![]() ![]() Figure 1C shows an example of the pelvis correctly positioned.Īltering the degree of limb extension or flexion and changing the degree of internal or external rotation can significantly affect the appearance of the femoral head and neck. Ideally, the sacrum, ilial wings, and entire 7th lumbar vertebra should be included in the image. Note the uniform and equal size of the obturator foramen on this well-positioned radiograph. In this image the femurs are parallel with each other and parallel with the imaging plate. If the stifles are kept internally rotated, the patella should be centrally located over the distal femurs, as seen in the normally positioned radiograph ( Figure 1B). The limbs are then extended, maintaining the internal rotation, until the femurs are parallel with the table. While in a flexed position, the limbs are internally rotated and abducted so that the stifles are almost touching. All but the pelvis and hindlimbs are within the trough. This view is best obtained with the dog placed in dorsal recumbency, which is done by using a foam positioning trough. Waltham, MA: UpToDate Inc.Step-by-Step: Pelvic Radiography Positioningįigure 1A demonstrates the normal positioning for the ventrodorsal hip-extended view (the view that should be submitted to the Orthopedic Foundation for Animals). Radiologic evaluation of the acutely painful knee in adults. Clinical decision rule for knee radiographs. Prospective validation of a decision rule for the use of radiography in acute knee injuries. Stiell IG, Greenberg GH, Wells GA, et al. Derivation of a decision rule for the use of radiography in acute knee injuries. ![]() Diagnostic accuracy and reproducibility of the Ottawa Knee Rule vs the Pittsburgh Decision Rule. J Am Coll Radiol 2015 12:1164.Ĭheung TC, Tank Y, Breederveld RS, Tuinebreijer WE, de Lange-de Klerk ES, Derksen RJ. ACR Appropriateness Criteria Acute Trauma to the Knee. Tuite MJ, Kransdorf MJ, Beaman FD, et al. National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary. Radiographic detection of hip and pelvic fractures in the emergency department. Prevalence of traumatic hip and pelvic fractures in patients with suspected hip fracture and negative initial standard radiographs-a study of emergency department patients. ĭominguez S, Liu P, Roberts C, Mandell M, Richman PB. Imaging Evaluation of the Painful Hip in Adults. ACR Appropriateness Criteria® Acute Hip Pain-Suspected Fracture. Declining hip fracture rates in the United States. Therapies for treatment of osteoporosis in US women: cost-effectiveness and budget impact considerations. Tosteson AN, Burge RT, Marshall DA, Lindsay R. Less than 12 or greater than 50 years old.Īnyone who cannot take 4 weight-bearing steps in the emergency department The sensitivity is not quite as high as the Ottawa Knee Rule, however, its simplicity may be preferable. Anyone who meets the following criteria should be evaluated with a knee x-ray. The sensitivity of this decision rule has been reported at 92%. Pittsburgh Decision tool: for acute knee trauma. Several studies have found a 100% sensitivity for acute fracture using this rule (…that’s pretty good).Ĭannot walk in the emergency department (after taking 4 steps) If any of the following criteria are met, knee x-ray should be obtained. Ottawa Knee Rule: for patients older than 18 years of age with acute knee pain. ![]() While using these rules may assist ED physicians to decide when to forgo a plain film, the radiologic evaluation of acute knee pain should always begin with an x-ray. There are two clinical decision tools for acute knee pain. Acute knee pain is most often caused by trauma, followed by infection and crystal-associated inflammation. Unlike hip pain, knee pain is more common in the pediatric and adolescent populations. In fact, one study found that over 500,000 visits per year were attributed to knee pain. Acute knee pain accounts for a large number of emergency department visits. ![]()
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