tib-fib, knee, femur, AP hip, Frog hip, xtable hip & patella
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| For AP tib/fib what joints must be included? | both knee and ankle (include at least 1-1 1/2" beyond joints
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| What superimposition is there on the AP tib/fib? | partial superimposition of fibula and tibia on proximal and distal ends
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| How do you check for rotation on the AP tib/fib? | *interosseous spacing: more space=medial rotation
less space=lateral rotation
*femoral & tibial condyles in profile
*intercondylar eminence centered in the intercondylar fossa
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| What is the interosseous spacing? | spacing between the fibula and tibia
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| What is the body positioning for the lateral tib/fib? | rotate the body until the patella is placed perpendicular to the IR.
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| What is the CR for the AP and lateral tib/fib? | midshaft of lower leg
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| On a lateral tib/fib, if there is too much superimposition of the tibia over the proximal head of the fibula how is the knee position in respects to the IR? | the knee is elevated and too far away from the IR.
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| On the lateral tib/fib, the femoral condyles may not be superimposed why is this? | due to beam divergence
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| How much is the foot and leg inverted on the AP proximal femur? | 15 degrees (just like AP hip)
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| How much is the foot and leg inverted for the distal femur? | 5 degrees (just like AP knee)
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| On the AP proximal femur, which trochanter should be in profile on the lateral side? | greater
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| Which joint should be included on the AP distal femur? and how much should be included? | knee joint must be included; lower margin of IR should be about 2" below knee
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| How much is the leg rotated internally on the AP knee? | 3-5 degrees
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| What is the CR for the AP, internal and external obliques of the knee? | 1/2" distal to the apex of the patella
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| How much is the tube angled for asthenic patients on the AP knee? | 5 degrees caudad; when thighs and buttocks are under 19cm
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| How much is the tube angled for hypersthenic patients on the AP knee? | 5 degrees cephalic; when the thighs and buttocks are greater than 24cm
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| Which joint space should be open on the AP knee? | tibiofemoral
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| How should the patella be positioned on the AP knee? | completely superimposed on the femur and in the center.
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| Is it ok for the tibial plateaus to be superimposed on the AP knee? | yes
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| How can you detect rotation for the knee? | *position of the patella
*superimposition of the fibula & tibia
*shape of condyles
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| Which oblique knee rotation has less superimposition of the fibula from the tibia? | medial rotation
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| On an AP knee, if the knee is bent which joint space closes? | tibiofemoral
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| On the lateral knee which anatomy should be perpendicular to the IR? | patella & femoral epicondyles
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| How much should the knee be flexed on the lateral? | 20-30 degrees
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| What is the CR for lateral knee? | 1" distal to medial epicondyle
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| How much is the tube angled on the lateral knee? | 5 to 7 degrees cephalic
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| Why is the tube angled on the lateral knee? | because the medial condyle extends lower or more distally than lateral condyle
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| Which joint spaces should be open on the lateral knee? | femoropatellar & tibiofemoral
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| T/F: On the lateral knee, the fibular head should be free of superimposition of the tibia. | false; if this occurs it means the knee is too close to the IR, and the foot is elevated. There should be slight superimposition on the lateral knee.
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| If the knee is bent more than 30 degrees what happens? | over flexion closes the femoropatellar joint space.
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| How can you detect rotation on a lateral knee? | *position of the fibula
*lack of superimposition of the medial and lateral condyle
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| Which condyle has the adductor tubercle connected to it? | medial condyle
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| What does it mean when the distal margins of the femoral condyles are not aligned? | incorrect tube angulation
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| If the fibula is used to detect rotation, where is it positioned for the knee to be too far away from the IR? | the fibula is anterior and more superimposed by the tibia than normal
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| How much do you rotate the knee for internal and external oblique knee? | 45 degrees
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| where is the CR placement for medial and lateral oblique knee? | 1/2" distal to apex of patella; midpt of knee
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| what does the medial oblique knee demonstrate? | lateral femoral condyle and tibial plateau in profile
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| On a medial oblique knee, if the tibiofibular joint space is closed how is the obliquity? | too shallow
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| If the fibula is not superimposed whatsoever by the tibia on a lateral knee, how is it rotated? | the knee is too close to the IR, heel is elevated; the fibula is too posterior
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| If you are determining rotation on a lateral knee using the medial or lateral condyle, how is the condyle positioned for the knee to be too far away from IR? | the medial condyle is too posterior
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| If the knee is elevated on a lateral knee, what are the ways you can tell? | *the medial condyle (adductor tubercle) is too posterior
*the fibula is too anterior or superimposed by the tibia more than slightly
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| What is the only projection that opens up the tibia and fibula at their proximal articulation? | medial oblique knee
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| What does the lateral oblique knee demonstrate? | medial condyle & tibial plateau in profile
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| What are the different tunnel views for the knee? | *Camp-coventry Method (PA)
*Holmblad Method (PA)
*Beclere Method (AP)
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| Which tunnel view has the body positioned PA where the body leans forward 20-30 degrees from vertical? | Holmblad Method
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| What is the tunnel view that the lower leg is flexed 40 degrees and the CR is perpendicular to the long axis of the lower leg? | Camp-coventry Method
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| What do all of the tunnel knee projections have in common? | all the CRs are perpendicular to the tib/fib
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| What does it mean when the patella can be seen through the intercondylar fossa? | the knee is over-flexed
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| As you flex the knee, how does the patella move? | it moves distally or downward
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| What does it mean if the distal margins of the condyles are separated? | there is not enough tube angulation; causing the joint space between the femoral condyles and tibia to be closed.
