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Reasons not to try relocation of hips…

April 7, 2014

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Dislocated hip

On this pelvis Xray you can see two hip replacements, the left one is dislocated.  If you look closely you can also see a fracture line just superior to the prosthesis near the greater trochanter.  Be careful reducing these without obtaining orthopedics input. 

The other prosthesis is interesting.  It is a hip replacement with a constrained acetabular liner.  You can see a radioopaque ring around the femoral head component of the arthroplasty.  This is a ring that functions to hold the hip in place.  If this dislocates (not in this case), then this requires open surgical intervention for relocation.  Don’t try to put one of these back in!

Image Contributor:  Hollis “Tag” Hopkins, MD

Author:  Russell Jones, MD

References

1.  THR: Constrained Acetabular Liners.  http://www.wheelessonline.com/ortho/12698

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Hip pain after a fall…

November 12, 2013

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Middle-aged male presents with hip pain after a fall:

Hip pain

This is a pathologic fracture.  CT showed a 12 inch tumor found infiltrating the right pelvic structures.  The pelvis xray shows that his distal femur has displaced through the acetabulum and you can see there is ill-defined destruction of the inferior pubic ramus.  He has contrast in the bladder from a prior CT at a transferring institution.  What is your differential diagnosis for this Xray?

Author:  Russell Jones, MD

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Imaging for acetabular fractures…

March 10, 2013

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This gentleman was in a trauma and sustained an acetabular fracture.  Here is a standard AP pelvis, “Judet” view, CT with bone windows, and a CT 3-dimensional reconstruction image.  On the plain films you can see contrast in the bladder, this is residual from a urogram looking for bladder injury (no injury identified):

Acetabular fx 1Acetabular fx Jud 1

Acetabular fx 3 Acetabular fx 2

There are several ways to image acetabular fractures:

1.  Standard AP pelvis films:  this is a good screening imaging modality

2.  “Judet” films:  xray images that can further delineate the extent, type of acetabular fracture.  wikiRadiography Judet Views

3.  CT pelvis with 3-dimensional reconstruction.  This is the “cadillac” of imaging that orthopedic surgeons get the most pre-operative information from.  Judet Views have largely been replaced by this imaging modality as it offers much more information for the surgeon.  On a PACS radiology system the images can be rotated, flipped to see the extent of the injury as if you were holding the pelvis in your hand.  Its pretty awesome.

Keep in mind that fractures of the acetabulum can be occult.  If you obtain plain films that look normal and the patient cannot bear weight, consider CT imaging for a better look.  MRI can also be of value much like an occult femoral neck fracture.

Here is a free, extensive discussion of imaging acetabular fractures (including a discussion about types of acetabular fractures) available online from Radiographics:

Acetabular Fractures

Author:  Russell Jones, M.D.

References

1.  Judet Views.  http://www.wikiradiography.com/page/Judet+Views

2.  Potok PS, Hopper KD, Umlauf MJ.  Fractures of the Acetabulum:  Imaging, Classification, and Understanding.  Radiographics. 1995 Jan; 15(1), 7-23.

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