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Hip and Pelvis Overview
MK Jesse, MD; Julia R. Crim, MD
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Overview

  • Acute pelvis injuries can be divided into 3 major categories: disruptions of the pelvic ring, fractures of the acetabulum, and isolated pelvic fractures, which do not involve the acetabulum or disrupt the pelvic ring. Radiologists should be able to categorize the injury into 1 of these patterns based on an AP radiograph of the pelvis obtained as part of the routine trauma evaluation. Additional views, or more often today, CT scans, are used to further categorize the injury pattern and direct treatment.
  • Hip injuries can be divided into 2 major categories: dislocations and fractures. Fractures are further subdivided into femoral head, femoral neck, intertrochanteric, subtrochanteric, or isolated trochanter fractures. Dislocations are most commonly posterior but may be anterior or central.
  • Sports injuries of the pelvis can be divided into intraarticular injuries, impingement syndromes, bursitis, fatigue fractures, and muscle/tendon injuries.
  • The older population may present with insufficiency fractures of the pelvis, bursitis, or tendinopathy and tears of the pelvic musculature.

Terminology

  • Pelvic ring disruptions are generally categorized by mechanism of injury: vertical shear, lateral compression, or AP compression. A clear categorization of injury mechanism is not always possible, however, in which case, the radiologist's role is to describe the fractures and disruption of the SI joint and pubic symphysis.
  • Acetabulum fracture terminology is a source of considerable confusion. The acetabulum consists of contributions from the pubis, ischium, and ilium, the 3 bones that compose the innominate bone. The innominate bone forms the bony bridge from the torso to the lower limb and is crucial for stability and locomotion. It can be divided into 2 columns. The anterior column extends from the sacrum to the pubic symphysis and is recognized on radiographs by the iliopectineal line. The posterior column extends from the sacrum to the ischial tuberosity and is represented on radiographs by the ilioischial line. The sciatic buttress is the critical weight-bearing portion of the columns, extending from the sacrum to the acetabulum. The anterior and posterior acetabular walls form an anteverted cup stabilizing the femoral head but do not provide structural integrity to the pelvis.
  • Fractures of the acetabulum may be categorized as simple patterns or complex combinations of the following: anterior or posterior wall, anterior or posterior column, or transverse. Column fractures are primarily in the coronal plane of the body. Transverse fractures are in the sagittal plane.
  • A fracture of the acetabulum is categorized as a fracture of the anterior or posterior column only when the column is disrupted in 2 places, i.e., not only does the fracture extend through the ilioischial or iliopubic lines, but it also includes a fracture of the inferior pubic ramus or ischial tuberosity. A both-column fracture completely separates the acetabulum from the sacrum, dividing the innominate bone into superior and inferior fragments and disrupting the sciatic buttress. The similar-appearing transverse and T-type fractures are oriented 90° from the both-column fracture; thus, they divide the innominate bone into medial and lateral fragments.
  • Isolated pelvis fractures include fractures of the iliac wing, avulsion injuries at tendon attachments, straddle injuries to the pubic rami, insufficiency fractures, and some fractures of the sacrum. Avulsion injuries usually occur in adolescent patients as Salter-Harris-type injuries.
  • Hip dislocations are categorized as anterior or posterior and are further described by the location of associated fractures.
  • Impingement syndromes are increasingly diagnosed in the pelvis. The most common of these is femoroacetabular impingement, a general term referring to impingement of the femur against the acetabulum due to variant morphology of the femoral head-neck junction or the acetabulum. This is an important cause of premature hip osteoarthritis. Iliopsoas impingement may refer to snapping of the iliopsoas tendon or may produce an isolated anterior acetabular labrum tear and can have a variety of causes. Ischiofemoral impingement refers to impingement of the quadratus femoris muscle between the lesser trochanter and the ischial tuberosity.
  • Muscle and tendon injuries in the pelvis may be acute or due to chronic overuse or degeneration. In athletes, injury to the aponeurosis of the rectus abdominis-adductor longus is an important cause of groin pain. Hamstring injuries are usually caused by forceful abduction (fall on ice), while gluteus medius and minimus tears are usually a chronic, degenerative phenomenon.

