RADIOLOGICAL ANATOMY OF LOWER LIMB

RADIOLOGICAL ANATOMY OF LOWER LIMBLEARNING OBJECTIVES

1-To correlate bone with the X Ray.

2- To identify the bone and joint in X-ray.3- To know the different views of the X ray.4- To identify the different directions on X Ray.

INTRODUCTION:

Radiological examination of the lower limb concentrates mainly on the bony structures, since the muscles, tendons and nerves blend into a homogeneous mass. Blood vessels may be visualized by using special contrast media.

A student must be cognizant of the age changes that take place in the body and how these will influence the radiographic appearances.

For example, knowing the times at which the primary and secondary centers of ossification appear in the different bones, and the dates at which they fuse, is essential since without this information an epiphysis line could be mistaken for a fracture.

Remember that a person has two lower limbs, and that the normal side may serve as a baseline for comparison with the potentially abnormal side.HOW TO READ AN X-RAY:The process of reading X-ray film should be as methodical as clinical examination. A convenient sequence for examination is; Patients

Soft tissues

Bones

Joints

Diagnostic Association .

PATIENTS: Make sure that the name on the film is that of your patients; mistaken identity is a potent source of error. Then try to look through the film and to visualize the living person, especially the age, build and sex.

SOFT TISSUES:Look for variation in shape in density.

BONES

When studying the bones and joint, establish a search pattern based on the local Anatomy. Throughout this search we record abnormalities of shape, density and architecture.

Examine carefully Periosteal surface, Cortex and Endosteum

JOINTS:

The radiographic joint consists of the articulating bones and space between them. The articular cartilage is radiolucent, varies in thickness 1 8 mm.

It looks much wider in children than in adults because much of the epiphysis is still cartilaginous and therefore radiolucent. DIAGNOSTIC ASSOCIATION:

The search for associated abnormalities, or clarification of some poorly observed feature in the plain film, may call for further examination by one of the other imaging techniques.

RULE OF 2S : Two views. Two joints. Two limbs. Two Occasions.

RADIOGRAPHIC APPEARANCES OF THE HIP REGIONIn AP view first, examine the relevant features seen in the pelvis, sacrum and sacroiliac joints. The iliopectineal line and the symphysis pubis are well shown. The boundaries of the obturator foramen and the ischial tuberosity can be identified. The superior shelving margin of the acetabulum can be seen. The articulating surfaces of the hip joint are seen to be parallel and separated by a narrow space occupied by radiotranslucent articular cartilage. The head, the neck, the greater and lesser trochanters, and the intertrochanteric crest of the femur can all be visualized.

The axial relationships of the hip joint should be studied. The inferior margin of the neck of the femur should form a smooth continuous curve with the superior margin of the obturator foramen (shentons line).

Radiograph (a) and line drawing (b) of Shenton's line

The angle formed by the long axis of the neck of the femur with the long axis of the shaft of the femur measures between 120 and 130 degrees. In lateral view first identify as many of the relevant parts of the pelvis as possible. The obturator foramen, the ischial spine and tuberosity, the pubic ramus, and the body of the pubis may all be recognized. The acetabular rims and the head and the whole neck and lesser trochanters and the proximal part of the shaft are visualized.

PELVIS (ANTEROPOSTERIOR)

1. Lateral part of the sacrum2. Gas in colon 3. Ilium4. Sacroiliac joint5. Ischial spine6. Superior ramus of pubis7. Inferior ramus of pubis8. Ischial tuberosity9. Obturator foramen10. Intertrochanteric crest11. Pubic symphysis

12. Pubic tubercle13. Lesser trochanter14. Neck of femur15. Greater trochanter16. Head of femur17. Acetabular fossa18. Anterior inferior iliac spine19. Anterior superior iliac spine20. Posterior inferior iliac spine21. Posterior superior iliac spine22. Iliac crest Hip Joint (Anteroposterior)1. Anterior superior iliac spine2. Ilium3. Anterior inferior iliac spine4. Pelvic brim5. Acetabular fossa6. Head of femur7. Fovea8. Superior ramus of pubis 9. Obturator foramen10. Inferior ramus of pubis11. Pubic symphysis12. Ischium13. Lesser trochanter14. Intertrochanteric crest15. Greater trochanter16. Neck of femur RADIOGRAPHIC APPEARANCES OF THE KNEE REGION:

In the AP view the lower part of the shaft of the femur, the lateral and medial epincondyles, and the adductor tubercle are easily visualized. The patella is seen superimposed in front of the lateral and medial femoral condyles. The fabella , a sesamoid bone in the lateral head of the gastrocnemius, is sometimes seen superimposed on the lateral femoral condyle.

The parallel joint surfaces, separated by a wide space occupied by the articular cartilage and the semilunar cartilages, which cast no shadow, are easily recognized. The intercondylar notch of the femur and the intercondylar eminence of the tibia are well shown.

The medial and lateral condyles of the tibia are seen. The head of the fibula partly overlaps the lateral condyle of the tibia. The neck of the fibula and the upper parts of the shafts of the fibula and tibia are usually clearly seen.

