Reading between the lines...
...it took several Xrays and an MRI before this abnormality was acted on. Can you see what injury this elderly lady sustained when she fell?
This shows an acetabular fracture on the right. These are not infrequently missed. Use these lines around the pelvis to help guide your eye and you’ll stand a better chance of spotting them.
The iliopectineal line (also called the iliopubic line, 1) extends from the medial border of the iliac wing, along the superior border of the superior pubic ramus to end at the pubic symphysis. This line is seen as the inner margin of the pelvic ring and defines the anterior column of the pelvis. In this lady it has clearly been disrupted.
The ilioischeal line (2) delineates the POSTERIOR column.
The teardrop (3) represents the summation of all the components of the anterior wall, and flows back and down from the anterior lip.
The posterior lip (4), and the main weight-bearing surface, the Dome (5) can also be traced - the latter also clearly not right.
Down at the femoral neck we have the Shenton arc (6)- a smooth curvilinear line connecting the medial aspect of the femoral neck with the under-surface of the superior pubic ramus. This is the one classically used to show NOFs. On the other side, the line of Klein (7) which should intersect the epiphysis, for subtle SUFE
It's not just Mr B who gets annoyed by people talking about a "fractured superior pubic rami"...!
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The Derrifoam Blog
Welcome to the Derrifoam blog - interesting pictures, numbers, pitfalls and learning points from the last few weeks. Qualityish CPD made quick and easy.....