Presentation
This is a case study on an x-ray phantom to demonstrate different imaging techniques of the Clements-Nakayama projection.
Note the difference the tube angle has on the appearance of the proximal femur, if a neck of femur fracture is suspected, a 10-15 degree angle with cephalad angle to the neck of the femur is most appropriate.
For femoral shaft fractures, a straight tube with 10-20 degrees posterior will produce high quality, femoral shaft images, however, full superimposition of the neck of the femur.
Note the difference the tube angle has on the appearance of the proximal femur, if a neck of femur fracture is suspected, a 10-15 degree angle with cephalad angle to the neck of the femur is most appropriate.
For femoral shaft fractures, a straight tube with 10-20 degrees posterior will produce high quality, femoral shaft images, however, full superimposition of the neck of the femur.
Case Discussion
The Clements-Nakayama view of the proximal femur is a highly specialized lateral projection utilized on patients with bilateral femoral fractures, or patients unable to mobilize due to postoperative requirements.
The angle of the x-ray tube will depend on the anatomy required.
Thanks to Linus Chin for performing these radiographic projections to aid this case study.