Anatomic Considerations

  • The bony pelvis forms a ring, which can be conceptually subdivided in several ways. In the adult, it is composed of 3 bones and 3 articulations. The sacrum articulates via the paired SI joints with the innominate bones on either side, which articulate with each other via the pubic symphysis. The SI joints and pubic symphysis are synovial joints but allow very limited motion. The bony pelvis can also be divided into the anterior portion of the ring, including the innominate bones from the ischial spine to the pubic symphysis, and the posterior ring, including the sacrum and the posterior portion of the innominate bones. Alternatively, the pelvis can be divided into the false pelvis above the iliopectineal line and part of the abdominal cavity and the true pelvis, which lies between the iliopectineal line and the ischial tuberosities.
  • The rectus abdominis and adductor longus tendons have a shared aponeurosis along the anterior surface of the pubic body. Differential stresses by the muscles can cause aponeurosis injuries, an important cause of athletic pubalgia. Athletic pubalgia may also reflect a sports hernia, where there is tearing of the posterior wall of the inguinal canal, osteitis pubis, or stress fracture. In recent years, there has been greater understanding of the complex anatomy of an interrelated group of osseous, tendinous, and visceral structures around the pubic symphysis called the rectus abdominis-adductor aponeurosis.
  • Seemingly minor variants in bony anatomy of the femoral head-neck junction or the acetabular coverage of the femoral head can predispose patients to develop the syndrome of femoroacetabular impingement.

Pathologic Considerations

  • Since the bony pelvis forms a ring, a high-impact injury will usually disrupt the ring in more than 1 place. Discovery of any pelvis disruption should prompt the search for additional injuries. Pelvic ring disruptions are also commonly associated with acetabular injuries, hip dislocations, and injuries elsewhere in the body.
  • Soft tissue injuries frequently accompany trauma to the pelvis. Injuries of the vasculature and urogenital system are highly associated with osseous trauma, and evaluation of all trauma CT scans of the pelvis must include scrutiny of soft tissue images, employing a high suspicion for intrapelvic injury.
  • There is increasing attention paid to impingement syndromes in the hip. Care must be taken by the radiologist to look beyond the clinical diagnosis of impingement for a full evaluation of a multitude of other causes of hip pain.

