1. X-Ray of the pelvis and lower limb
Pelvis & Lower limb
X-Ray of the pelvis and lower limb

2. Joint of lower limb

3. Hip # - types
Femoral head usually the result of high energy trauma and a dislocation of the hip joint often accompanies this fracture.
Femoral neck subcapital, or intracapsular denotes a # adjacent to the femoral head in the neck between the head and the greater trochanter
Intertrochanteric a break in which the # line is between the greater and lesser trochanter on the intertrochanteric line .
Subtrochanteric # actually involves the shaft of the femur immediately below the lesser trochanter, may extend down the shaft of the femur.

4. CT pelvis 3D recon Pelvic x-ray

5. MRI PELVIS Multiple pelvic fractures

6. X-Ray of pelvic fractures
A suspected pelvic fracture requires the following plain x-rays
(1)Standard AP view
(2)Outlet view
(3)Inlet view
These may be supplemented by CT scans for further clarification and evaluation and for patient management.
Assessment for associated soft tissue injuries such as urethral and/or bladder injuries is a must especially in unstable pelvic fractures

7. AP View of the pelvis: the X-ray beam is perpendicular to the pelvis and the film cassette

8. Inlet view of the pelvis: The X-ray beam is directed to the mid pelvis at 60 degree angle to the film cassette.

9. Outlet view of the pelvis: The X-ray beam is directed from the feet to the symphysis at 40 degree angle to the film cassette.

10. Normal x-ray AP view of pelvis

11. Stable pelvic fracture pelvic ring intact Plain x-ray CT

12. Stable pelvic fracture
Plain film of the pelvis shows the normal arcuate line of the right SI joint and fracture of the left superior pubic rami.
CT shows fracture of the anterior sacrum near the left SI joint

13. Stable pelvic fracture

14. Unstable pelvic fracture pelvic ring interrupted
Plain x-ray AP view showing bilateral separation of SI joints and wide diastasis of symphysis pubis

15. Unstable pelvic fractures

16. Acetabular fractures
Acetabular fractures occur primarily in young adults as a result of high energy trauma.
The contact area between femoral head & acetabulum will be decreased.
Mal union of the acetabular fracture will lead to post traumatic arthritis.
2 basic x-ray views are required for assessment of acetabular fracture:-
(1) AP view followed by-
(2) 45 degree internal oblique view ( Judet view)

17. Dislocation of the hip joint
Types:
Posterior dislocation
Most common type of dislocation.
Femoral head is lateral & superior to acetabulum
Posterior rim of acetabulum is usually fractured
Associated sciatic nerve injury in 10%
Anterior dislocation
Femoral head displaced into the obturator, pubic or iliac region
Internal dislocation
Always associated with acetabular fracture
Femoral head protrudes into the pelvic cavity.

18. Dislocation of Hip Anterior dislocation of hip
Dislocation of Hip Anterior dislocation of hip. Plain x-ray showing abduction and external rotation.

19. Posterior dislocation of hip Plain x-ray showing adduction & internal rotation of the hip

20. Lower limb Proximal femur

21. LEFT FEMUR

22. Right neck femur fracture

23. Fractures of the proximal femur
Classification
Intracapsular fractures involving femoral head or neck:
Capital: uncommon
Subcapital: common
Transcervical: uncommon
Extracapsular fractures involving the trochanters
Intertrochanteric
Subtrochanteric

24. Fracture proximal femur Trans cervical fracture

25. Fracture proximal femur Intertrochanteric fracture (Extacapsular fracture)

26. Fracture proximal femur Subtrochanteric fracture

27. (A) Undisplaced intertrochanteric fracture not clearly seen on plain x-ray. (B) Corresponding MR clearly displays the fracture

28. Avascular necrosis of femoral head ( post fracture complication)

29. Mid shaft femur fx

30. Fractures of distal femur
Classification
1-Supracondylar
Non displaced
Displaced
Impacted
Comminuted
2-Condylar
3-Intercondylar

31. Fracture of the distal femur Comminuted intercondylar fracture

32. Transmission of energy resulting in concomittant injury patterns In all orthopaedic injuries it is mandatory to rule out additional injuries to the joint above and below to rule out ipsilateral fractures of the femur, acatabulum and patella epecially after high energy vehicle trauma

33. Standard x-ray views for the knee (A) AP view (B) Lateral view (C) Tunnel view (D) Skyline view

34. X-ray lateral view of the knee showing joint effusion following trauma: displacement of the black translucent fat line in supra patella region

35. Left knee

36. LEFT KNEE

38. Tibial plateau fracture AP view: Vertical lucent fracture line ( black arrows) with cortical step (white arrow) Cross table lateral view: fat fluid level in supra patella region

39. Fracture patella

40. Lower limb Articular surface fracture

41. Left tibia/fibula

45. Standard AP and Lateral views of the ankle

46. Left ankle

47. X-ray lateral view of the ankle showing effusion: displacement of the translucent fat line (arrows)

48. Lower limb Massoneuve fracture : eversion injury

49. Lower limb Massoneuve fracture : disruption of the tibiofibular syndesmoses

50. (A) Bimalleolar fracture : Horizontal fracture line in medial malleolus and oblique fracture line in lateral malleollus
(B) Trimalleolar fracture: Above plus fracture of posterior malleolus.

51. Lines in the foot.

52. Standard X-rays for the foot (A) Lateral view (B) AP view (C) Oblique view

54. LEFT FOOT

56. Fracture of the base of the 5th metatarsal bone (FX) (not to be mistaken with normal apophysis (AP) which is parallel to shaft )

57. Lisfranc fracture dislocation Fracture of 2nd to 5th metatarsal bone with lateral subluxation

58. March Fracture History of walking for 400km
(A) Initial X-ray normal in appearance
(B) Positive bone scan
(C) Subtle subcortical fracture 2nd metatarsal bone after 10 days
(D) Significant callus formation after 3 weeks

59. Fracture of the neck of Talus X-ray lateral view showing horizontal lucent fracture line

60. Calcaneal fracture (A) Lateral view showing vertical lucent fracture line extending to articular surface (B) Calcaneal view shows extent of fracture

61. Lower limb Plain x-ray lateral view shows oblique fracture line extending to articualr surface CT shows extent of calcaneal fracture Calcaneum: fall from height