The innominate bones are formed from three separate bones – the pubis, ilium and ischium. The bony pelvis consists of the sacrum, coccyx and a pair of innominate bones. Understanding pelvic anatomy and utilising the pelvic reference lines, arcs and stripes are therefore useful and can translate to better patient care. This may aid in early detection of potentially debilitating abnormalities, particularly in relation to paediatric hip pathology, and help prevent long-term adverse sequelae. By correctly utilising these reference guides, very subtle abnormalities may be detected and further appropriate imaging and treatment can be initiated. For example, when assessing for the presence of a fracture in an elderly patient, one should not reference the line of Klein, which is used for evaluating the presence of slipped upper femoral epiphysis (SUFE) on a pelvic radiograph. Some of the reference guides are used for age-specific populations, some for symptom-specific scenarios and some for problem solving. This pictorial essay reviews pertinent reference guides that are utilised for reporting plain radiographs of the pelvis and demonstrates various pathologies that distort their appearance. The overlapping and complex configuration of pelvic anatomic structures form the bases of the lines, arcs and stripes concept in assessment of pelvic radiographs. Other more dedicated pelvic radiograph projections are often only performed for problem solving and usually requested by specialist orthopaedic surgeons. The conventional pelvic radiograph remains the primary imaging modality for the assessment of osseous structures related to the pelvic girdle and hips in both adult and paediatric populations.
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