2. Right v left example -
Pelvis and hips
Right v left example -
Pelvis and hips
• This image of the pelvis
shows subtle
irregularity of the
cortical outline of the
right femoral neck
• Comparison with the
other side - which is
asymptomatic -
increases confidence of
a genuine abnormality
• There is also loss of the
normal trabecular
pattern indicating a
fracture (#) 2
3. Clinical information
•Right groin pain after
a fall
•Shortened and
externally rotated right
leg
Diagnosis
•Fractured neck of
right femur
3
5. • Shenton's line is
formed by the
medial edge of the
femoral neck and
the inferior edge of
the superior pubic
ramus
• Loss of contour of
Shenton's line is a
sign of a fractured
neck of femur
• IMPORTANT NOTE:
Fractures of the
femoral neck do not
always cause loss
of Shenton's line
5
7. • The cortex of the
proximal femur is
intact
• The Lateral view is
often not so clear
because those with
hip pain find the
positioning required
difficult
7
9. • The capsule
envelopes the
femoral head and
neck
• Subcapital,
transcervical and
basicervical
fractures are
intracapsular hip
injuries
• Intertrochanteric
and subtrochanteric
fractures do not
involve the neck of
femur
9
11. • Shenton's line is
disrupted
• Increased density of
the femoral neck is
due to overlapping -
impacted bone
• The lesser
trochanter is more
prominent than
usual - due to
external rotation of
the femur
11
15. `
• I - Incomplete or
impacted bone injury
with valgus
angulation of the
distal component
• II - Complete (across
whole neck) -
undisplaced
• III - Complete -
partially displaced
• IV - Complete - totally
displaced
15
19. • A fracture line runs
between the
trochanters
• There is
comminution with
separation of the
lesser trochanter
• Note the fracture
does not involve the
femoral neck
19
21. • This fracture passes
distal to the
trochanters
• The femoral neck
remains intact
21
22. Hip dislocation
• (dislocation of the femoral
head from the acetabulum)
is most frequent following
total hip replacement
(THR). Dislocation is usually
in a posterior direction
which clinically leads to leg
shortening, with flexion and
internal rotation at the hip
(note - hip fractures usually
cause external rotation).
• may be accompanied by
fracture of the
acetabulum, or
significant soft tissue
injuries not visible with
X-ray.
22
23. • The femoral head
lies superior and
lateral to the
acetabulum
• No associated
fracture is visible in
this case but
significant soft
tissue injury is likely
23
27. • Spiral fracture with
posterior angulation,
lateral displacement
and shortening
• There is rotation of the
distal femur so the
knee faces laterally
• X-rays of the proximal
femur (not shown) did
not reveal further
injury
• Injury occurred in a
road traffic crash
27
29. Transverse fracture with
rotational displacement
and shortening
Patient with known
history of widespread
bone metastases - note
the abnormal bone
texture
Injury occurred after a
trivial fall
29
33. • This x-ray showing the
cartilage ( hyaline ) ,
meniscus and joint soft
tissue.
• We can not specific any
abnormality for knee
components unless we
request MRI for the
patient.
33
41. • The Horizontal Beam
Lateral view is useful
for assessing soft
tissues as well as bones
• The quadriceps and
patellar tendons are
visible
• Note the normal
suprapatellar pouch
between fat pads
above the patella
(asterisks) - widening
of these fat pads or
increased density in
this area can indicate a
knee joint effusion
41
43. • Not usually indicated in
the context of trauma
• More helpful to assess
knee pain due to
suspected
patellofemoral
compartment
osteoarthritis
• Normal patellofemoral
compartment spacing
(arrowheads)
43
55. • The patella is bipartite
(in 2 parts) - a common
normal variant
• Note: Injury to the
interface of the 2
components is possible
which may be
symptomati
55
57. • Comminuted fractures
of the tibial and fibular
shafts with medial
displacement and
posterior angulation
• X-rays of the distal end
of the bones (not
shown) did not reveal
further injury
57
59. • Periosteal stress
reaction are signs of
stress injury (often not
present on the initial X-
ray)
• History of chronic pain
worsened by activity
59
65. • The weight-bearing
portion is formed by
the tibial plafond and
the talar dome
• The joint extends into
the 'lateral gutter' (1)
and the 'medial gutter'
(2)
• The joint is evenly
spaced throughout
65
71. • Soft tissue swelling
laterally (asterisks)
• Transverse fracture of
fibular tip (Weber A)
• The ankle joint remains
aligned normally
• Weber A = Distal
to ankle joint (this case)
• Weber B = At level
of ankle joint
• Weber C = Proximal
to ankle joint
71
73. • Transverse medial
malleolus fracture
• Lateral malleolus
fracture - at level
of ankle joint (WeberB)
• Joint widened medially
due to lateral
displacement of the
talus
73
75. 1 - Medial malleolus fracture
2 - Lateral malleolus fracture -
proximal to the ankle and
extending up the fibula (Weber
C fracture)
3 - Posterior malleolus fracture
• The joint is unstable and
widened anteriorly
(arrowheads) and at the
distal tibiofibular
syndesmosis (asterisk)
• The talus is displaced
posteriorly and laterally
along with the medial and
lateral malleolus bone
fragments
75
77. • 1 - Disruption of the
medial ankle joint with
small bone avulsion
• 2 - Disruption of the
distal tibio-fibular
syndesmosis
• No fibular fracture is
visible at the ankle
raising the suspicion of
a proximal fibular
fracture
77
87. • Flattening of Bohler's
angle (18° in this case)
• Depression of the
articular surface of the
posterior subtalar joint
(red line) from its
normal position (green
line)
• Fracture lines can be
seen passing through
the calcaneus
87
93. Metatarsals and phalanges
of the toes are numbered 1
to 5
1 = Big toe
5 = Little toe
MC = Medial Cuneiform
IC = Intermediate
Cuneiform
LC = Lateral Cuneiform
93
95. MTPJ = Metatarsophalangeal
Joints
IPJ = Interphalangeal Joint
(of big toe only)
PIPJ = Proximal
Interphalangeal Joints
DIPJ = Distal Interphalangeal
Joints
Note the medial side
sesamoid is 'bipartite' (in 2
parts) - this is a common
normal variant - not a
fracture
95
97. • DP - Normal alignment
of the 2nd Metatarsal
with the Intermediate
Cuneiform
• Oblique - Normal
alignment of the 3rd
Metatarsal with the
Lateral Cuneiform
• Position of the Lisfranc
Ligament shown
97
99. • Second metatarsal
displaced from the
intermediate
cuneiform
• No fracture is visible
but this is a severe
injury which is
debilitating if
untreated
• Note: Lisfranc ligament
injury can be subtle
and does not always
result in displacement -
If there is a clinically
suspected ligament
injury then clinical and
radiological follow-up
must be arranged
99
103. • Left image - The
fracture line passes
transversely across the
bone
• Right image - A normal
unfused 5th metatarsal
base apophysis is
aligned more
longitudinally along
the bone
103
105. • Subtle periosteal stress
reaction of the 2nd
metatarsal
• History of chronic pain
worsened by activity
• Note: Stress fractures
are not always visible
on the initial X-ray - if
suspected repeat X-ray
or MRI may be
required
105
