IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Clements-Nakayama positioning

Case contributed by Andrew Murphy
Diagnosis not applicable

Presentation

This is a case study on an x-ray phantom to demonstrate different imaging techniques of the Clements-Nakayama projection.

Scroll to see the angle change

Annotated image

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.

Neck of femur vs femoral shaft

Annotated image

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. 

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.