ORTHO-RADIOLOGY

MEASUREMENT

Scoliosis (Cobb) Angle

Operative indication
Increasing curve in growing child
Severe deformity (>50 degrees)
with asymmetry of trunk in
adolescent
Pain uncontrolled by nonoperative
treatment
Thoracic lordosis
Significant cosmetic deformity

Lordotic
Angle

Cobb Angle : normal

31 500
measured using the
superior end plate of
L1 and the inferior
end plate of L5)

Jacksons Angle :
normal35 - 47 0
measured using the
posterior edge of L1
and posterior edge
ofL5

Lumbo-sacral Angle
(BOXALL)
The lumbosacral
angle, described by
Boxall is defined by
the tangent in the
posterior edge of S1
and the tangent in
the cranial end of L5.
It normally lies
between 90 and
110.

Lumbo-sacral Angle
(FERGUSON)
Formed when an oblique line is drawn
through and parallel to the sacral
base and joined with a line drawn
horizontally.
Normal 41 degrees with standard
deviation of plus or minus 7 degrees
gives a range of 34 to 48 degrees.
An increased angle indicates possible
shearing and compressive forces on
the lumbar facets and posterior disc
causing early degenerative changes.
Decreased angle may affect weight
bearing transfer and contribute to
early disc and vertebra degeneration.

Vertebral body height loss /

compression Fr
Klinis : LBP; spinal
instability; SCI
Frankel A,B,C,D,E
A = 4, a 5cm, a
5 cm
4/(5+5):2 4/5 x
100% = 80%
20%
INDIKASI OPERASI
BILA >50%

10/16/16

Grade 5
10
> 100% slippage

Figure 11.69 The spinous-process sign. The spinous-process sign can

help differentiate true spondylolisthesis from pseudo-spondylolisthesis by the
appearance of a step-off in the spinous processes above the level of
vertebral slip in the former and below that level in the latter.

Spondylolisthesis and
pseudospondylolisthesis.
(A). Lateral view of the lumbar
spine demonstrates the typical
appearance of spondylolisthesis
secondary to a defect in the
pars interarticularis. Note that
the most dorsal aspect of the
spinous process of L-5 forms a
step with that of L-4 above the
level of slippage of L-5. (B) In
spondylolisthesis without
spondylolysis (degenerative
spondylolisthesis), a step-off in
the spinous processes below
the level of vertebral slippage
is an identifying feature.

Patellar tilt angle

Angle between the
horisontal line and
the line joining the
edges of patella
and or the line
along sub chondral
bone of the anterior
patella
Normal : <50

Figure 9.3 Femoropatellar

relationship. The length of
the patella and the patellar
ligament are approximately
equal; normal variability
does not exceed 20%.

Sulcus and congruence angles.

The sulcus angle, formed by lines extending from the deepest point of the
intercondylar sulcus (a) medially and laterally to the tops of the femoral condyles,
normally measures approximately 138.
To determine the congruence angle, the sulcus angle is bisected to establish a reference line
(ba), which is drawn to connect the apex of the patella (b) with the deepest point of the
sulcus (a). In normal subjects, this line is close to vertical. A second line (ca) is then drawn
from the lowest point on the articular ridge of the patella (c) to the deepest point of the
sulcus (a). The angle formed by this line and the reference line is the congruence angle.

If the lowest point on the patellar articular ridge is

lateral to the reference line, then the congruence
angle has a positive value; if it is medial to the
reference line, as in the present example, then the
angle has a negative value. In Merchant's study,
the average congruence angle in normal subjects
was -6 (SD, 11).

An angle of +16 or

greater was found to be associated with

various patellofemoral disorders, particularly
lateral patellar subluxation

Figure 9.40 Subluxation of the patella. A 23-year-old woman

experienced occasional knee pain and buckling, particularly while
jogging. (A) Standard axial view of the patella shows no apparent
abnormalities. (B) Merchant axial view, however, demonstrates lateral
subluxation of the patella. Note the positive congruence angle (see Fig.
9.7).

 The angle of the longitudinal

arch is one of the angles drawn on
the weightbearing
lateral foot radiograph. The angle
is formed between the calcaneal
inclination axisand a line drawn
along the inferior edge of the
5th metatarsal.
The normal angle is 150-170
degrees.
In pes cavus, as the height of the
longitudinal arch increases, the
calcaneal inclination angle
increases. The obtuse angle
between the calcaneal inclination
axis and the 5th metatarsal
decreases below 150 degrees.
In pes planus, the angle of the
longitudinal arch increases such
that the lines become parallel and
the angle exceeds 170 degrees.

Calcaneal Pitch
DEFINITION:
angle formed by the horizontal and a line from the base
of heel & inferior cortex of calcaneus (figure 1). compare
to pes planus (figure 2).
ABNORMAL:
if < 20 degrees then pes planus
if > 25 degrees then pes alta

Femoral neck angle

DEFINITION:
angle formed by axis of femoral
shaft and line drawn along axis of
femoral neck passing through center
of head of femur (figure 2). An
example of coxa valgus is provided
in the top image.
ABNORMAL:
if < 125 degrees then coxa varus
deformity
if > 135 degrees then coxa valgus
deformity

Tibio femoral angle

DEFINITION:
angle between femur axis and
tibia axis. Tibiofemoral angle
positive if both axes have
external concavity; negative if
both axes have internal
concavity.
ABNORMAL:
if < 0 degrees then varus
deformity
if > 10 degrees then valgus
deformity

Boehler angle
DEFINITION:
angle (yellow line) formed by
line drawn from
posterosuperior calcaneal
tuberosity to tip of the posterior
facet of the subtalar joint (red
line) and line from tip of
posterior facet through superior
margin of anterior process of
calcaneus (blue line).
ABNORMAL:
if < 20 degrees compression
of superior aspect of bone,
fracture of calcaneus or of
posterior facet

Carrying Angle
Clear lower arm
from hip when swing
& carrying
Higher in female
For reconstruction
surgey
Normal 5 15
> 15 cubitus valgus

KellgrenLawrenc
e
grading
for knee
OA

Grade 1 : minimal osteophytes at lateral tibial condyle (arrowhead).

Grade 2 : small but definite osteophyte (arrowhead) and sharpening of
tibial spine (arrows) without reduction of joint space.
Grade 3: definite narrowing of medial joint space (arrow) and
osteophyte (arrowhead).
Grade 4: gross loss of lateral joint space (white arrow), marked
osteophytes (arrowheads), and sclerosis of subchondral bone (black
arrow)