Lower Extremities Third Part Dr Mohamed El Safwany, MD.

Intended Learning Outcomes The student should be able to understand radiological aspects related to lower limb trauma.

Hip Xray views AP and “frog legs” (abducted) Lateral views hard to interprete Evaluate the relationship of femoral head to the acetabulum Look for cortical discontinuities Look at trabecular pattern

Hip dislocations From M V Accidents Most common posterior dislocation – –On AP - head of femur located superiorly and laterally displaced Anterior dislocation: inferior and medial Look for associated fracture fragments from the acetabulum

Hip dislocation Posterior dislocation: Head of the femur superior and laterally located Anterior dislocation: Head of femur located inferiorly and medially to the acetabulum

Hip Dislocation posterior dislocation

Acetabular Fracture

Pelvic Fracture Pelvic Fracture Open Book fx

Hip fractures Femoral neck - Osteoporotic Unable to walk after a fall Little deformity Intertrochanteric - post traumatic Shorter leg in internal rotation Stress fracture is difficult to detect in elderly Non displaced fracture is better seen MRI Bone scan ( may take several days to show)

Intertrochanteric fracture

Hip Fracture Hip fracture classifications most often are based on their anatomic locations: head, neck, intertrochanteric, trochanteric, and subtrochanteric Hip fracture classifications most often are based on their anatomic locations: head, neck, intertrochanteric, trochanteric, and subtrochanteric

Hip & Proximal Femur Fractures Femoral head fractures –These usually are associated with hip dislocations. Superior femoral head fractures normally are associated with anterior dislocations, while inferior femoral head fractures are associated with posterior dislocations. –Type 1 - Single fragment fractures –Type 2 - Comminuted fractures Femoral neck fractures –Type 1 - Stress fractures or incomplete fractures –Type 2 - Impacted fractures –Type 3 - Partially displaced fractures –Type 4 - Completely displaced or comminuted fractures Intertrochanteric fractures –Type 1 - Single fracture line; no displacement; considered stable –Type 2 - Multiple fracture lines or comminution; displacement; unstable Trochanteric fractures –Type 1 - Nondisplaced fractures –Type 2 - Displaced fracture; greater than 1 mm displacement for greater trochanteric fractures and greater than 2 mm displacement for lesser trochanteric fractures Subtrochanteric fractures –Stable - Bony contact of medial and posterior femoral cortices –Unstable

 Femoral Head Femoral Neck   Intertrochanteric Trochanteric  Trochanteric 

Hip & Proximal Femur fracture Leg is shortened and externally rotated Leg is shortened and externally rotated

Aseptic necrosis hips Xray changes Flattening, irregularity, sclerosis of superior aspect femoral head(late) Early findings on MRI/bone scan Caused by trauma and chronic steroid use

Aseptic necrosis of the hips

X Ray MRI

Slipped Capital Epiphysis Cause unknown Does not occur before age 9 y Overweight teenage male Radiographic diagnosis Thickened epiphyseal plate Medial displacement of the femoral head relative to the femoral neck Lateral and frog leg views used for diagnosis

Slipped Capital Epiphysis

Osgood - Schlatter disease Traumatic tibial lesion in children Avultion fracture of the anterior tibial tuberosity Frequent in active boys participating in sports Pain Age y Heals with rest

Osgood - Schlatter disease

Legg-Perthes disease(aseptic necrosis of the femoral head) Boys more than girls Limp + pain + limited movement of the hip Irregularity, sclerosis and fragmentation of epiphysis Resulting deformity with OA after a few decades

Legg-Perthes disease(aseptic necrosis of the femoral head)

Question State radiographic features of O’sgood Schlatter disease?

Assignments 5 Students will be selected for assignments.

Suggested Readings Sutton’s Radiology

Thank You Thank You