Examine Fig. 8.15 as you answer the following questions. Items 31 to 33 pertain to the modified axiolateral projection, Clements-Nakayama method. 15° Fig. 8.15 Modified axiolateral hip, Clements-Nakayama method. 31. List 3 reasons the modified axiolateral (Clements- Nakayama method) of the hip would be preferable to the axiolateral projection (Danelius-Miller method) to image a lateral hip. a) b) c)
The correct Answer and Explanation is:
Three Reasons for Choosing the Clements-Nakayama Method:
- When a Patient Cannot Raise the Opposite Leg The Danelius-Miller method requires the patient to raise the unaffected leg out of the way to properly position the X-ray. If the patient has trauma, mobility limitations, or fractures that prevent them from doing this, the Clements-Nakayama method allows imaging without needing to move the opposite limb.
- Minimized Motion & Patient Discomfort Because the Clements-Nakayama technique keeps both legs down, it can be more comfortable for patients dealing with pain or instability. It minimizes movement during positioning, reducing the risk of further injury while obtaining a high-quality lateral hip image.
- Better for Detecting Subtle Hip Fractures This method provides a modified angle that can enhance the visualization of suspected hip fractures, especially in elderly patients or those with complex fractures. It is particularly useful for identifying femoral neck fractures that may not be clearly seen using other projections.
Explanation
The Clements-Nakayama method is a modified axiolateral hip projection used when the standard Danelius-Miller method cannot be performed. This technique is particularly advantageous in trauma scenarios where the patient cannot lift the unaffected leg due to pain, injury, or medical constraints. Unlike the traditional axiolateral hip projection, where the opposite leg is elevated, the Clements-Nakayama approach allows imaging without significant patient repositioning.
The method is performed by angling the X-ray beam 15° posteriorly, which helps visualize the hip joint while accommodating for anatomical overlap. This adjusted angle makes it easier to diagnose conditions such as femoral neck fractures or hip dislocations with greater accuracy.
Additionally, minimizing patient movement is critical in trauma imaging. Patients who have experienced falls, fractures, or hip surgeries may struggle to position their leg in a way required by the Danelius-Miller projection. By keeping both legs down and adjusting the angle of the X-ray, the Clements-Nakayama method significantly reduces discomfort and risk of further injury while still providing a lateral view of the hip.
Radiographers often prefer this technique for elderly patients and trauma cases where maintaining stability is key. Though it may not be the first-line imaging method, it serves as an essential alternative in specific clinical situations that demand adaptability.
