The femoral neck is the proximal femur’s weakest point. Intracapsular fracture of the hips includes the femoral head and neck. The shortening and exorotation of the affected leg is a classical clinical presentation of proximal femoral fractures (14). These fractures may be caused by a simple fall or high-energy trauma in younger people (13). Proximal femoral fractures occur regularly in elderly patients with osteoporosis. Hip images on each side are taken vertically from the groin region (12). In the Löwenstein view, patients are turned onto the affected hip at least 45° with the hip flexion angle of 90° and internal rotation angle of 45° in a supine position. The flexing of hip and knee joints on the other side prevents interference in radiographic projection.Ī radiographic cassette is positioned on the side of the hip to project toward the groin region at 35° to 45° (11). In the cross-table lateral view, the lower extremity is internally rotated by 15° to 20° in a supine position (10). įrog-leg lateral images are particularly useful in evaluating the femoral head shape and head or neck transitions to confirm conditions, like epiphysiolysis and avascular necrosis (9). Meanwhile, the hip is externally rotated by 45° (8). The knee joint is flexed 30° to 40° in a supine position. The X-ray passes through the hip joint from medial to lateral. In the frog-leg lateral view, images show both sides of the hips. There are various imaging techniques for lateral hip radiography, such as the frog-leg lateral view, cross-table lateral view, and Löwenstein view. The image is taken in a supine position towards the middle of the line connecting the upper symphysis pubis and anterior-superior iliac spine. The image becomes distorted as the hip is externally rotated (7). One of the most common mistakes in AP hip radiographs is taking the images in a supine position ( lying on one’s back with the face upward). The leg is then internally rotated 15˚ to 20˚ to achieve femoral anteversion, extending the femoral neck and improving its evaluability (6). Patients lie on their back, and the X-rays pass through the hip joint from anterior to posterior. The distance between the film and the X-ray tube should be 1.2 meters (5). The anteroposterior hip image shows both hip joints to allow comparison with the other hip. A standard hip radiographic examination generally includes an anteroposterior (AP) image and a lateral image (also known as “frog leg”). Hip joint images can be taken from various angles. Softer body tissues, like skin and muscles, allow the X-ray beam to pass through the body and appear darker on X-ray images (4). The X-ray image appears in black and white.ĭense body parts, like bones, block the passage of the X-ray beam through the body and appear white on X-ray images. The images are recorded on a computer program or special film and show the bones and soft tissues of the hip joints and pelvis. How Does Hip Radiography Work?ĭuring the radiographic test, an X-ray machine sends a radiation beam through the pelvic bones and hip bones to record the X-ray images. If a patient needs hip surgery, an X-ray may be taken before and after the surgery. This imaging technique can also detect a dislocated joint, broken bones, bone cysts, tumors, and hip joint infections (3). Hip radiography can help determine the cause of common signs and symptoms, such as pain, limping, swelling, tenderness, or deformity in the hip area (2). Īn appropriate image testing and thorough understanding of standard radiographic techniques can help radiologists achieve better diagnostic accuracy. A radiographic examination is the most basic and critical method of diagnosing various hip disorders (1). Hip radiography (or hip X-ray) uses a small amount of radiation to produce images of the hip joints, which attach the legs to the pelvis.
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