Hftluxationen

1
Post Partum Pelvic Instability An
Update EFORT Vienna 3-6 June 2009
The value of Radiological Investigations
P V Giannoudis MD, FRCS Professor
Chairman Academic Department of Orthopaedic
Trauma Surgery University of Leeds, UK
2
Imaging Techniques

• Conventional Radiography
• Computer Tomography (CT)
• Magnetic Resonance Imaging (MRI)
• Scintigraphy
• Diagnostic Injection Techniques

3
Imaging Techniques
Conventional Radiography
subchondral sclerosis osteophytes osteolysis
4
Conventional Radiography
Low sensitivity Large variation on quality of
imaging especially for SI joints
5
Conventional Radiography Single Leg Stance stress
views


6


7
Conventional Radiography Single Leg Stance stress
views
... The ranges of physiologic motion at the pubic
symphysis measured on the single-leg-stance
radiographs can be used to identify pathologic
amounts of motion at this site. ... up to 5 mm
of physiologic motion can occur at the pubic
symphysis in asymptomatic individuals, as
demonstrated by alternating-single-leg-stance
radiographs.
David N. Garras, Joshua T. Carothers and Steven
A. Olson Single-Leg-Stance (Flamingo)
Radiographs to Assess Pelvic Instability How
Much Motion Is Normal? JBJS am 2008 90 2114-2118
8
Conventional Radiography Single Leg Stance stress
views
... 38 mixed group of patients (males/females) ...
7 pregnancy related PGP ... 25 demonstrated
pelvic instability (average, 1.98 cm range, 0.5
to 5 cm). ... standing anteroposterior and
single-leg-stance pelvic radiographs aid in the
diagnosis of pelvic instability more effectively
than do the standard three radiographs of the
pelvis.
Jodi Siegel, David C Templeman, Paul Tornetta III
Single-Leg-Stance Radiographs in the Diagnosis
of Pelvic Instability JBJS am 2008 90 2119-2125
9
Imaging Techniques

• Conventional Radiography
• Computer Tomography (CT)
• Magnetic Resonance Imaging (MRI)
• Scintigraphy
• Diagnostic Injection Techniques

10
Computer Tomography - CTscan

• The relation between CT findings and symptoms
• is not sufficiently clarified.
• Shibata et al. 2002, Hodge and Bessette 1999

subchondral sclerosis osteophytes non-uniform
joint width
11
Imaging Techniques

• Conventional Radiography
• Computer Tomography (CT)
• Magnetic Resonance Imaging (MRI)
• Scintigraphy
• Diagnostic Injection Techniques

12
Magnetic Resonance Imaging MRI scan
High Sensitivity, Moderate specificity Useful
preoperatively, on symptomatic pts
Braun et al. 2000, Wurdinger et al. 2002
13
Magnetic Resonance Imaging MRI scan
14
(No Transcript)
15
(No Transcript)
16
Both legs
17
Right leg
18
Left Leg
19
Imaging Techniques

• Conventional Radiography
• Computer Tomography (CT)
• Magnetic Resonance Imaging (MRI)
• Scintigraphy
• Diagnostic Injection Techniques

20
Scintigraphy - Bone scan

• poor specificity - sensitivity
• Yildiz et al. 2001, Maigne et al. 1998

21
Imaging Techniques

• Conventional Radiography
• Computer Tomography (CT)
• Magnetic Resonance Imaging (MRI)
• Scintigraphy
• Diagnostic Injection Techniques

22
Diagnostic Injection Techniques
Great specificity average sensitivity


23
Diagnostic Injection Techniques
Questionable for extrarticular pathologies Only
under guidance


24
CONCLUSION

• Stress views, MRI scan, Guided Injections all
  valuable.
• Combination with History Clinical examination
  Provocation Tests