The value for patients under 3 years must be 0 and in older children this ranges from 0 to 22%. We can measure the lateral displacement of the femoral head with regard to the Perkin line by dividing the width of the head that crosses the Perkin line by the diameter of the head. This leads to four quadrants and a normal femoral head has to be located in the inferomedial quadrant.
(A) Hilgenreiner line, connects the inferior tips of the iliac bones, at the triradiate cartilage.The most useful lines and angles that can be drawn in the pediatric pelvis assessing hip dysplasia are as follows: The range of normal values is from 90 to 135° and is related to the infant’s age. Lines are drawn from the highest point of the ischium to the most prominent point of the symphysis, joining at the inside of the pelvis. Symphysis os-ischium angle (of Tönnis): This evaluates the pelvic position in the sagittal plane.In neutral rotation the ratio is 1 but is considered to be acceptable when it is between 0.56 and 1.8. Obturator foramen diameter ratio (of Tönnis): A quotient of pelvic rotation by dividing the horizontal diameter of the obturator foramen of the right side and that of the left.Reliability of measurements increases if indicators of pelvic alignment are taken into account: Unfortunately the time the joint gives a good x-ray image is also the point at which nonsurgical treatment methods cease to give good results.Ĭhildren Image quality checking Image quality checking. When the infant is around 3 months old a clear roentgenographic image can be achieved. Ultrasound imaging yields better results defining the anatomy until the cartilage is ossified. PMID 26224834.X-rays of hip dysplasia are one of the two main methods of medical imaging to diagnose hip dysplasia, the other one being medical ultrasonography. The ongoing relevance of acetabular fracture classification. Hutt JR, Ortega-Briones A, Daurka JS et-al.Plain Radiography of the Hip: A Review of Radiographic Techniques and Image Features. ABC of Emergency Radiology, Third Edition. Emergency Department Evaluation and treatment of Acute Hip pain. Academic Radiology, Vol 25, No 10, October 2018. The views and needs of program directors. Radiology Education in Medical School and Residency. Want a more in-depth review? Check out Taming the Sru, Startradiology, or, all of which have excellent reviews of the pelvic x-ray.ĭealing with polytrauma? Check out EMRad’s approach to the wrist, foot, elbow, shoulder, ankle, or knee. The lateral radiograph should include the acetabulum, ischial spine and tuberosity, and proximal femur.įigure 12: Judet view.The patient’s legs should be internally rotated to maximize visualization of the femur anatomy.The AP radiograph of the pelvis should include the whole pelvis, proximal 3rd of the femur, and the lumbar spinous processes, coccyx, and pubic symphysis in a straight line.Require minimal movement of the affected painful hip.For trauma: “Cross Table Lateral” or “Horizontal Beam Lateral” has these views.
There are multiple ways to perform the “lateral view”.A standard “hip series” consists of the AP view of the pelvis and a lateral view of the affected extremity.2 visits: Bring patient back for repeat filmsĪn approach to the traumatic adult hip x-ray.2 occasions: Always compare with old x-rays if available.2 sides: If unsure regarding a potential pathologic finding, compare to another side.2 joints: Image above and below the injury.2 abnormalities: If you see one abnormality, look for another.MRI hip protocols can be done in as little as 5-15 minutes.īefore we begin: Make sure to employ the rule of 2’s Consider MRI for patients with significant hip pain and negative x-rays. 2% of occult hip fractures will be missed by CT.Compared with CT, pelvic radiographs have a sensitivity of 64% to 78% for the identification of pelvic fractures in blunt trauma.Hip fractures have a very high one-year mortality.Hip and thigh pain are common complaints in the ED.Why the hip matters and the radiology rule of 2’s The Hip Identify clinical scenarios in which an additional view might improve pathology diagnosis.Interpret traumatic hip x-rays using a standard approach.When applicable, it will provide pertinent measurements specific to management, and offer a framework for when to get an additional view, if appropriate. This is EMRad, a series aimed at providing “just in time” approaches to commonly ordered radiology studies in the emergency department.