Lower Extremities

1. Lower Extremities • Third Part Dr Mohamed El Safwany, MD.

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

3. 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

4. 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

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

7. Hip Dislocation • posterior dislocation

9. Acetabular Fracture

11. Pelvic Fracture Open Book fx

12. 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)

14. Intertrochanteric fracture

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

16. 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

17. Femoral Head Femoral Neck Intertrochanteric Trochanteric 

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

20. 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

21. Aseptic necrosis of the hips

22. X Ray MRI

23. 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

24. Slipped Capital Epiphysis

25. Osgood - Schlatter disease • Traumatic tibial lesion in children • Avultion fracture of the anterior tibial tuberosity • Frequent in active boys participating in sports • Pain • Age 10-15 y • Heals with rest

26. Osgood - Schlatter disease

27. 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

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

29. Question • State radiographic features of O’sgoodSchlatter disease?

30. Assignments • 5 Students will be selected for assignments.

31. Suggested Readings • Sutton’s Radiology

32. Thank You