![]() The gluteal fat stripe is represented by a line parallel to the upper part of neck of the femur. Fat planes: visible on AP plain radiograph ( Figs. The femoral neck appears shorter and discontinuous in displaced fracture. The femoral head and neck should be continuous. Posteroinferior migration of the femoral head on the lateral view indicates posterior dislocation. The ischial tuberosity is posterior and aids in orienting the image. Note the acute pubic angle and flared iliac crests. Note the more obtuse pubic angle and broad iliac crests. 3.6 Anteroposterior plain radiograph comparing female and male pelvis. 3.4 Anteroposterior plain radiograph of the pediatric hip. 3.7):Ĭross-table view: this view provides visualization of the anterior and posterior aspects of the femoral neck, and the lateral aspect of the femoral head and the proximal femur.įemoral head, neck, and shaft greater and lower trochanters and ischial tuberosity should be visible on the lateral view. The iliac crests appear flared in males and broad in females. The pubic angle is obtuse in females and acute in males. Two main features help distinguish male and female pelvis ( Fig. Knowledge of the patient’s age is important in order to differentiate open epiphysis from fractures. The pelvic bones are not fused and appear separated on radiographs. 1, sacral arcuate lines 2, iliopectineal line 3, ilioischial line 4, Shenton’s line.Īssessment is done on AP and frog-leg lateral views of both pelvis ( Figs. 3.3 Pelvic lines on anteroposterior plain radiograph. The greater and lesser trochanters should be clearly visible and symmetric on both sides. The cortex of the femoral head and neck should be smooth and continuous with a normal trabecular pattern. ![]() A discontinuation of this line may indicate femoral neck fracture. Shenton’s line: this line is drawn from the inferomedial neck of the femur to the inferior border of the superior ramus ( Fig. Asymmetry of the teardrop sign may indicate occult acetabular fracture. Teardrop sign should be assessed: it marks the convergence of the pubis, the ischium, and the ilium. Location of the femoral head medial to the pectineal line indicates acetabular bone loss or possible medial femoral head migration in the acetabulum. On each side, the line is drawn from the medial border of the iliac wing to the medial border of the ischium, ending at the ischial tuberosity ( Fig. Ilioischial line: this line represents the posterior column. Disruption indicates anterior column fracture ( Fig. It divides the pelvis into major (false) and minor (true) pelvis. Iliopectineal line: this line extends posteriorly from the sacral promontory, arcuate line, and ends anteriorly at the pectineal line. Positive crossover sign indicates presence of femoroacetabular impingement or developmental dysplasia of the hip. In acetabular retroversion, anterior and posterior walls cross each other. The acetabular walls: the posterior wall should be lateral to the anterior wall. The obturator foramen should be symmetric bilaterally. ![]() Iliac crests should both be on the same level. Arcuate lines should be symmetrical angular lines indicate sacral fracture. Sclerosis and joint space narrowing characterize sacroiliitis. Normal sacroiliac joint appears as a thin white line. The sacroiliac joint widths should be equal. The symphyseal joint space should be ≤ 5 mm. The pubic symphysis should be in line with the center of the sacrum. 1, coccyx 2, pubic symphysis 3, sacrum 4, sacroiliac joint 5, iliac crests 6, obturator foramen 7, acetabular sourcil 8, teardrop 9, superior pubic ramus 10, inferior pubic ramus 11, ischial ramus 12, ala of ilium 13, fifth lumbar vertebrae 14, fourth lumbar vertebrae 16, lesser trochanter 17, greater trochanter. 1, the fifth lumbar vertebrae 2, sacrum 3, iliac crest 4, ilium 5, anterosuperior iliac spine 6, anteroinferior iliac spine 7, acetabulum 8, superior pubic ramus 9, obturator foramen 10, ischial tuberosity 11, pubic symphysis 12, fovea 13, lesser trochanter 14, shaft of femur 15, greater trochanter 16, intertrochanteric crest 17, neck of femur 18, head of femur 19, posteroinferior iliac spine. 3.1 Plain radiograph of the hip and pelvis (anteroposterior view). Distance of 3 to 5 cm is considered normal. Neutral alignment of the hip and pelvis is confirmed by measuring the distance from the sacrococcygeal junction to the superior symphysis pubis. Important landmarks are as follow: iliopectineal line, ilioischial line of Kohler, Shenton’s line, sourcil, teardrop sign, and acetabular floor. Alignment is evaluated by visualization of symmetry. Specialized views: frog-leg lateral, anterior and posterior oblique (Judet’s views), false profile, Ferguson’s view (pelvic outlet), and the pelvic inlet view. Routine: anteroposterior (AP) and lateral views. ![]()
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