Radiological anatomy of lower limb

1. Radiological anatomy of
the lower limb
All the information, including the images and pics
collected from different sources is strictly for teaching
purposes only.
G R N 1

2. Learning objectives
1. Show the bones and their parts in the
radiographs of lower limb
2. Explain the related applied anatomy
G R N 2

3. G R N 3

4. G R N 4

5. Anteroposterior radiograph of an adult female pelvis. 1. Sacral promontory. 2.
Sacroiliac joint. 3. Margin of anterior sacral foramen. 4. Pelvic brim. 5. Fovea
of femoral head. 6. Obturator groove. 7. Gas in pelvic colon. 8. Sacral spines.
9. Coccyx. 10. Symphysis pubis.
G R N 5

6. G R N 6

7. Shenton’s line- Radiologically seen
Shenton’s line is an imaginary
curved line drawn along the inferior
border of the superior pubic ramus
(superior border of the obturator
foramen) and along the
inferomedial border of the neck
of femur.
This line
should be continuous and smooth.
Interruption of the Shenton line can
indicate :
• fractured neck of femur
• developmental dysplasia of the hip
(DDH)
G R N 7

8. FRACTURE FEMUR
# NECK OF FEMUR INTERTROCHANTERIC #
INTERNAL # FIXATION G R N 8

9. • Subcapital (avascular necrosis most
common)
FRACTURE NECK
OF THE FEMUR
Intracapsular-
Extracapsular-
G R N 9

10. Comminuted fracture of the left femur
anterior view (B) and lateral view (C).
G R N 10

11. AQUIRED DISLOCATION
• Posterior(most common)
• Joint flexed, adducted, medially rotated –
• Traumatic- Car dashboard strike-Femoral head
forced out of acetabulum ,capsule tear is
posterioinferiorly.
G R N 11

12. CONGENITAL DISLOCATION
•Loose joint capsule
• Hypoplastic head
• Externally rotated
short limb
• Inability to abduct
•Assymmetry of skin folds
of thigh
G R N 12

13. PERTHES DISEASE
•Destruction,flattening of
head of femur
•Increased joint space
G R N 13

14. HEMI-ARTHROPLASTY & TOTAL
ARTHROPLASTY OF HIP JOINT
G R N 14

15. G R N 15

16. skyline Merchant view of the Knee joint is a superior-inferior projection of the patella. It is
one of many different methods to obtain an axial projection of the patella.. Note the patellar
fracture in the second radiograph.
G R N 16

17. Anteroposterior (A) and lateral (B) radiographs of the knee in a boy aged 14 years.
1. Patella. 2. Cartilaginous growth plates. 3. Intercondylar eminence. 4.
Prolongation of proximal tibial epiphysis and growth plate forming the tibial
tuberosity. G R N 17

18. G R N 18

19. Talocrural
Joint(Ankle joint)
• Talocrural (ankle) Joint- formed between
the tibia, fibula, and talus.
G R N 19

20. G R N 20

21. G R N 21

22. Ankle radiograph- anterior view
1, Tibia.
2, Medial Malleolus.
3, Fibula.
4, Lateral Malleolus.
5, Talus.
6. 1st Metatarsal
G R N 22

23. Ankle radiograph-lateral view
3, Talus.
4, Calcaneus.
5, Navicular Bone.
6, Cuneiform Bone.
7, Cuboid Bone.
G R N 23

24. The mortise view(where the rotated internally 15° to 20°) is the most
pertinent projection for assessing the articulation of the tibial plafond and
two malleoli with the talar dome G R N 24

25. Ankle #s
Fracture dislocation of the ankle - fracture of the medial malleolus and
lateral malleolus
G R N 25

26. Fibular fracture
Left ankle radiograph through the cast material shows a non- displaced
spiral distal fibular shaft fracture.
G R N 26

27. Pilon(=Pestle) fractures or
Tibial plafond fractures
Tibial plafond fractures that involve many fragments and enter the ankle joint
are best treated with a combination of plates and screws in the fibula, screws in
the tibia, and an external fixator spanning the fracture site for about 3 months.
G R N 27

28. G R N
28

29. Maisonneuve Fracture- is a spiral fracture of the proximal third of
the fibula associated with a tear of the distal tibiofibular syndesmosis and
the interosseous membrane. There is an associated fracture of the medial
malleolus or rupture of the deep part of deltoid ligament.
G R N
29

30. Syndesmosis Injury
Mortise widening(
Tib-Fib Syndesmosis
Injuries)
G R N
30

31. Tib/Fib Clear
Space
should be < 5mm
Medial Clear
Space
should be < 5mm
Mortise View is important
If not….SCREW IT!
G R N
31

32. Ankle Radiographs
AP Lateral Mortise
G R N
32

33. The anteroposterior(dorsoplantar)
radiograph of the foot is obtained
with the patient supine and the knee
flexed so that the sole of the foot rests
on the table.
Lateral radiograph of the foot
G R N
33

34. Jones Fracture
• Fracture to the
diaphysis at the base
of the 5th metatarsal
• Repetitive stress,
direct force, or
inversion and PF of
foot
• Healing slow; high
nonunion rate
G R N 34

35. 5th MT Shaft Fracture
G R N 35

36. Tarsometatarsal articulations
(also known as the "Lisfranc joint”) LISFRANC INJURY
G R N
36

37. LISFRANC INJURY
G R N
37

38. Calcaneal fracture (lover’s fracture)
G R N
38

39. Boehler’s angle or calcaneal angle is the angle between two lines drawn tangent to
the anterior and posterior aspects of the superior surface of calcaneus on the lateral
radiograph.
The normal value for this angle is between 20° to 40°. A value less than 20° can be
seen in calcaneal fracture.
G R N
39

40. THANK YOU
G R N 40