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JSS Medical College, Mysuru
IMAGING IN HIP DISORDERS
Dr. Sanjana B C
Resident,
JSS Medical College,Mysuru
For more Radiolo...
JSS Medical College, Mysuru
ANATOMY
• Ball and socket type
of Synovial joint
• One of most stable
joints in the body
• Art...
JSS Medical College, Mysuru
JSS Medical College, Mysuru
Movements
& Muscles
• Psoas major
• Iliacus
• Gluteus Maximus
• Hamstring muscles
• Adductor L...
JSS Medical College, Mysuru
FROG LEG LATERAL VIEW
RADIOGRAPHIC VIEWS
AP VIEW
JSS Medical College, Mysuru
JUDET VIEW
JSS Medical College, Mysuru
LINES AND ANGLES OF HIP
KLEIN’S LINE.
AP and frog-leg projections of the hip in slipped femora...
JSS Medical College, Mysuru
Coxa Vara.
Decreased angle
(double-headed
arrow).
Skinner’s Line
FEMORAL ANGLE.
LINES AND ANGL...
JSS Medical College, Mysuru
SHENTON’S LINE.
Hip Dislocation. Note the
interruption in the smooth arc
of Shenton’s line.
LI...
JSS Medical College, Mysuru
Protrusio Acetabuli
The medial displacement
of the acetabulum and
femoral head in relation to
...
JSS Medical College, MysuruFor more Radiology Education
visit www.jssmcradiology.com
ACETABULAR ANGLE. Observe the abnorma...
JSS Medical College, MysuruFor more Radiology Education
visit www.jssmcradiology.com
LINES AND ANGLES OF HIP
JSS Medical College, MysuruFor more Radiology Education
visit www.jssmcradiology.com
TEARDROP DISTANCE
The abnormality is ...
JSS Medical College, Mysuru
DEVELOPMENTAL DYSPLASIA
OF THE HIP
• Congenital or developmental deformation or misalignment o...
JSS Medical College, Mysuru
JSS Medical College, Mysuru
DEVELOPMENTAL DYSPLASIA
OF THE HIP
• On radiography–
Disruption of Shenton’s line and/or
the i...
JSS Medical College, Mysuru
PROXIMAL FOCAL FEMORAL DEFICIENCY
• Proximal focal femoral deficiency (PFFD) - a congenital di...
JSS Medical College, MysuruFor more Radiology Education
visit www.jssmcradiology.com
•SCFE represents a Salter type I
frac...
JSS Medical College, Mysuru
• Frayed metaphyseal margin
• Beaked inferior-medial epiphysis
• Increased teardrop distance
•...
JSS Medical College, Mysuru
LEGG-CALVÉ-PERTHES DISEASE
• An idiopathic avascular necrosis of the proximal femoral
epiphysi...
JSS Medical College, MysuruFor more Radiology Education
visit www.jssmcradiology.com
• MRI excellent for early detection a...
JSS Medical College, Mysuru
CATTERALL CLASSIFICATION
JSS Medical College, Mysuru
TRANSIENT SYNOVITIS
• An aseptic inflammation of the hip, presumably of post viral etiology.
•...
JSS Medical College, Mysuru
• Septic joint occurs most commonly from pyogenic infection and may result
from haematogenous ...
JSS Medical College, Mysuru
ACETABULAR FRACTURES
• Signs of capsular distension.
• widening of the teardrop space, and dis...
JSS Medical College, Mysuru
JSS Medical College, Mysuru
FEMORAL HEAD FRACTURE
JSS Medical College, Mysuru
POSTERIOR DISLOCATION
• Most commonly caused by impact of
dashboard on knee.
• Hip flexed, int...
JSS Medical College, Mysuru
ANTERIOR DISLOCATION
• Extreme external rotation, less-pronounced abduction and
flexion.
X-ray...
JSS Medical College, Mysuru
AVASCULAR NECROSIS
NECROSISAVASCULAR NECROSIS
• Most commonly seen on
anterolateral aspect
• C...
JSS Medical College, Mysuru
AVASCULAR NECROSIS
Femoral head AVN represents ischemic injury of femoral head.
The Ficat clas...