Imaging Considerations

  • Radiographs of the pelvis are the 1st-line imaging technique in the setting of high-impact trauma, hip fractures, and suspected developmental lesions. On an AP view of the pelvis, the ilioischial, iliopectineal (iliopubic), and arcuate lines should be assessed for incongruence or asymmetry. With pelvis fractures, Judet views or oblique views should be considered. It is wise to remember that a single radiographic view is a 2D survey and is inadequate for complete evaluation of the musculoskeletal pelvis. Standing AP radiograph of the pelvis and frog-leg lateral views of the hips are integral tools for evaluation of femoroacetabular impingement and developmental dysplasia of the hip. Radiographs can be normal in the setting of proximal femur fractures, particularly subcapital femoral neck fractures or pelvis insufficiency fractures. When these entities are suspected and radiographs are equivocal, particularly in osteoporotic patients, MR is the imaging method of choice.
  • There are a number of different lateral views that can be obtained of the hip. In the trauma setting, the groin lateral (cross-table lateral) is always obtained. The patient lies supine, the contralateral hip is flexed and the thigh elevated, and a cross-table beam is directed 10° cephalad, centered on the affected hip. In the sports medicine setting, there are a number of different lateral views obtained, which provide visualization of slightly different portions of the anterior femoral head and neck, and different views of the acetabulum. All are obtained AP. The frog-leg lateral is obtained with the patient supine, the hip and knee flexed, and the soles of the feet placed against each other. The Lowenstein lateral view is obtained with the patient supine, posterior rotation of the pelvis by 45°, flexion of the hip and knee, and the knee flat against the table. The false profile lateral view is obtained with the patient upright, hip and knee extended, and the pelvis rotated 45-65° posteriorly. The modified Dunn lateral is obtained supine with the hip flexed 45°, the knee flexed 90°, and the foot flat against the table.
  • CT has become the standard of care for imaging high-impact pelvis trauma. High-resolution bone CT scans can be generated from standard soft tissue acquisitions obtained during a visceral trauma study. Postprocessing for CT of the osseous pelvis includes coronal and sagittal reformats and a variety of 3D reconstruction techniques. These are useful not only in the setting of trauma but in the evaluation of femoroacetabular impingement and acetabular dysplasia. 3D can be performed using surface rendering of bones, or a translucent algorithm, which mimics radiographs. CT is less sensitive than MR for subtle trabecular bone injuries, such as femoral neck fractures and insufficiency fractures in osteoporotic patients.
  • US has become an important tool for assessing myotendinous injuries around the pelvis. The ability to image while simultaneously performing dynamic maneuvers lends US unique capabilities in the musculoskeletal system. However, it should be reserved as a targeted examination for specific indications rather than a global survey tool.
  • MR is the method of choice for sports injuries and cryptogenic pelvic pain. It is wise to perform large FOV coronal T1 and STIR imaging because the pain generator is often outside the region of clinical suspicion. This is supplemented by smaller FOV, high-resolution imaging of the area of greatest concern. T1 sequences are helpful in detecting fracture lines in subtle trabecular injuries.
  • A noncontrast bony pelvis MR protocol is quick and easy to perform, while also accurate for diagnosing a variety of bone, muscle, and tendon lesions. In the setting of painful lesions, including suspected radiographically occult hip fracture, stress or avulsion fracture, or osteonecrosis, a bony pelvis MR is often the most prudent imaging choice. A 3- or 4-sequence bony pelvis protocol can be implemented for emergency department patients or inpatients to confirm these diagnoses while minimizing impact on a busy MR schedule.
  • An athletic pubalgia MR protocol combines large FOV imaging of the entire pelvis with higher resolution imaging centered on the pubic symphysis. This noncontrast protocol adds a coronal oblique imaging plane prescribed along the plane of the anterior iliac wing and high-resolution sagittal images through the pubic symphysis performed with a surface coil centered over the symphysis. This imaging strategy offers improved specificity for lesions involving the rectus abdominis-adductor aponeurosis and is the protocol of choice in young patients with groin pain or clinical athletic pubalgia.
  • A noncontrast hip MR protocol can be employed when a localized hip injury is suspected in a nonarthritic hip. Such a protocol should include large FOV imaging of the pelvis as well as smaller FOV sequences dedicated to the hip in question, including an oblique axial plane prescribed along the femoral neck on a coronal localizer. Though arthrographic protocols improve conspicuity of labrum and cartilage abnormalities, high-resolution noncontrast protocols are also diagnostic.
  • Direct MR arthrography is the most sensitive imaging method for evaluation of internal derangement of the hip. The hip is injected with a mixture of gadolinium contrast diluted 1:200 with iodinated contrast, saline, and anesthetic. MR arthrographic protocols offer high-resolution imaging of the hip in 3 planes with fat-suppressed T1-weighted spin-echo sequences as well as a more global view of the pelvis in the form of large FOV coronal and axial acquisitions. Oblique axial images are most suited to delineate anterosuperior femoral head-neck morphology. Radial imaging may improve diagnostic accuracy in suspected labrum injury. Intraarticular infusion of anesthetic during the arthrogram injection, with assessment of any change in symptoms during provocative hip maneuvers, can provide further diagnostic information.

Therapeutic Considerations

  • CT and MR have advanced understanding of pelvis injuries, anatomic abnormalities, and overuse syndromes. This in turn has guided advances in surgical treatment. US has an increasing role in both diagnosis and treatment of muscle, tendon, and bursa abnormalities.

