Lower Extremity Critiques -- File 03
AP Pelvis
Image # 31 File # 003
Critique: Substantial rotation of the pelvis to/toward the patient’s right side. Note also the
asymmetrical appearance of the ischial spine. The left ischial spine is not visualized, while the
right spine is (greatly enlarged appearance). In addition to symmetry of the ischial spines, if
visualized at all, to determine rotation, measure from the region of the patient’s ASIS, to the
sacroiliac joint space (both sides). Due to the gross amount of rotation in this image, the
measurement was obtained by measuring bi-laterally the inferior distance between the sacroiliac
joint space yielding a difference of ≈ 4 cm. Wow! Compare to page 354-355 - Vol. I.
Plantodorsal (axial projection) and Lateral Calcaneus
Image # 3
File # 003
Critique: Correctly positioned plantodorsal (sufficient dorsiflexion) and lateral calcaneous
demonstrating a fracture through the lateral process of the calcaneous. Also note that correct
exposure factors were utilized. Note: since the plantodorsal and dorsoplantar projections have
the same radiographic appearance, if performed correctly, you will not be required to
differentiate between the two positions on film/slide tests. You will, however, be required to
describe and explain the fundamental differences on the written portion of the test. Compare to
pages 279, 280 281 - Vol. I.
Plantodorsal (axial projection) and Lateral Calcaneus
Image # 24 File # 003
Critique: The casted plantodorsal position demonstrates improper centering, as evidenced by the
image’s placement an the top of the film. Also, the image fails to clearly demonstrate the subtalar
joint space and the sustentaculum tali due to insufficient penetration. The lateral projection is
correctly positioned and possesses ample penetration. Compare to pages 279, 280, 281 - Vol. I.
Plantodorsal (axial projection) Calcaneus
Image # 28 A & B File # 003
Critique: Image A demonstrates the effect when the CR is angled substantially greater than 40 0 .
Note that the increased angulation in image A causes the fibula to encroach upon the
sustentaculum tali and other structures distal to the joint space. In image B, (same patient), the
CR angulation was corrected, causing the fibula to be positioned above the joint space, as it
should be. Both projections demonstrate a comminuted fracture of the calcaneus. Ouch !
AP Standing Ankle
Image # 125 File # 003
Ballinger-Vol., I pg 301
Critique: AP standing/weight-bearing ankle showing slight internal rotation. Note the lack of
tissue space between the talus and the tibia, which is the purpose of this procedure.
AP Ankle Stress Views
Image # 143 File # 003
Critique: Properly positioned AP ankle showing stress applications of Valgus (outward stress)
and Varus (inward stress). The purpose of Valgus and Varus is to show range of motion in the
ankle joint. When Valgus exists in the knee joint, the patient is said to be “knock-kneed (genu
valgum).” When Varus exists, the patient is said to be “bowlegged (genu varum).”
Note: genu refers to the knee.
Standing Feet (Lateral)
Image # 119 & 119A File # 003
Ballinger - Vol. I, pg. 270 -271.
Critique: Excellent positioning of the feet with the patients standing/weight bearing
demonstrating loss of foot arch in 119B and moderate to normal arch in 119A.
AP and Oblique Foot
Image # 11 File # 003
Critique: Although the positioning is correct, the film orientation is incorrect, i.e., the
cassette was transverse as opposed to being placed longitudinally with the long axis of the foot.
AP Hip
Image #120 File # 003
Critique: Lack of proper foot inversion. Note visualization of lesser trochanter. Also note
splaying (flattening) of femoral head. Splaying is common in Legge-Perthes Disease (children)
and in ischemic necrosis of bone (Bo Jackson Disease!) Splaying of femoral head probably
contributed to the lack of foot/femoral inversion.
Femur
Image # 126 A
File # 003
Image # 126 B
File # 003
Image # 126 C
File # 003
Critique: Correctly positioned distal lateral, AP proximal and distal AP. Note on image 126 A
(Lateral) the presence of a large amount of callus, which indicates the healing process is well
advanced. However, look at image 126 B (distal AP) and 126 C (proximal AP) and note that the
healing process has been interrupted by re-fracture. In fact, the indwelling pin is also broken.
The fractured callus is also seen on image 126 A.