JSS Medical College, Mysuru
JSS Medical College, Mysuru
• MRI –
focal lesion in the anterosuperior portion of femoral head that
is well demarcated but...
JSS Medical College, Mysuru
JSS Medical College, Mysuru
JSS Medical College, Mysuru
FEMOROACETABULAR IMPINGEMENT
• The theory behind femoroacetabular impingement is that certain
...
JSS Medical College, Mysuru
Laterally prominent femoral head margins create femoral head asphericity bilaterally.
The supe...
JSS Medical College, Mysuru
HERNIATION PIT OF THE FEMORAL NECK
• The majority of these lesions are
asymptomatic, though la...
JSS Medical College, Mysuru
Thin-section CT - subcortical cyst with a thin sclerotic border
but may demonstrate defects in...
JSS Medical College, Mysuru
Thank You
For more Radiology Education visit
www.jssmcradiology.com
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Imaging in hip disorders

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The presentation covers the comprehensive Imaging of common hip Disorders

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Imaging in hip disorders

  1. 1. JSS Medical College, Mysuru IMAGING IN HIP DISORDERS Dr. Sanjana B C Resident, JSS Medical College,Mysuru For more Radiology Education visit www.jssmcradiology.com
  2. 2. JSS Medical College, Mysuru ANATOMY • Ball and socket type of Synovial joint • One of most stable joints in the body • Articulation between acetabulum and femoral head.
  3. 3. JSS Medical College, Mysuru
  4. 4. JSS Medical College, Mysuru Movements & Muscles • Psoas major • Iliacus • Gluteus Maximus • Hamstring muscles • Adductor Longus, Brevis, Magnus • Gluteus Minimus and Medius • Tensor Fascia Lata, gluteus Medius and Minimus • Two Obturators ,two Gamelli & Quadratus femoris. FLEXION EXTENSION ADDUCTION ABDUCTION MEDIAL ROTATION LATERAL ROTATION
  5. 5. JSS Medical College, Mysuru FROG LEG LATERAL VIEW RADIOGRAPHIC VIEWS AP VIEW
  6. 6. JSS Medical College, Mysuru JUDET VIEW
  7. 7. JSS Medical College, Mysuru LINES AND ANGLES OF HIP KLEIN’S LINE. AP and frog-leg projections of the hip in slipped femoral capital epiphysis. Note the lack of overlap across the line by the femoral head.
  8. 8. JSS Medical College, Mysuru Coxa Vara. Decreased angle (double-headed arrow). Skinner’s Line FEMORAL ANGLE. LINES AND ANGLES OF HIP
  9. 9. JSS Medical College, Mysuru SHENTON’S LINE. Hip Dislocation. Note the interruption in the smooth arc of Shenton’s line. LINES AND ANGLES OF HIP
  10. 10. JSS Medical College, Mysuru Protrusio Acetabuli The medial displacement of the acetabulum and femoral head in relation to the line. LINES AND ANGLES OF HIP
  11. 11. JSS Medical College, MysuruFor more Radiology Education visit www.jssmcradiology.com ACETABULAR ANGLE. Observe the abnormally wide angle (double-headed arrows) on the left in association with congenital hip dislocation. SYMPHYSIS PUBIS WIDTH- traumatic diastasis. LINES AND ANGLES OF HIP
  12. 12. JSS Medical College, MysuruFor more Radiology Education visit www.jssmcradiology.com LINES AND ANGLES OF HIP
  13. 13. JSS Medical College, MysuruFor more Radiology Education visit www.jssmcradiology.com TEARDROP DISTANCE The abnormality is the result of early Legg- Calvé-Perthes disease. Observe the crescent sign in the femoral capital epiphysis (thick arrow). LINES AND ANGLES OF HIP
  14. 14. JSS Medical College, Mysuru DEVELOPMENTAL DYSPLASIA OF THE HIP • Congenital or developmental deformation or misalignment of the hip joint.
  15. 15. JSS Medical College, Mysuru
  16. 16. JSS Medical College, Mysuru DEVELOPMENTAL DYSPLASIA OF THE HIP • On radiography– Disruption of Shenton’s line and/or the iliofemoral line. • CT arthrography with intra- articular contrast to assess the attempted concentric positioning of the head within the acetabulum. • MRI is employed in adult DDH to assess for avascular necrosis and for presurgical planning. Small hypoplastic femoral capital epiphysis, lateral and superior subluxation of the femoral head, and a shallow acetabulum (Putti’s triad ).