Selected References

  1. Mayer SW et al: Comparison of 2D, 3D, and radially reformatted MR images in the detection of labral tears and acetabular cartilage injury in young patients. Skeletal Radiol. 50(2):381-8, 2021
  2. Kheterpal AB et al: Value of response to anesthetic injection during hip MR arthrography to differentiate between intra- and extra-articular pathology. Skeletal Radiol. 49(4):555-61, 2020
  3. Chopra A et al: Comparative reliability and diagnostic performance of conventional 3T magnetic resonance imaging and 1.5T magnetic resonance arthrography for the evaluation of internal derangement of the hip. Eur Radiol. 28(3):963-71, 2018
  4. Nüchtern JV et al: Significance of clinical examination, CT and MRI scan in the diagnosis of posterior pelvic ring fractures. Injury. 46(2):315-9, 2015
  5. Riley GM et al: MRI of the hip for the evaluation of femoroacetabular impingement; past, present, and future. J Magn Reson Imaging. 41(3):558-72, 2015
  6. Scheinfeld MH et al: Acetabular fractures: what radiologists should know and how 3D CT can aid classification. Radiographics. 35(2):555-77, 2015
  7. Alton TB et al: Classifications in brief: Letournel classification for acetabular fractures. Clin Orthop Relat Res. 472(1):35-8, 2014
  8. Khurana B et al: Pelvic ring fractures: what the orthopedic surgeon wants to know. Radiographics. 34(5):1317-33, 2014
  9. Lachiewicz PF: Abductor tendon tears of the hip: evaluation and management. J Am Acad Orthop Surg. 19(7):385-91, 2011
  10. Hodnett PA et al: MR imaging of overuse injuries of the hip. Magn Reson Imaging Clin N Am. 17(4):667-79, vi, 2009
  11. Omar IM et al: Athletic pubalgia and "sports hernia": optimal MR imaging technique and findings. Radiographics. 28(5):1415-38, 2008
  12. Pfirrmann CW et al: MR arthrography of acetabular cartilage delamination in femoroacetabular cam impingement. Radiology. 249(1):236-41, 2008
  13. Parvizi J et al: Femoroacetabular impingement. J Am Acad Orthop Surg. 15(9):561-70, 2007
Related Anatomy
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Related Differential Diagnoses
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References
Tables

Tables

Overview

  • Acute pelvis injuries can be divided into 3 major categories: disruptions of the pelvic ring, fractures of the acetabulum, and isolated pelvic fractures, which do not involve the acetabulum or disrupt the pelvic ring. Radiologists should be able to categorize the injury into 1 of these patterns based on an AP radiograph of the pelvis obtained as part of the routine trauma evaluation. Additional views, or more often today, CT scans, are used to further categorize the injury pattern and direct treatment.
  • Hip injuries can be divided into 2 major categories: dislocations and fractures. Fractures are further subdivided into femoral head, femoral neck, intertrochanteric, subtrochanteric, or isolated trochanter fractures. Dislocations are most commonly posterior but may be anterior or central.
  • Sports injuries of the pelvis can be divided into intraarticular injuries, impingement syndromes, bursitis, fatigue fractures, and muscle/tendon injuries.
  • The older population may present with insufficiency fractures of the pelvis, bursitis, or tendinopathy and tears of the pelvic musculature.

