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Citation, DOI & article dataCitation: Murphy, A., Bell, D. Hip (Clements-Nakayama view). Reference article, Radiopaedia.org. (accessed on 08 Sep 2022) https://doi.org/10.53347/rID-53099 The Clements-Nakayama view of the hip is a highly specialized lateral projection utilized on patients with bilateral femoral fractures, or patients unable to mobilize due to postoperative requirements. When performed correctly the projection can yield images of a high diagnostic quality comparable to the horizontal beam lateral hip. This projection can also be utilized to image the femoral shaft in the setting of bilateral femoral fractures (see figure 1). On this page:The projection was first described in 1980 as a method to image patients after total hip arthroplasty 1 however it can be utilized in most scenarios where a lateral view of the hip and the patient is unable to move.
The radiograph has a uniform exposure throughout, evident by the fine bony detail and no areas of overexposure. If the distal femur is overexposed, then a filter may be required. The lesser trochanter can be seen in profile, while the proximal femoral shaft superimposes the greater trochanter. The femoral neck is central to the image and shows no signs of radiographic foreshortening or elongation. There is a clear visualization of the articular surface of the acetabulum and the head of the proximal femur. This is one of the harder projections in trauma imaging to master, it is used infrequently and requires a higher level of skill than standard hip views. Something to consider when setting up for a Clements-Nakayama view is the patient's soft tissue volume, patients with a higher proportion require a steeper posterior angle to clear the other leg. The posterior angle is necessary to achieve a true lateral hip, however, be wary of any metal on the table that may project onto the image. This is why the patient should be as close as safely possible to the edge of the table closest to the detector. The best way to approach the examination would be to consider this projection similar to a shoot through the hip, however, you are angling down rather than raising the leg. Quiz questionsReferencesRelated articles: Imaging in practicePromoted articles (advertising)How much Cr angle from the horizontal is required for the modified Axiolateral?Chapter 8. What central ray angle is required for the Axiolateral projection ClementsHip Axiolateral Clements-Nakayama Modification
Lateral hip image, CR is angled 15 degrees posterior instead of toes being medially rotated.
How much rotation of the body is required for posterior axial oblique projection for acetabulum?The posterior oblique (Judet method) for the acetabulum requires a 10- to 15-degree rotation of the body.
What type of CR angle is required for the posterior axial oblique projection Teufel method?Situation: A PA axial oblique projection (Teufel method) is performed on a patient. The resultant radiograph demonstrates distortion of the acetabulum. The following positioning factors were used: 40° anterior oblique, 12° cephalad CR angle, and CR centered to the upside hip (acetabulum).
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