  17. 17. JSS Medical College, Mysuru PROXIMAL FOCAL FEMORAL DEFICIENCY • Proximal focal femoral deficiency (PFFD) - a congenital disorder characterized by varying severity of shortening and dysplasia of the femur and acetabulum, and varus angulation of the proximal femur. Classification system : -In type A, the femur is shortened compared with the normal size, but the femoral head is present and located within the acetabulum. -In type B, the femur is short with a varus angulation, and there is a gap between the femoral head, which is located within the acetabulum, and the femoral neck. -In type C, the femoral head is rudimentary or absent. The femur is markedly short, and the acetabulum is dysplastic. -In type D, the entire femur is rudimentary, with absent femoral head and acetabulum.
  18. 18. JSS Medical College, MysuruFor more Radiology Education visit www.jssmcradiology.com •SCFE represents a Salter type I fracture, through the physis, resulting in the femoral head “slipping” inferomedially with respect to the femoral neck. SLIPPED CAPITAL FEMORAL EPIPHYSIS •Onset of a limp accompanied by hip pain referred to knee in an obese adolescent boy.
  19. 19. JSS Medical College, Mysuru • Frayed metaphyseal margin • Beaked inferior-medial epiphysis • Increased teardrop distance • Medial buttressing on the femoral neck • Lateral buttressing on the femoral neck (Herndon’s hump) • Curved contour of deformed proximal femur (pistol-grip deformity)
  20. 20. JSS Medical College, Mysuru LEGG-CALVÉ-PERTHES DISEASE • An idiopathic avascular necrosis of the proximal femoral epiphysis and occurs in the 3- to 12-year age group; 5:1 male predominance. STAGE I: EARLY asymmetric femoral epiphyseal size (smaller on affected side) apparent increased density of the femoral head epiphysis widening of the medial joint space blurring of the physeal plate radiolucency of the proximal metaphysis STAGE II: FRAGMENTATION subchondral lucency femoral epiphysis fragments femoral head outline is difficult to make out mottled density thickened trabeculae STAGE III: REPARATIVE re-ossification begins shape of the femoral head becomes better defined bone density begins to return STAGE IV: HEALED changes depend on severity the femoral head may be nearly normal or may demonstrate flattening of the articular surface, especially superiorly widening of the head and neck of the femur
  21. 21. JSS Medical College, MysuruFor more Radiology Education visit www.jssmcradiology.com • MRI excellent for early detection and identifying status of articular cartilage. Diminished bright signal of marrow fat following loss of normal ciculation and thickening of non ossified femoral cartilage and acetabular labrum. • Coronal T1-weighted spin-echo MR image shows flattening and fragmentation of left proximal femoral ossific nucleus (arrowheads) as well as mild loss of containment. All ossific fragments show abnormal signal hypointensity. • Isotopic scans cold in early phase before plain film changes.
  22. 22. JSS Medical College, Mysuru CATTERALL CLASSIFICATION
  23. 23. JSS Medical College, Mysuru TRANSIENT SYNOVITIS • An aseptic inflammation of the hip, presumably of post viral etiology. • It is the most common cause of hip pain or a limp in children under the age of ten years. • The condition is self-limiting and treated with rest and analgesics. • Ultrasound - presence of a joint effusion.
  24. 24. JSS Medical College, Mysuru • Septic joint occurs most commonly from pyogenic infection and may result from haematogenous dissemination, contiguous spread of infection from local tissues, direct inoculation, or contamination at surgery. SEPTIC ARTHRITIS • Radio graphically with increased teardrop distance or elevation of the gluteus minimus fat stripe. • Sub acute or chronic infections demonstrate bone erosions, loss of joint space and areas of avascular necrosis. • MRI is sensitive and more specific for early cartilaginous damage T1: low signal within subchondral bone T2: perisynovial edema C+ (Gd): synovial enhancement For more Radiology Education visit www.jssmcradiology.com
  25. 25. JSS Medical College, Mysuru ACETABULAR FRACTURES • Signs of capsular distension. • widening of the teardrop space, and distorted fascial planes of the psoas and gluteus medius muscles. • obturator internus sign. • Approximately 20% of all pelvic fractures in adults involve the acetabulum. • Almost all acetabular fractures are the result of indirect injury (injury to the foot, knee, or greater trochanter of the femur).
