Trauma: Pelvis

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Trauma: Pelvis
The bony pelvis consists of the ilium, ishium, and pubis, which form an anatomic ring with the sacrum (Mechem, 2013). The pelvis also includes the pelvic girdle – right and left hipbones, and the coccyx. Each hipbone is formed by three bones fused to one another to form a single bone. The ilium is the superior, the ishium is inferior and posterior, and the pubis is inferior and anterior. The hipbones join anteriorly at the symphysis pubis, or pubic symphysis. Posteriorly, each hipbone joins the sacrum at the sacroiliac joint (McGraw-Hill). Soft tissues surrounding the pelvis are the urinary bladder, uterus, bowel and sacrospinous ligaments (Kalman).
The visual differences of the anatomy between a patient in an AP vs. PA projection of the pelvis are that in an AP projection, everything is more clearly visible. In a PA projection of the pelvis, the sacrum and coccyx make the anatomy of interest more obscured.
The projections that are performed for the pelvis are the Judet method, inlet and outlet axial projections, Lillienfield method, and an AP projection.
For the Judet method, the acetabulum can either be seen upside or downside. First, place the patient in a forty-five degree posterior oblique position, and center for either the upside or downside hip joint. Place a forty-five degree support under elevated side; position the arms up and to the side with the acetabulum of interest and corresponding leg bent and under the opposite extended leg. The central ray for the downside acetabulum is perpendicular to two inches distal and two inches medial to the downside ASIS. The central ray for the upside acetabulum is perpendicular to two inches distal to the upside ASIS. Suspend respiration during the exposure with a sour...

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...ks Cited

Mechem, C. (2013, March 20). Pelvic Fracture in Emergency Medicine. In
Medscape. Retrieved March 3, 2014, from http://emedicine.medscape.com/article/825869-overview#a0101 McGraw-Hill. Anatomy of Bones and Joints. New York City, NY: McGraw-Hill Company.
Kalman, M. A. Radiologic Soft Tissue Shadows in the Pelvis: Another Look.
Retrieved March 3, 2014, from http://www.ajronline.org/doi/pdf/10.2214/ajr.130.3.493 Baert, A. L., & Sartor, K. (2006). Imaging of the Hip & Bony Pelvis. N.p.: Springer.
Retrieved March 3, 2014, from http://books.google.com/books?id=Yj67PmOTfusC&pg=PA7&lpg=PA7&dq=how+to+position+for+the+lilienfeld+projection+of+the+pelvis&source=bl&ots=bLZ_tT0e6t&sig=YXyxMY3m4xDkGtH-QgUPibVIoFE&hl=en&sa=X&ei=rx4UU Bontrager, K. L. (2014). Handbook of Radiographic Positioning and Techniques (Eighth ed., pp. 162-166). St. Loius, MO: Elsevier.

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