Radiological diagnostics of the coxo-femoral articulation: the correct technique for an effective diagnosis. Case report

Abstract

Purpose

• The correct diagnosis could be missed in the presence of an incomplete or incorrectly performed radiological technique, the proper diagnosis could be missed without an incomplete radiological technique or when it is not well-conducted.
• Knowing the articular biomechanics of the joint compartment to be studied is a fundamental step in the radiological process. It is extremely important to know the biomechanics of the elbow joint because it is a fundamental step of the radiological process.
• The correct radiological technique is one of the many fundamental steps that protects the health and safety of the patient (The right radiological technique is one of the most important medical step to protect the patient's physical health and safety.

Patient's medical history

The medical history concerns a 59-year-old patient who accesses the first-aid point of a hospital unit integrated in the territory, after an accident in the workplace. The man, trying to sit down again on his own workstation, fell on the ground and got a trauma in the back of the left coxo-femoral joint.

The patient, after having been examined by the doctor in 118, arrives at radiology with a request for further radiological diagnosis of the pelvis and left hip. The space referred to the clinical classification reports "workplace injury, gluteus trauma and left side functional pain and impotence". The first radiographic approach has provided beyond the standard projections the oblique projection of the hip known as Frog Legs. Following the first investigation the patient was found to be free of fractures. At the first orthopedic check-up, ten days after the trauma, the patient underwent a radiographic check, which revealed a left hip fracture. The second radiographic approach was different than the first, the projective technique focused on projections that could enhance the painful area of the patient, which after a while still made autonomous walking impossible. In the second radiographic approach the projections that revealed the fracture were free of abduction movements, however, as a last one, an oblique Lauenstein projection was performed. Following clinical deterioration, the patient performed a left hip CT scan within a few days (It is the anamnesis of a fifty-nine-year-old patient that get him to the Emergency Room of an integrated hospital unit area, after an accident at work. Trying to sit on his work station, this man fell down on the ground and injured his left Coxo-femoral joint. After an in depth visit made by the E.R. doctor, the man went to radiology department with a medical request for a deepening pelvis and left hip X-ray. His X-ray results suffer substantial damage: “work-related accident, gluteus muscle and left hip trauma, pain and functional impotence”. The first X-ray interpretation has planned the implementation of the following X-ray projections: Pelvis AP X-ray projections, left hip AP X-ray projections and left hip OBL projections, also known as Frog Legs. After this first check, there was absence of traumatic fractures of the examinated joint. Ten days after the trauma, during the second check, the X-ray projections revealed a left hip fracture. The second radiographic approach was different than the first, the projective technique focused on projections that could enhance the painful area of the patient. In the second radiographic approach the projections showed the fracture were free of abduction movements, however, as a last one, an oblique Lauenstein projection was performed.

Following clinical deterioration, the patient performed a left hip CT scan in a few days.

Conclusions

The radiographer is called to know the correct technique of performing the examinations both as regards the correct exposure and as regards the choice of the best projective approach. The TSRM is required to put into practice its technical and practical knowledge in synergy with its communication skills, in order to be able to interface as best as possible with the patient, in order to carry out the most correct projections to be applied on a joint biomechanical basis. Given the profound correlation between joint physiology and the choice of the most correct radiological projections, one could suggest the inclusion of joint biomechanics as a discipline of the degree course in radiology imaging and radiotherapy techniques.

The Frog Legs projection is used almost exclusively in the study of dysplastic pathology, moreover in most cases it is performed in comparative terms to offer a morphological comparison between the two joints. It is therefore concluded that it is good practice not to perform any projection that foresees abduction in traumatic patients, in order to guarantee an optimal report and protection of the patient's health

In view of the above, we can conclude that a precise diagnosis is an essential quality of a good execution technique. Radiographer should be prepared for every eventuality and he/she should apply all the communication skills, to be able to understand all the patient's needs, in order to make correct projections. For a cultural advancement of radiographer, the knowledge of articular biomechanics is essential to be able to understand what kind of projection are required to answer the diagnostic question, respecting the health and safety of patients.

The Frog Legs projection is used almost exclusively in the study of dysplastic pathology, moreover in most cases it is carried out in comparison to offer a morphological comparison between the two joints.

In conclusion we can say that it is not a good practice to perform projections that foresees abduction in traumatic patients, in order to guarantee an optimal report and protection of the patient's health.