Terminology

  • Pelvic ring disruptions are generally categorized by mechanism of injury: vertical shear, lateral compression, or AP compression. A clear categorization of injury mechanism is not always possible, however, in which case, the radiologist's role is to describe the fractures and disruption of the SI joint and pubic symphysis.
  • Acetabulum fracture terminology is a source of considerable confusion. The acetabulum consists of contributions from the pubis, ischium, and ilium, the 3 bones that compose the innominate bone. The innominate bone forms the bony bridge from the torso to the lower limb and is crucial for stability and locomotion. It can be divided into 2 columns. The anterior column extends from the sacrum to the pubic symphysis and is recognized on radiographs by the iliopectineal line. The posterior column extends from the sacrum to the ischial tuberosity and is represented on radiographs by the ilioischial line. The sciatic buttress is the critical weight-bearing portion of the columns, extending from the sacrum to the acetabulum. The anterior and posterior acetabular walls form an anteverted cup stabilizing the femoral head but do not provide structural integrity to the pelvis.
  • Fractures of the acetabulum may be categorized as simple patterns or complex combinations of the following: anterior or posterior wall, anterior or posterior column, or transverse. Column fractures are primarily in the coronal plane of the body. Transverse fractures are in the sagittal plane.
  • A fracture of the acetabulum is categorized as a fracture of the anterior or posterior column only when the column is disrupted in 2 places, i.e., not only does the fracture extend through the ilioischial or iliopubic lines, but it also includes a fracture of the inferior pubic ramus or ischial tuberosity. A both-column fracture completely separates the acetabulum from the sacrum, dividing the innominate bone into superior and inferior fragments and disrupting the sciatic buttress. The similar-appearing transverse and T-type fractures are oriented 90° from the both-column fracture; thus, they divide the innominate bone into medial and lateral fragments.
  • Isolated pelvis fractures include fractures of the iliac wing, avulsion injuries at tendon attachments, straddle injuries to the pubic rami, insufficiency fractures, and some fractures of the sacrum. Avulsion injuries usually occur in adolescent patients as Salter-Harris-type injuries.
  • Hip dislocations are categorized as anterior or posterior and are further described by the location of associated fractures.
  • Impingement syndromes are increasingly diagnosed in the pelvis. The most common of these is femoroacetabular impingement, a general term referring to impingement of the femur against the acetabulum due to variant morphology of the femoral head-neck junction or the acetabulum. This is an important cause of premature hip osteoarthritis. Iliopsoas impingement may refer to snapping of the iliopsoas tendon or may produce an isolated anterior acetabular labrum tear and can have a variety of causes. Ischiofemoral impingement refers to impingement of the quadratus femoris muscle between the lesser trochanter and the ischial tuberosity.
  • Muscle and tendon injuries in the pelvis may be acute or due to chronic overuse or degeneration. In athletes, injury to the aponeurosis of the rectus abdominis-adductor longus is an important cause of groin pain. Hamstring injuries are usually caused by forceful abduction (fall on ice), while gluteus medius and minimus tears are usually a chronic, degenerative phenomenon.

Anatomic Considerations

  • The bony pelvis forms a ring, which can be conceptually subdivided in several ways. In the adult, it is composed of 3 bones and 3 articulations. The sacrum articulates via the paired SI joints with the innominate bones on either side, which articulate with each other via the pubic symphysis. The SI joints and pubic symphysis are synovial joints but allow very limited motion. The bony pelvis can also be divided into the anterior portion of the ring, including the innominate bones from the ischial spine to the pubic symphysis, and the posterior ring, including the sacrum and the posterior portion of the innominate bones. Alternatively, the pelvis can be divided into the false pelvis above the iliopectineal line and part of the abdominal cavity and the true pelvis, which lies between the iliopectineal line and the ischial tuberosities.
  • The rectus abdominis and adductor longus tendons have a shared aponeurosis along the anterior surface of the pubic body. Differential stresses by the muscles can cause aponeurosis injuries, an important cause of athletic pubalgia. Athletic pubalgia may also reflect a sports hernia, where there is tearing of the posterior wall of the inguinal canal, osteitis pubis, or stress fracture. In recent years, there has been greater understanding of the complex anatomy of an interrelated group of osseous, tendinous, and visceral structures around the pubic symphysis called the rectus abdominis-adductor aponeurosis.
  • Seemingly minor variants in bony anatomy of the femoral head-neck junction or the acetabular coverage of the femoral head can predispose patients to develop the syndrome of femoroacetabular impingement.

Pathologic Considerations

  • Since the bony pelvis forms a ring, a high-impact injury will usually disrupt the ring in more than 1 place. Discovery of any pelvis disruption should prompt the search for additional injuries. Pelvic ring disruptions are also commonly associated with acetabular injuries, hip dislocations, and injuries elsewhere in the body.
  • Soft tissue injuries frequently accompany trauma to the pelvis. Injuries of the vasculature and urogenital system are highly associated with osseous trauma, and evaluation of all trauma CT scans of the pelvis must include scrutiny of soft tissue images, employing a high suspicion for intrapelvic injury.
  • There is increasing attention paid to impingement syndromes in the hip. Care must be taken by the radiologist to look beyond the clinical diagnosis of impingement for a full evaluation of a multitude of other causes of hip pain.

