentaculum tali

Lateral
malleolus

Medial Posterior
malleolus tuberosity
http://www.wikiradiography.net/page/Calcaneum+Radiographic+Anatomy 49
 X-ray of the Right Foot
Oblique

Sesamoid
bones

Phalanges

Metatarsals

7 tarsal bones:
• calcaneus (Ca)
• talus (T)
• navicular (N)
• cuneiform I, II, III
• cuboid (Cu)

Dorsiplantar
50
 Please label
X-ray of the Left Foot
Oblique

Sesamoid
bones

Phalanges

Metatarsals

7 tarsal bones:
• calcaneus (Ca)
• talus (T)
• navicular (N)
• cuneiform I, II, III
• cuboid (Cu)

Dorsiplantar
51
 Please label
X-ray of the Toes

Sesamoid
bones

Phalanges

Metatarsals

Dorsiplantar Oblique 52
 Reading List & References

Saladin KS. Human Anatomy (4th edition).

McGraw Hill, 2014
E. Reif. Pocket Atlas of Radiographic
Anatomy (3rd Edition). Thieme Medical
Publisher, 2010.
Martensen KM. Radiographic Image
Analysis (3rd Edition). Saunders
Elsevier, 2011.

+ Other internet resources

53