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X-rays:

Hip

Mentor : Dr. dr. Adrian Khu, Sp.OT,


FICS
Presentator : Roni pahlawan
Proximal Femur & Hip:
Injuries
 Fractures:
 Femoral neck, intertrochanteric, femoral
head, greater & lesser trochanter,
subtrochanteric
 Dislocations:
 Anterior, posterior, central, (inferior)
Proximal Femur: Anatomy

Ward’s Triangle
Proximal Femur: Images

 AP
 Internal rotation!

 Lateral
 Cross-table Lateral
 Frog-leg Lateral
Proximal Femur: Images
Cross-table lateral view
* = ischial tuberosity
Proximal Femur:
Fracture Classification
1. Relationship to capsule
 Intracapsular, extracapsular

2. Anatomic location
 Neck, trochanteric, intertrochanteric,
subtrochanteric, shaft

3. Degree of displacement
Proximal Femur:
Approach to the film
1. Shenton’s Line
 Femoral neck #
 Dislocation

2. ‘S’ and ‘Reverse S’ patterns


3. Position of lesser trochanter
 Dislocation

4. Femoral head size


 Dislocation

5. Trace trabecular groups


Left posterior dislocation – note Shenton’s line
Proximal Femur:
Approach to the film

Lowell’s ‘S’ patterns


Impacted femoral neck #
Hip: Dislocations
 Etiology
 Adults: high energy mechanism (MVA)
 Elderly, prosthetic joints, kids < 6yo: minor mech
 Types:
 Posterior >> anterior > central (> inferior)
 Orthopedic emergencies:
 Urgent reduction after ABC’s / stabilization
 Significant neurovascular complications
 Often multiple associated injuries
 Mandate CT post-reduction
Hip: Dislocation imaging

 Plain Films: ant vs. post dislocations


 Femoral head size
Posterior dislocation  femoral head smaller
 Lesser trochanter visibility
Post dislocation  adduction & internal rotation,
lesser trochanter not seen
Ant dislocation  external rotation; lesser
trochanter clearly visible
 CT
 Indicated for more detailed evaluation of
femoral neck, intra-articular #’s, and acetabulm
Anterior dislocation
Posterior dislocation

Lesser trochanter
Proximal Femur: Fractures
 Femoral head fracture:
 Usually 2° to dislocation
 Pipkin classification
 Femoral neck fracture:
 Can be subtle (check lines, ‘S’)
 Describe as nondisplaced (15-20%) vs displaced
 Intertrochanteric fracture:
 High energy or weak bone
 Classify according to number of bone fragments
(e.g. two-part)
Displaced femoral neck fracture
Nondisplaced femoral neck #

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