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zAnatomy (duplicate) > Anatomy - hip and pelvis > Flashcards

Anatomy - hip and pelvis Flashcards

1
Q

List four dangers of the Stoppa approach

A

Corona Mortis (lateral 1/3 sup. pubic ramus)Bladder (insert foley)Obturator nerve and vessels (when exposing quad plate)External iliac vessels (mobilize early)

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2
Q

What is the potential space of retzius ?

A

Anterior to bladder post to pubic symphisis

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3
Q

What muscle do you have to take down to see quadrilateral plate?

A

Rectus abdominus

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4
Q

What fascia separates the middle and lateral window of the ilioinguinal approach?

A

Iliopectineal fascia

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5
Q

List five contents of the Greater sciatic notch

A

piriformissuperior and inferior gluteal vessels and nervessciatic and posterior femoral cutaneous nervesinternal pudendal vesselsnerves to the obturator internus and quadratus femoris

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6
Q

List the structures that separate the windows in the ilioinguinal approach

A

Lateral: Iliac wing to Iliopsoas and femoral nerveMiddle: psoas to External iliac vesselsMedial: External iliac vesselst to rectus abdominus

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7
Q

What are the Denis zones of the sacrum?

A

1: lateral to foramen2: middle3: medial to foramina into spinal canal

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8
Q

What nerve root runs along the sacral ala?

A

L5

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9
Q

What is the sacral ala?

A

Top of sacrum forming iliosacral triangle

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10
Q

What is the importance of iliac cortical density?

A

On the lateral this parallels the alar slope, you want to be below this when inserting an SI screw

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11
Q

On an AP pelvis is the posterior wall lateral or anterior?

A

Lateral!

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12
Q

Judet views describe

A

Obturator oblique - AC (iliopectineal line), PWIliac oblique - AW, PC (ilioischial line)

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13
Q

What is a morale lavale lesion?

A

Internal degloving of subcutaneous tissue off of the lumbosacral fascia

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14
Q

What are key SI ligaments? What are the other three important ones?

A

Anterior, Posterior, InterosseousSacrotuberous, Sacrospinous, Iliolumbar ligament

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15
Q

Name the Contents of the Sciatic Notch Relative to Piriformis

A

Contents of GSNAbove piriformis:Superior Gluteal Nerve & ArteryBelow Piriformis:Pudendal nerve and internal pudendal arteryNerve to obturator internusPosterior femoral cutaneous nerveSciatic nerveInferior gluteal artery and nerveNerve to quadratus femoris

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16
Q

What travels through LSN?

A

Obturator internus muscleNerve to obturator internusPudendal nerveInternal pudendal vein

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17
Q

What is the cruciate anastomosis made of?

A

First perforator of profundaInferiorgluteal arteryMCFALCFAClinical Relevance:The cruciate anastomosis is clinically relevant because if there is a blockage between the femoral artery and external iliac artery, blood can reach the popliteal artery by means of the anastomosis. The route of blood is:Internal iliac –> inferior gluteal artery –> a perforating branch of the deep femoral artery –> lateral circumflex femoral artery –> its descending branch –> superior lateral genicular artery –> popliteal artery.

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18
Q

Nerves relative to psoas Lateral (3) Medial (2) Between iliac and psoas 1 Piercing than anterior

A

Lateral - iliohypogastric, lioinguinal, LFCNMedial - obturator, lumbosacral trunkBetween - femoralPiercing - genitofemoral

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19
Q

What nerve is at risk with a retractor under transverse acetabular ligament?

A

Obturator

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20
Q

How can we adduct after an obturator neurectomy

A

Pectineus, femoral

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21
Q

What nerve is above piriformis?

A

Superior gluteal nerve

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22
Q

What structure is most at risk of posterior ICBG harvest?

A

Superior gluteal artery, to a lesser extent cluneal nerves

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23
Q

Between What muscles does the posterior obturator nerve run between?

A

Adductor brevis and magnus

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24
Q

In the anterior Smith-Peterson approach the deep interval is between?

A

Rectus femoris and Gluteus medius

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25
Q

Name the ligaments connecting the pubic sympysis

A

Superior pubic ligament (stronger)Inferior (arcuate) public ligament

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26
Q

What type of joint is the pubic symphysis?

