THE PELVIS AND SACROILIAC JOINTS

DIAGNOSTIC PROCEDURES 1 Alison Scott

Pelvis
Formed by two hip bones, the sacrum, and the coccyx Hip bones are large irregular-shaped bone - three bones fused together Ilium, Ischium Pubis

Gender Differences

The Innominate Bone

Ilium
Flat bone Superior aspect of hip bone Auricular surface of the ilium articulates with the sacrum to form the Sacro-Iliac joints The ilium forms part of the acetabulum which articulates with the head of femur to form the Hip Joint

Main Parts
Iliac crest-superior border, easily palpable, lies at the level of the 4th lumbar vertebra Anterior superior iliac spine- easily palpable Posterior superio iliac spine- lies posterior to the iliac crest usually two dimples indicate

Ilium cont
Iliac fossa-Medial surface-concave surface for the iliacus muscle Sacro pelvic surface - three parts Iliac tuberosity- for ligament attachment Auricular surface for articulation with the sacrum Pelvic surface- forms part of the wall of true pelvis

Ischium
Flat bone Forms posterior and inferior portion of pelvis bone 2 parts Body-forms part of the acetabulum. At the postero-inferior area of the body lies the ischial tuberosity for attachment to the hamstring muscle Ramus-flat bone which continues with the inferior pubic ramus

Pubis
Flat bone Forms inferior and medial aspect of hip bone Pubis forms part of acetabulum which articulates with femur in the hip joint Right and left pubic bones articulate with each other to form the symphysis pubis

Pubis cont
Body-anterior wall of the true pelvis and articulates with the opposite pubic bone to form the symphysis pubis Superior ramus- forms part of the acetabulum Inferior ramus- joins with the ramus of the ischium

Pubis cont
Obturator foramen-large opening formed by ischium and the pubis.-foramen is occupied by the obturator membrane Acetabulum-cup shaped socket on lateral aspect of hip bone for articulation with the head of femur

Symphysis Pubis joint

Cartilaginous joint Right and left pubic bodies articulate both surfaces covered in articular hyaline cartilage- fibrous cartilage disc called Inter Pubic Disc connects the two bones Minimal movements

Radiographic Anatomy of the Pelvis

Gender Differences

Pelvis - Anteroposterior

Gonad Protection

Gonad Protection

Sacro-iliac Joints
Synovial plane joints The sacrum articulates with the articular surface of the ilium. Joint spaces are directed obliquely forward Synovial membrane lines the fibrous capsule Supporting ligaments strengthen the joint

SI Joints cont
Movements restricted to slight anteroposterior rotation during flexion and extension of the trunk

Pathology
Phleboliths-rounded calcification found in the pelvis calcification of the veins, usually rounded with an opaque rim and a transparent inner rim Bladder calculi have the same density throughout

Pathology
Fracture -always check for contra-coup injury Osteoarthritis Pagets disease-unknown cause usually men over 40years- affects lumbar spine, skull, pelvis and long bonesradiographically appears as coarse textured bone

Pathology
Metastatic disease- from Ca bladder or prostate Congenital dislocation of the hip (CDH)spontaneous dislocation of the hip occurring either before or during birth

Pathology SI joints
Subluxation-commonest after pregnancy Ankylosing spondylitis- fusion of the joints of the spine usually start in the SI Joints Radiographically the joint edges become blurred and irregular

Pelvis fracture

Fracture Pubis / Ischium

Fracture Pubis / Ischium

Fracture Pubis / Ischium

Ischeal and Pubic Fractures

Avulsed Ischeal Tubercle

Pubic Symphysis Widening

Fracture Acetabulum

Fracture Acetabulum - ORIF

Osteoarthritis

Osteogenic Sarcoma

Fracture-Dislocation

Chondrosarcoma

Chondrosarcoma

Chondrosarcoma

Metastatic Disease

Metastatic Disease

Metastatic Disease

Pagets Disease

Myeloma

Rickets

Fibrous Dysplasia

Oblique SI joints

Sacroiliac Joint Diastasis

Ankylosing Spondylitis

Sacroiliac Joints

Asymmetry

Iliac Crest

? Fracture

? Fracture