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| what is the CR for the PA patella? | perpendicular to mid patella area
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| How much do you flex the knee for a lateral patella? | 5-10 degrees
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| What is the CR for the lateral patella? | perpendicular to mid patellofemoral joint
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| What are the different tangential projections for the patella? | *settegast Method
*inferosuperior (sunrise) projection
*bilateral merchant method
*hughston method
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| What projection has the patient's knee flexed 90 degrees and the CR is between the patella & femoral condyles? | settegast method
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| How much is the knee flexed for the inferosuperior sunrise projection? | 40-45 degrees
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| What is the CR for the merchant bilateral method? | 30 degrees caudad; midway between patellae
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| which projection for the patella is PA and the knees are flexed 45 degrees and the tube is angled through the femoropatellar joint space? | Hughston method
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| Which side is the larger condyle normally on? | medial side
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| How much should the knees be flexed on the bilateral merchant? | 40 degrees
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| How much should the knees be flexed for the Beclere method? | Bontrager: 40-45 degrees
Merrill's: 60 degrees
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| What is the CR placement for the Beclere method? | 1/2" distal to the apex of the patella
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| What is the CR placement for the AP hip? | perpendicular to the femoral neck
Merrill's: 2 1/2" distal to midpoint of ASIS & pubic symphysis
Bontrager: 1-2" distal to mid-femoral neck
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| Where is the femoral neck located? | 1-2" medial and 3-4" distal to ASIS
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| What makes the femoral neck foreshortened on the AP Hip? | *externally rotating the foot
*foot being in a natural straight position
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| Rotating the leg & foot 15 degrees internally affects the visualization of what? | *lesser trochanter
*femoral neck (elongates)
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| T/F: for the AP hip, you want to include the acetabulum, and adjacent parts of pubis, ischium & ilium. | True
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| How much of the proximal femur should be included in the AP hip? | 1/3
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| What is the patient position for the lateral frog-leg hip? | supine; flex knee and hip on affected side with sole of foot against the inside of opposite leg at the knee.
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| How much is the recommended abduction for the lateral frog hip? | 45 degrees from vertical
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| On the lateral frog hip, how much should the affected side knee be flexed from the table? | 60-70 degrees from the table
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| What is the CR placement for the lateral frog-leg hip? | perpendicular to IR; directed to mid-femoral neck
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| T/F: on the lateral frog-leg hip, the femoral neck should not be overlapped by the greater trochanter. | false; the femoral neck will be overlapped by the greater trochanter.
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| On the lateral frog-leg hip, where is the lesser trochanter positioned almost everytime? | the lesser trochanter should be seen on the posterior surface of the femur.
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| What happens when the leg is not flexed enough on the lateral frog? | the greater trochanter is too lateral
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| What is flexion responsible for on the lateral frog? | greater trochanter placement
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| What happens when the leg is flexed too much on the lateral frog-leg? | the greater trochanter is too medial
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| What does abduction demonstrate on the lateral frog-leg hip? | femoral neck; whether its foreshortened or not
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| What happens when the affected hip is abducted too much? (80 degrees from vertical) | *foreshortened femoral neck
*femoral shaft in profile
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| What happens when the affected hip is abducted too little? (20 degrees from vertical) | *femoral neck in profile
*femoral shaft is foreshortened
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| What does it mean when it says the femoral shaft is foreshortened? | the distance/space between the greater and lesser trochanters is shortened.
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| On the tangential patella, what may cause the femoropatellar joint space to be not opened enough? | *incorrect tube angle
*knees over-flexed
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| What positioning error foreshortens the femoral neck on a lateral frog leg? | too much abduction
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| what positioning error places the greater trochanter too medially on a lateral frog leg? | too much flexion
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| What positioning error places the greater trochanter too lateral on a lateral frog leg? | too little flexion
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| What positioning error foreshortens the femoral shaft on a lateral frog leg? | too little abduction
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| On a lateral frog leg if the greater trochanter still remains lateral what positioning error is this? | not enough flexion
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| On a lateral frog leg if the greater trochanter moves too medially what positioning error is present? | too much flexion
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| Abduction affects what? | femoral neck
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| For the xtable lateral hip, how much do you rotate the leg & foot? | 15-20 degrees medially
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| T/F: Rotate the leg & foot 15 degrees internally for all xtable lateral hips. | false; do not rotate for trauma patients, this includes prosthesis patients
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| How should the IR be aligned for a xtable lateral hip? | IR should be parallel with the long axis of the femoral neck
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| What is the CR placement for a xtable lateral hip? | perpendicular to long axis of the femoral neck
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| If the foot & leg are inverted, what is the position of the lesser trochanter? | only a small part of the lesser trochanter will be visualized posteriorly.
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| How much should the knee be flexed on a lateral femur? | 45 degrees
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| For the proximal lateral femur what is the patient positioning? | unaffected leg positioned posterior
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| For the distal lateral femur what is the patient positioning? | unaffected leg positioned either posterior or anterior (depends on patient comfort)
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| where is the greater trochanter on the proximal lateral femur? | superimposes the whole femoral neck due to beam divergence
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| On a distal lateral femur, what if the femoral condyles are not superimposed over each other? | this may happen because of beam divergence; this causes the space between the femoral condyles and tibia to be closed as well
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| what space should be open on the distal lateral femur? | femoropatellar joint
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