A

Synovial amphiarthroidal joint

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27
Q

What do the medial sacral crest and alae of the sacrum represent embryologically?

A

Medial sacral crest: fused spinous processesAlae and SI articular processes: fused TP and costal processes

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28
Q

What strucures are near the posterior sacral foramina?

A

Dorsal primary rami

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29
Q

What structures are near the anterior sacral foramina?

A

Ventral primary rami

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30
Q

In which direction are the coccyx of men and women directed?

A

Men: anteriorly towards pubis (like a penis)Women: vertically

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31
Q

List the signs of sacral dysmorphism

A

5 signs:Sacralization of L5Lumbarization of S1Mammillary processesOval or oblong foramenTongue in Groove sign of SI joint

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32
Q

What are the superficial surface markings of the SI joint?

A

Dimples of Venus

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33
Q

At what age are the SI joints fused by?

A

Age 50

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34
Q

Name the ligaments of the SI joint

A

PosteriorAnteriorInterosseous

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35
Q

WHere does the sacrotuberous ligament, sacrosinous ligament and iliolumbar ligaments run?

A

Sacrotuberous: sacrum to ischial tuberositySacrospinous: sacrum to ischial spineIliolumbar: iliac crest fo 5th lumbar TP

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36
Q

What are the boundaries of the greater sciatic notch?

A

PSISIschial spineNote: the sacrospinous ligament changes the “notch” into a “foramen”

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37
Q

What are the borders of the lesser sciatic foramen?

A

Ischial spine and tuberositysacrospinous ligament (superior border)sacrotuberous ligament (inferior border)

38
Q

What the obturator foramen, membrane and canal?

A

Foramen: big hole between pubic ramiMembrane: Membrane that covers the foramen (obturator int/ext attach)Canal: superior opening in membrane, allowing passage of obturator n/a/v

39
Q

What attaches to the obturator membrane?

A

Obturator internusand externus

40
Q

What is the anteversion of the femoral neck?

A

15 degrees

41
Q

What is the average neck shaft angle of the femur?

A

~127 degrees

42
Q

What is the version of the acetabulum?

A

15 degrees anteverted (to match the femur)

43
Q

What are the ligaments that make up the hip capusle?

A

Anterior:Iliofemoral ligament (Y ligament of Bigelow): Strongest ligament that runs from AIIS to intertrochanteric linePubofemoral ligamentPosterior:Ischiofemoral ligament: attaches to femoral neck

44
Q

What is the zona orbicularis?

A

Circular fibers that form a collar around the femoral neckForm the annular ligament of the femoral neck

45
Q

The labrum is continuous with what structure?

A

Transverse acetabular ligament

46
Q

Describe the criteria for an adequate AP pelvis x-ray

A

Coccyx in line with symphysisSymmetric teardropssymmetric Obturator foraminaSymhysis:sacrococcygeal distance of:32mm in men47mm in women

47
Q

What angle is classically measured off a Dunn view?

A

Alpha angleThe alpha angle is formed by a line drawn from the center of the femoral head through the center of the femoral neck, and a line from the center of the femoral head to the femoral head/neck junction, found by the point by which the femoral neck diverges from a circle drawn around the femoral head. At present, the upper end of normal is an alpha angle of 50 - 55 degrees.

48
Q

What angle is measured from a false profile view?

A

Anterior CEA

49
Q

List the 6 fundamental lines of Letournel

A

Anterior wallPosterior wallroof (or dome/tectum)iliopectineal line (anterior column)ilioischial line (posterior column)teardrop

50
Q

List the levels of:Aortic bifurcationCommon iliac bifurcation

A

Aortic bifurcation: L4Common iliac bifurcation: S1

51
Q

Name the branches of the internal iliac artery (6)

A

ObturatorSuperior and inferior glutealInternal pudendalVesicularLateral sacral

52
Q

What is the corona mortis? Where is it located?

A

Common Anatomic variant (+ in 83%)Anatomosis between:Obturator + external iliac OR inferior epigastric arteries orLocated 40-96mm from the pubic symphysis (median 6cm)

53
Q

What are the branhces of the profunda femoral artery?

