Anatomy - pelvis and hip 2 Flashcards
when does trirardiate cartilage fuse?
14-16yo
what type of joint is the pubic symphysis?
non-synovial amphiarthroidal jointhas fibrocartilagenous disc
what are the pubic symphysis ligaments? which is strongest?
superior pubic ligament (strongest)inferior (arcuate) pubic ligament
coccyx points which way?
men: anteriorlywomen: vertically
signs of sacral dysmorphism? clinical relevance?
sacralization of L5lumbarization of S1mamillary processesoval/oblong foraminatongue-in-groove signnarrowed S1 tunnel (for SI screws)recessed sacral ala puts L5 nerve root at risk when XRays appear to show intraosseous screws
what type of joint is the SI joint? when does it fuse?
diarthroidal, gliding synovialfuses by age 50
list the SI joint ligaments
anterior SI ligsposterior SI ligsinterosseous SI ligs
what ligament runs from:sacrum to ischial spinesacrum to ischial tuberosityiliac crest to L5 transverse process
sacrospinoussacrotuberousiliolumbar
boundaries of greater sciatic notch?
ischial spineiliumsacrospinous ligament
greater sciatic notch contents SUPERIOR to piriformis muscle
superior gluteal n and a (and v, vena comitantes)
contents of greater sciatic notch INFERIOR to piriformis muscle
POPS IQpudendal n and internal pudendal a (and v, vena comitantes)nerve to Obturator internusposterior femoral cutaneous nsciatic ninferior gluteal n and a (and v, vena comitantes)nerve to Quadratus femoris
boundaries of the lesser sciatic notch
ischial spineischial tuberositysacrospinous ligsacrotuberous lig
contents of lesser sciatic notch
obturator internusnerve to obturator internuspudendal ninternal pudendal a (and v)
what is the obturator canal and what does it contain?
opening at superior end of obturator membraneobturator n,a,v pass thru it
normal femoral anteversion as adult and at birth?
15 deg. 30-40deg at birth
normal neck shaft angle of femur of adult and at birth?
127 deg. 150 at birth.
acetabular anteversion?
15 deg
name the ligaments that make up the hip capsule. What is strongest?
anterior:iliofeoral lig (Y-lig of bigelow) - strongest lig in body. from AIIS to intertroch linepubofemoral ligposterior:ischiofemoral lig
what is the zona orbicularis?
circular fibres forming a collar at femoral neck - like its own “annular ligament”
acetabular labrum is ____ with the cartilage posteriorly and _____ anteriorly
continuous, marginally attached
acetabular labrum functions: name 2
deepens socket by 30%seals fluid - protects cartilage
adequate AP pelvis xray: list criteria
coccyx in-line with symphysissymmetrical teardrops, obturator foramina, iliac wingssymphysis to sacro-coccygeal junction vertical distance (difficult to see): 32mm men, 47mm womensympysis to tip of cocyx: 1-3cm
what is the utility of frog-leg lateral xray of hip?
profile of head/neck junctionsee subtle SCFEs
How is the Dunn view taken?what is its utility?
hip flexed to 45 or 9020 deg abduction, neutral rotationbeam shot straight down at hiputility: profiles head/neck junction to check alpha angle for FAI (
how do you take a false profile xray?what is its utility?
standing patientER body relative to cassette 65 degbeam centred on fem headutility: for anterior CEA: 40=pincer
what spinal level is the aortic bifurcation?common iliac bifurcation?
L4, S1
name the internal iliac artery branches
obturatorsuperior glutealinferior glutealinternal pudendalvesicularlateral sacral
what is the corona mortis and where is it?
anatomic variantanastomosis between obturator artery and either external iliac or inf epigastric arteryocurs variable distance from symphysis, behind sup pub ramus (40-96mm from symphysis)
what two major arteries supply the proximal femur?they are branches of what?
MFCA and LFCAbranch of profunda femoris
describe the path of the superficial femoral artery(start from external iliac artery)
external iliac artery crosses under inguinal ligament into femoral trianglebecomes common femoral arterydivides into profunda femoris and superficial femoral arterySFA runs along anteromedial thigh under sartoriusin hunter’s canalbetween vastus med and adductor longusexits through adductor hiatusgoes through adductor hiatus and becomes popliteal artery
describe the path of the medial fem circumflex artery
between pectineus and psoas anteriorlythen btw obt externus and adductor brevisthen btw adductor magnus and brevisthen along superior edge of quad femascending branch runs over obturator externus, deep to piriformis into piriformis fossa
describe the path of the lateral fem circumflex artery
lies deep to rectus and sartoriusascending br to GTdescending br under lateral rectus
what is the cruciate anastomosis?significance?
anastomosis of:inferior gluteal aMFCALFCAfirst perforator of profunda (ascending branch)allows collateral flow in case blockage between ext iliac and femoral arteries
femoral triangle:borders and floor?
sartorius, adductor longus, inguinal ligfloor: (lat to med)iliacus, psoas, pectineus add longus
fem triangle contents
lat to med:fem N, A, V, and LymphaticsNAVAL
acetabular zones - what defines them?
line from centre of acetab to ASISline perpendicular to that one thru centre of acetabget 4 zones: PS, PI, AS, AI
acetabular zone: posterior superiorsafe for screws?risks?
safe.risks: i.e. the stuff in GSN above piriformis and originating above this pointsuperior gluteal n,a,vsciatic n
acetabular zone: posterior inferiorsafe?risks?
saferisks: (the stuff in GSN below piriformis)sciatic ninf gluteal n,a,vpudendal ninternal pudendal a,v(not posterior fem cutaneous n or n to quad fem)
acetabular zone: anterior superiorsafe?risks?