Imaging Considerations

  • Radiographs of the pelvis are the 1st-line imaging technique in the setting of high-impact trauma, hip fractures, and suspected developmental lesions. On an AP view of the pelvis, the ilioischial, iliopectineal (iliopubic), and arcuate lines should be assessed for incongruence or asymmetry. With pelvis fractures, Judet views or oblique views should be considered. It is wise to remember that a single radiographic view is a 2D survey and is inadequate for complete evaluation of the musculoskeletal pelvis. Standing AP radiograph of the pelvis and frog-leg lateral views of the hips are integral tools for evaluation of femoroacetabular impingement and developmental dysplasia of the hip. Radiographs can be normal in the setting of proximal femur fractures, particularly subcapital femoral neck fractures or pelvis insufficiency fractures. When these entities are suspected and radiographs are equivocal, particularly in osteoporotic patients, MR is the imaging method of choice.
  • There are a number of different lateral views that can be obtained of the hip. In the trauma setting, the groin lateral (cross-table lateral) is always obtained. The patient lies supine, the contralateral hip is flexed and the thigh elevated, and a cross-table beam is directed 10° cephalad, centered on the affected hip. In the sports medicine setting, there are a number of different lateral views obtained, which provide visualization of slightly different portions of the anterior femoral head and neck, and different views of the acetabulum. All are obtained AP. The frog-leg lateral is obtained with the patient supine, the hip and knee flexed, and the soles of the feet placed against each other. The Lowenstein lateral view is obtained with the patient supine, posterior rotation of the pelvis by 45°, flexion of the hip and knee, and the knee flat against the table. The false profile lateral view is obtained with the patient upright, hip and knee extended, and the pelvis rotated 45-65° posteriorly. The modified Dunn lateral is obtained supine with the hip flexed 45°, the knee flexed 90°, and the foot flat against the table.
  • CT has become the standard of care for imaging high-impact pelvis trauma. High-resolution bone CT scans can be generated from standard soft tissue acquisitions obtained during a visceral trauma study. Postprocessing for CT of the osseous pelvis includes coronal and sagittal reformats and a variety of 3D reconstruction techniques. These are useful not only in the setting of trauma but in the evaluation of femoroacetabular impingement and acetabular dysplasia. 3D can be performed using surface rendering of bones, or a translucent algorithm, which mimics radiographs. CT is less sensitive than MR for subtle trabecular bone injuries, such as femoral neck fractures and insufficiency fractures in osteoporotic patients.
  • US has become an important tool for assessing myotendinous injuries around the pelvis. The ability to image while simultaneously performing dynamic maneuvers lends US unique capabilities in the musculoskeletal system. However, it should be reserved as a targeted examination for specific indications rather than a global survey tool.
  • MR is the method of choice for sports injuries and cryptogenic pelvic pain. It is wise to perform large FOV coronal T1 and STIR imaging because the pain generator is often outside the region of clinical suspicion. This is supplemented by smaller FOV, high-resolution imaging of the area of greatest concern. T1 sequences are helpful in detecting fracture lines in subtle trabecular injuries.
  • A noncontrast bony pelvis MR protocol is quick and easy to perform, while also accurate for diagnosing a variety of bone, muscle, and tendon lesions. In the setting of painful lesions, including suspected radiographically occult hip fracture, stress or avulsion fracture, or osteonecrosis, a bony pelvis MR is often the most prudent imaging choice. A 3- or 4-sequence bony pelvis protocol can be implemented for emergency department patients or inpatients to confirm these diagnoses while minimizing impact on a busy MR schedule.
  • An athletic pubalgia MR protocol combines large FOV imaging of the entire pelvis with higher resolution imaging centered on the pubic symphysis. This noncontrast protocol adds a coronal oblique imaging plane prescribed along the plane of the anterior iliac wing and high-resolution sagittal images through the pubic symphysis performed with a surface coil centered over the symphysis. This imaging strategy offers improved specificity for lesions involving the rectus abdominis-adductor aponeurosis and is the protocol of choice in young patients with groin pain or clinical athletic pubalgia.
  • A noncontrast hip MR protocol can be employed when a localized hip injury is suspected in a nonarthritic hip. Such a protocol should include large FOV imaging of the pelvis as well as smaller FOV sequences dedicated to the hip in question, including an oblique axial plane prescribed along the femoral neck on a coronal localizer. Though arthrographic protocols improve conspicuity of labrum and cartilage abnormalities, high-resolution noncontrast protocols are also diagnostic.
  • Direct MR arthrography is the most sensitive imaging method for evaluation of internal derangement of the hip. The hip is injected with a mixture of gadolinium contrast diluted 1:200 with iodinated contrast, saline, and anesthetic. MR arthrographic protocols offer high-resolution imaging of the hip in 3 planes with fat-suppressed T1-weighted spin-echo sequences as well as a more global view of the pelvis in the form of large FOV coronal and axial acquisitions. Oblique axial images are most suited to delineate anterosuperior femoral head-neck morphology. Radial imaging may improve diagnostic accuracy in suspected labrum injury. Intraarticular infusion of anesthetic during the arthrogram injection, with assessment of any change in symptoms during provocative hip maneuvers, can provide further diagnostic information.