A

Medial and lateral femoral circumflex arteriesPerforators

54
Q

Descibe the course of the femoral artery in the thigh

A

Enters thigh from under inguinal ligament as the common femoral artery, a continuation of the external iliac arteryHere, it lies midway between the ASIS and the symphysis pubisThe common femoral artery gives off the profunda femoris artery and becomes the superficial femoral arterySuperficial descends along the anteromedial part of the thigh in the femoral triangleThen it enters and passes through the adductor (subsartorial) canalBecomes the popliteal artery as it passes through an opening in adductor magnus near the junction of the middle and distal thirds of the thigh

55
Q

What is the primary blood supply to femoral head?

A

Medial femoral circumflex artery

56
Q

Describe the proximal femur blood supply

A

MFCA: femoral head via retinacular vesselsLFCA: GTObturator: vessels within ligamentum teres

57
Q

What are the borders of the femoral triangle?What makes up the floor, in what order?

A

Sartorius: laterallyAdductor longus: mediallyinguinal ligament: superiorlyFloor (lat to med): iliacus, psoas, pectineus, adductor longus

58
Q

What are the contents of the femoral triangle?

A

NAVEL (spell NAVEL towards the navel, aka lateral to medial)

59
Q

Describe the safe zone for acetabular screws:Which zone is safe? Dnagerous? What is at risk in each zone?

A

Divided into quadrants with one line running from ASIS to center of acetabulum and another line perpendicular to thatPosterior superior (Safest): sciatic nerve, superior gluteal n/a/vPosterior inferior: safe if screws Anterior superior: UNSAFE: external iliac artery/veinsAnterior inferior: UNSAFE: obturator n/a/v (b/c aiming for obturator foramen)

60
Q

Name the short external rotators, from most proximal to most distal:

A

PiriformisGemellus superiorObturator internusGemellus inferiorObturator externusQuadratus femoris

61
Q

Name the OINA of all the muscles of the hip - see list in answers

A

Good luck

62
Q

Name the hip flexors and extensors:

A

Flexors:IliopsoasRectus femorisSartoriusExtensors:Gluteus maximusHamstrings: (ST, SM, BF)

63
Q

Name the hip aB and aDDuctors

A

ABductors:gluteus mediusgluteus minimusTFL (in a flexed hip)Adductors:Adductor brevis, longus, magnusPectineusGracilis

64
Q

What is the innervation of adductor magnus?

A

Dual:Obturator (adductor) posterior divisionTibial of sciatic (hamstrings)

65
Q

Name the internal rotators of the hip

A

Gluteus medius (anterior fibers)Gluteus minimus (anterior fibers)TFLsemimembranosussemitendinosuspectineusadductor magnus (posterior fibers)

66
Q

Describe the lubosacral plexus +/- draw it…..

A

Made up of lumbar and sacral plexi from T12 - S3Lumbar plexus: ventral rami of L1-L4 on anterior surface of quadratus lumborum within/deep to psoas majorSacral plexus: ventral rami from L4-S4

67
Q

Name the origin and course of femoral nerve

A

Origin: L2-4Emerges between psoas and ilicusRuns superficial and medial to psoas tendonInto femoral triangledivides and innervates quads

68
Q

What is the origin of LFCN and where does it exit pelvis?

A

L2-3Exits pelvis under inguinal ligament, 2cm distal to ASIS

69
Q

Where is the sciatic nerve most likely to be found in relation to piriformis and SERs?

A

Deep to piriformis, superficial to SER- Usually sits on top of SER, that’s why during a posterior approach you can use them to protect it

70
Q

What is the internervous plane of the anterior approach to the hip?

A

Femoral and superior gluteal nerveSuperficial: sartorius & TFLDeep: Rectus femoris and gluteus medius

71
Q

In the lateral approach to the hip, where does the superior gluteal nerve run?

A

3-5cm above GT

72
Q

What is the interval for the medial (Ludloff) approach to the hip?

A

Incision: 3cm below pubic tubercleNo real internervous planeSuperficial: adductor longus/gracilis: both anterior division of obturator nerveDeep: adductor brevis and adductor magnus: posteriorly by sciatic nerve, anterior adductor division by the posterior division of the obturator nerveDangers:Anterior division of obturator nerve between longus/brevisPosterior division of obturator nerve on magnus & under brevisMedial femoral circumflex artery on distal psoas

73
Q

Name the dangers of the ilioinguinal approach

A

Nerves:Femoral nerve: running beneath inguinal canal on iliopsoasLFCN: medial to ASIS beneath external obliqueVessels:Femoral vessels: in femoral sheathInferior epigastric artery: medial to inginal ring. LigateCorona mortisOther:BladderSpermatic cord/round ligament

74
Q

Where do the cluneal nerves run in a posterior bone graft approach?