  26. 26. JSS Medical College, Mysuru
  27. 27. JSS Medical College, Mysuru FEMORAL HEAD FRACTURE
  28. 28. JSS Medical College, Mysuru POSTERIOR DISLOCATION • Most commonly caused by impact of dashboard on knee. • Hip flexed, internally rotated, adducted. • X Ray - femoral head is usually displaced posterior, superior, and slightly lateral to the acetabulum and also internally rotated hence the lesser trochanter is usually obscured on AP view. • Generally results from axial load applied to femur, while hip is flexed.
  29. 29. JSS Medical College, Mysuru ANTERIOR DISLOCATION • Extreme external rotation, less-pronounced abduction and flexion. X-ray signs – • The lesser trochanter being more visible due to external rotation. • The hip is abducted and the femur head is usually inferior to the acetabulum. • Shenton's line is also broken.
  30. 30. JSS Medical College, Mysuru AVASCULAR NECROSIS NECROSISAVASCULAR NECROSIS • Most commonly seen on anterolateral aspect • Causes – trauma, fat embolism, caissons disease, alcoholism, steroid therapy, collagen vascular diseases
  31. 31. JSS Medical College, Mysuru AVASCULAR NECROSIS Femoral head AVN represents ischemic injury of femoral head. The Ficat classification : stage 0 plain radiograph: normal MRI: normal clinical symptoms: nil stage I plain radiograph: normal or minor osteopaenia MRI: oedema bone scan: increased uptake clinical symptoms: pain typically in the groin stage II plain radiograph: mixed osteopenia and/or sclerosis and/or subchondral cysts, without any subchondral lucency (crescent sign: see below) MRI: geographic defect bone scan: increased uptake clinical symptoms: pain and stiffness stage III plain radiograph: crescent sign and eventual cortical collapse MRI: same as plain film clinical symptoms: pain and stiffness+/- radiation to knee and limp stage IV plain radiograph: end stage with evidence of secondary degenerative change MRI: same as plain radiograph clinical symptoms: pain and limp
  32. 32. JSS Medical College, Mysuru
  33. 33. JSS Medical College, Mysuru • MRI – focal lesion in the anterosuperior portion of femoral head that is well demarcated but is inhomogeneous T1- low signal intensity T2- double line sign, made of two concentric low signal intensity bands with central hyperintense line which may represent hypervascular granulation tissue.
  34. 34. JSS Medical College, Mysuru
  35. 35. JSS Medical College, Mysuru
  36. 36. JSS Medical College, Mysuru FEMOROACETABULAR IMPINGEMENT • The theory behind femoroacetabular impingement is that certain anatomic variations lead to impingement between the proximal femur and acetabular rim with flexion and internal rotation. • Two types- Cam type Pincer type
  37. 37. JSS Medical College, Mysuru Laterally prominent femoral head margins create femoral head asphericity bilaterally. The superior portions of the acetabular labra are partially detached bilaterally
  38. 38. JSS Medical College, Mysuru HERNIATION PIT OF THE FEMORAL NECK • The majority of these lesions are asymptomatic, though larger lesions, especially in runners, have been linked with hip symptoms It represents a herniation of synovium or soft tissues into the bone through a cortical defect, hence the alternate name synovial herniation pit Radiologic Features- a discrete, sharply marginated geographic lesion at the antero-superior aspect of the femoral neck.
  39. 39. JSS Medical College, Mysuru Thin-section CT - subcortical cyst with a thin sclerotic border but may demonstrate defects in the cortical surface. Hounsfield values vary from 30 to 50 HU with no significant contrast enhancement. MRI shows features consistent with fluid (high signal on T2- and intermediate on T1-weighted images.)
  40. 40. JSS Medical College, Mysuru Thank You For more Radiology Education visit www.jssmcradiology.com

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