Therapeutic Considerations

  • CT and MR have advanced understanding of pelvis injuries, anatomic abnormalities, and overuse syndromes. This in turn has guided advances in surgical treatment. US has an increasing role in both diagnosis and treatment of muscle, tendon, and bursa abnormalities.

Selected References

  1. Mayer SW et al: Comparison of 2D, 3D, and radially reformatted MR images in the detection of labral tears and acetabular cartilage injury in young patients. Skeletal Radiol. 50(2):381-8, 2021
  2. Kheterpal AB et al: Value of response to anesthetic injection during hip MR arthrography to differentiate between intra- and extra-articular pathology. Skeletal Radiol. 49(4):555-61, 2020
  3. Chopra A et al: Comparative reliability and diagnostic performance of conventional 3T magnetic resonance imaging and 1.5T magnetic resonance arthrography for the evaluation of internal derangement of the hip. Eur Radiol. 28(3):963-71, 2018
  4. Nüchtern JV et al: Significance of clinical examination, CT and MRI scan in the diagnosis of posterior pelvic ring fractures. Injury. 46(2):315-9, 2015
  5. Riley GM et al: MRI of the hip for the evaluation of femoroacetabular impingement; past, present, and future. J Magn Reson Imaging. 41(3):558-72, 2015
  6. Scheinfeld MH et al: Acetabular fractures: what radiologists should know and how 3D CT can aid classification. Radiographics. 35(2):555-77, 2015
  7. Alton TB et al: Classifications in brief: Letournel classification for acetabular fractures. Clin Orthop Relat Res. 472(1):35-8, 2014
  8. Khurana B et al: Pelvic ring fractures: what the orthopedic surgeon wants to know. Radiographics. 34(5):1317-33, 2014
  9. Lachiewicz PF: Abductor tendon tears of the hip: evaluation and management. J Am Acad Orthop Surg. 19(7):385-91, 2011
  10. Hodnett PA et al: MR imaging of overuse injuries of the hip. Magn Reson Imaging Clin N Am. 17(4):667-79, vi, 2009
  11. Omar IM et al: Athletic pubalgia and "sports hernia": optimal MR imaging technique and findings. Radiographics. 28(5):1415-38, 2008
  12. Pfirrmann CW et al: MR arthrography of acetabular cartilage delamination in femoroacetabular cam impingement. Radiology. 249(1):236-41, 2008
  13. Parvizi J et al: Femoroacetabular impingement. J Am Acad Orthop Surg. 15(9):561-70, 2007