A

8cm lateral to midline, so stay medial

75
Q

Where do the superior gluteal vessels run in a posterior approach to bone graft?

A

Near the sciatic notchStay proximal to sciatic notch

76
Q

What is the most common nerve injured during THA?

A

Sciatic, peroneal division b/c it is more lateral

77
Q

What is the only muscle innervated by peroneal nerve proximal to the fibular neck?

A

Short head of biceps femoris

78
Q

What is the most common complication in posterior iliac crest bone graft harvesting?

A

Injury to the superior gluteal artery

79
Q

Which vessel provides the dominant supply to the femoral head?

A

Lateral epiphyseal vessels of the MCFA

80
Q

A patient is undergoing percutaneous S1 SI screw fixation for a sacroiliac joint diastasis. What is the most common strength deficit sequela of this proposed screw trajectory? 1. Loss of hip flexion2. Loss of knee extension3. Loss of ankle dorsiflexion4. Loss of great toe extension5. Loss of ankle plantar flexion

A

4: Loss of great toe extension due to damage to L5

81
Q

What is the only hip approah with a true internervous plane? What is the plane?

A

Anterior (Smith Peterson) approachFemoral & superior gluteal nervesSuperficial: Sartorius & TFLDeep: G. med & rectus femoris

82
Q

What are the dangers of the anterior approach to the hip?

A

LFCN: 2.5cm below ASIS, passing over sartorius- Go through fascia of TFL (Hueter approach) to avoid damaging itFemoral artery and nerveAscending branch of LFCA

83
Q

What are the planes and dangers of the lateral approach to the hip?

A

Plane: No true internervous plane:Muscle splitting: Gluteus medius (SGN) proximally and v.laterais (femoral) distallyDangers:SGN: 3-5cm proximal to GTFemoral bundle: gentle anterior retractor placementTransverse branch of the lateral femoral circumflex artery

84
Q

What is the plane and dangers of the anterolateral approach to the hip?

A

Plane: No true internervous plane: SGNTFL/G. mediusDangers:femoral n/a/v overlying psoas: protect with careful anterior retraction

85
Q

What is the plane/dangers of the posterior approch to the hip?

A

Plane: No true plane: ITB/glut maximus splitDangers:Sciatic nerve: reflect SER to protect it. Beware early division variantInferior gluteal artery: when splitting g.max, ligate/coagulate if seen. May retract into pelvis causing uncontrollable bleedingAscending branches of medial femoral circumflex artery. Protect by preserving quadratus femoris. Safe to release the proximal 1cm of quadratus femoris

86
Q

What is the most common position of the sciatic nerve in relation to the piriformis? What are the other variants?

A

See picture

87
Q

Describe the position, incision, plane and dangers of the surgical dislocation of the hip:

A

Position: LateralIncision: Lateral skin incision or one that is just anterior to the usual posterior approach incisionPlane: None: SGN onlyIncise TFL & ID g. mediusGT osteotomyElevate g. minimus and capsuleCapsulotomyDislocate anteriorly

88
Q

Describe the medial approach to the hip:PositionIncisionPlaneDangers

A

Position: Supine with hip flexed, abducted and ER (figure 4)Incision: 3cm below pubic tubercle. Can be either mini transverse (for adductor release) or longitudinal down adductor longusPlane:Superficial: adductor longus/gracilis. Both anterior division of the obturator nerveDeep: Adductor brevis/Adductor magnus. Posteriorly by sciatic nerve. Anteriorly by posterior division of the obturator nerveDangers:Anterior division of obturator nerve: between longus and brevisPosterior division of obturator nerve: runs on adductor magnus and under brevisMedial femoral circumflex artery: runs medally on distal part of psoas tendon

89
Q

What are the dangers in a posterior approach to PSIS for bone grafting? what is more commonly injured?

A

Superior gluteal a/v (more commonly injured)Cluneal nerves: 8cm lateral to midline at PSIS

90
Q

What does the external iliac artery become?

A

Common femoral artery, after the inguinal ligament

zAnatomy (duplicate) (13 decks)

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