Managing Minor Musculoskeletal Injuries and Conditions First Edition Managing Minor Musculoskeletal Injuries and Conditions First Edition. David Bradley. © 2014 John Wiley & Sons, Ltd. Published 2014 by John Wiley & Sons, Ltd. Companion website: www.wiley.com/go/bradley/musculoskeletal

The lower back and hip

Lower back and hip 1 Rather cute this, isn’t it? Have you ever seen such a tiny fractured femur! Note the callus formation (thin arrows) and the comparison of the size of the femur with the nappy pin. The thick arrow points to the hip joint. Of course nothing can be seen; this is because the exact architecture of the acetabulum is composed of cartilage, as is the upper end of the femur. The ossification of the femoral capital epiphysis cannot even be seen at this stage.

Lower back and hip 2 Apart from lots of gas in the intestines (all the black blotches over the abdomen), what do you see on this film? After you have studied it, look at the next slide.

Lower back and hip 2 – my comments The slide shows a congenital dislocation of the girl’s left hip. There are several lines that can be drawn on the film to make the different points clear and perhaps you can do some further study here by looking up the term ‘Shenton’s lines’ and then drawing them on another film at a later date. For now the main four points are as follows: The femoral capital epiphysis on the left is only about half the size of the normal one on the right. The left femur rides a lot higher up the pelvis. The left femur is also positioned more laterally that the right. The acetabulum on the left is shallow to non-existent, whereas on the right the ‘cup’ may be seen.

Lower back and hip 3 This is a difficult one for you, unless you have seen it before or read the accompanying book. It may sometimes be found by chance on patients who have no features, or it may be associated with major problems It shows an oblique view of the lumbar spine, demonstrating a condition called spondylolisthesis, in this instance of L4 (2 arrows) andd L5 (big arrow) . From this unusual angle, if you look carefully, you will be able to see an outline of a dog. The dog’s neck is the pars interarticularis of the vertebrae and with this condition there is a fault line through it making it look as though it has been cut through. This is fancifully called ‘decapitation of the terrier’.