Radiographic Synopsis

AP projection. Radiographic recognition is easy when an overt intrapelvic bulge of the acetabulum is seen, but may be difficult in subtle cases, given the overlap with normal variations in acetabular depth.

1. Loss of the 'teardrop' configuration obtained by the intersection of the acetabular line (laterally) with the ilioischial line (medially) is not a reliable indicator, since it is affected by minor degrees of rotation (Resnick and Niwayama. 1995). Similarly, mere 'crossing' of the acetabular line and ilioischial line alone is also not adequate.

2. A radiographic diagnosis of abnormal protrusion can be made with confidence when the distance between the medially located acetabular line and the laterally located ilioischial line is more than 3 mm in adult men or more than 6 mm in adult women (Resnick and Niwayama 1995). Abnormal values in children are over 1 mm for boys and over 3 mm for girls (Crichton and Curlewis 1962). 3. Marked beaking of the Y-cartilage associated with coxa vara may be the initial signs of developing protrusio acetabuli.

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