In the lateral view the lower part of the shaft of the femur is seen, and the lateral and medial femoral condyles are partly superimposed on each other. The patella is clearly visualized in front of the femoral condyles.

The intercondylar eminence of the femur and its summit is overlapped by the femoral condyles. The lateral and medial tibial condyles are superimposed, and the tibial tuberosity is seen on the anterior surface of the bone. The head, neck, and upper part of the shaft of the fibula are seen, the fibula overlapping the tibia to some extent.

KNEE JOINT (ANTEROPOSTERIOR)1. Femur2. Patella3. Medial epicondyle of femur4. Lateral epicondyle of femur5. Medial condyle of femur6. Lateral condyle of femur7. Intercondylar eminence 8. Intercondylar notch9. Knee joint10. Lateral condyle of tibia11. Medial condyle of tibia12. Tibia13. Fibula KNEE JOINT (LATERAL) 1. Femur2. Lateral condyle of femur3. Medial condyle of femur4. Fabella5. Patella6. Base of patella 7. Apex of patella8. Intercondylar eminence9. Apex of fibula10. Fibula11. Tibia12. Tibial tuberosity. LOWER LEG (ANTEROPOSTERIOR)

1. Femur2. Medial condyle of femur3. Lateral condyle of femur4. Knee joint5. Intercondylar eminence6. Lateral condyle of tibia7. Medial condyle of tibia8. Fibula9. Tibia10. Head of fibula11. Neck of fibula LOWER LEG (LATERAL) 1. Femur2. Knee joint3. Intercondylar eminence4. Tibial tuberosity5. Fibula6. Tibia7. Ankle joint8. Talus9. Calcaneus .

PATELLA (DISTAL-PROXIMAL)

1. Patella2. Medial part of patella3. Lateral part of patella4-5. Patellofemoral joint6. Lateral femoral condyle7. Medial femoral condyle RADIOGRAPHIC APPEARANCES OF THE ANKLE JOINT:

In the AP view the lower ends of the tibia and fibula and the inferior tibiofibular joint are well shown. The medial and lateral malleoli and the articular surfaces of the tibia and the body of the talus are easily seen. The lateral malleolus usually partly overlaps the lateral aspect of the talus.

The articular surface of the lower end of the tibia and the superior surface of the talus are seen to be parallel and separated by a narrow space occupied by the articular cartilage, which is radiotranslucent. Other than the talus, the tarsal bones are not clearly visualized.The lateral view shows the lower ends of the tibia and fibula; the lateral and medial malleoli are superimposed. The articuar surfaces of the ankle joint are clearly visualized. The talus and calcaneum are seen in profile, and the subtalar and transverse tarsal joints can be identified. The cuneiform bones and the cuboid are overlapped and not clearly seen.

ANKLE JOINT (ANTEROPOSTERIOR)

1. Fibula2. Tibia3. Distal tibiofibular joint4. Malleolar fossa 5. Lateral malleolus6. Ankle joint7. Medial malleolus8. Talus ANKLE JOINT (LATERAL)

1. Fibula2. Tibia3. Ankle joint4. Promontory of tibia5. Trochlear surface of talus6. Talus7. Posterior tubercle of talus 8. Calcaneus9. Sustentaculum tali10. Tarsal tunnel11. Navicular12. Cuneiforms13. Cuboid RADIOGRAPHIC APPEARANCES OF THE TARSUS, METATARSUS AND PHALANGES The views commonly used are: (1) Anteroposterior, (2) Lateral, and (3) Oblique.

The particular view used will depend on which bone is need to be visualized to best advantage. The oblique view of the metatarsal bones is often of greater value than the lateral view, since in the later the bones are superimposed.

In the Anteroposterior view, the tarsal bones the metatarsals, and the phalanges are seen. The two sesamoid bones of the big toe overlap the head of the first metatarsal bone.

FOOT (DORSO-PLANTAR)

A-E: Toes 1-5. (A: Great toe)I-V. Metatarsals1, 3: Distal phalax4: Middle phalax2,5: Proximal phalax

6. Interphalangeal joints7. Metatarsophalangeal joints8. Sesamoids9. Head of metatarsal10. Shaft (body) of metatarsal11. Base of metatarsal12. Cuneiforms13. Navicular14. Cuboid15. Talus16. Calcaneus17. Tibia18. Fibula19. Tarsometatarsal joints20. Transverse midtarsal joint.

FOOT (OBLIQUE)

A-E: Toes 1-5. (A:Great toe)1,3: Distal phalax4: Middle phalax2,5: Proximal phalax

6. Interphalangeal joints7. Metatarsophalangeal joints8. Sesamoids9. Head of metatarsal10. Shaft (body) of metatarsal11. Base of metatarsal12. Cuneiforms13. Navicular14. Cuboid15. Talus16. Calcaneus17. Tibia18. Fibula19. Tarsometatarsal joints20. Transverse midtarsal joint

AT BIRTH

15 MONTHS

3 YEARS

FRACTURE VS EPIPHISEAL LINE

MRI HIP JOINT

MRI KNEE JOINT

MRI ANKLE JOINTCT HIP JOINT