NOT SAFErisks: external iliac vessels
acetabular zone: anterior inferiorsafe?risks?
NOT SAFErisks: obturator n,a,v
name the hip flexors
iliopsoasrectus femorissartorius
name the hip extensors
glut maxhamstrings (semi T, semi M, biceps fem)
name the hip abductors
glut medglut minTFL (in flexed hip)
name the hip adductors
adductor longus/brevis/magnuspectineusgracillis
list the short external rotators of the hip from superior to inferior (in terms of insertion site)
piriformis - ventral sacrum to piriformis fossasup gemellusobt internusobt externus:inf gemellusquad femoris
list the hip internal rotators
glut medius - anterior fibresglut min - anterior fibresTFLsemi-Msemi-Tpectineusadductor magnus - posterior fibres
list the nerves coming off lumbosacral plexus LATERAL to psoas
iliohypogastric nilioinguinal nLFCN
list the nerves coming off lumbosacral plexus MEDIAL to psoas
obturator nlumbosacral trunk
what nerve emerges between psoas and iliacus?
femoral n
what nerve pierces the psoas and lies anterior to it?
genitofemoral n
where is the LFCN relative to the ASIS?
2cm medially
what is most common nerve injury during THA? Which division and why?
sciatic n.peroneal division b/c more lateral
what is the only muscle innervated by peroneal n proximal to fibular neck?
short head of biceps femoris
structure most at risk during posterior ICBG harvest is?what else is at risk?
superior gluteal arteryalso: cluneal nerves, sciatic n
describe the path of the obturator nerve in the thigh
passes through obturator foramen to enter thighdivides into anterior and posterior branchesanterior: travels anterior to obturator externusthen lies between adductor brevis and longus/pectineusposterior branch:pierces obturator externus, then between adductor brevis and magnus
after loss of obturator n, how can the hip still adduct?
with pectineus. supplied by femoral n.
vessel at ligamentum teres comes from what major artery?
posterior branch of obturator artery
describe smith peterson approach
incision from ASIS curved downwardsbetween sartorius (femoral n) and TFL (sup gluteal n)between rectus medially (femoral n) and glut medius laterally (sup gluteal n)
dangers of smith peterson approach
femoral n/a/vascending branch of LFCALFCN
dangers of hardinge approach?
sup glut n - runs betrween medius and minimusbranches 3-5cm above GTfemoral bundle - watch retractorstnrasverse branch of LFCA
describe watson jones approach
incision along anterior GTcurve incision towards ASIS at GT tipsplit ITB curving towards ASISretract medius+minimums posteriorly, TFL anteriorlyIM plane - abductors and TFL - both sup glut nPRN GT osteotomy
dangers of moore’s/southern approach?
AKA posterior approach to hipsciatic ninf glut a when splitting maximusMFCA branch along top of quad fem - can release maximum proximal 1cm
describe medial approach to hipwhat is the other name for this approach?
Ludloff approach.supine with hip in figure-4incision 3cm below pubic tubercle, longitudinal down longusplane: between adductor longus and gracillis (IM plane, both obturator n anterior division)then between adductor brevis and magnus(IN plane?? posterior magnus=sciatic n)
dangers of ludloff approach?
anterior obturator n - between add longus and brevisposterior obturator n - on magnus under brevisMFCA - medial/distal part of psoas tendon
boudaries of the I-I approach lateral window?
iliac wing to psoas (and fem n)
boundaries of middle window of I-I approach?
psoas to external iliac vessels
boundaries of medial window of I-I approach?
external iliac vessels to rectus abdominus
describe modified stoppa approach
surgeon stands on contralateral sidepfannenstiel incision 1-2cm above symphysissplit rectus, incise transversalisenter space of retzius, potect bladdersubperiosteal dissection along sup pubic ramus/brim up to internal iliac fossaidentify corona mortis - ligatedetach iliopectineal fasciaexpose quad plate
dangers of modified stoppa approach?
corona mortisbladderspermatic cord (careful laterally)external iliac vesselsobturator n/a/v
describe extended iliofemoral approach
extension to smith petersonsmith pete incision, but extend proximally along crest and distally along femur as neededexpose both tables of pelvisouter: from reflected head of rectus to sciatic notch, detach medius and minimus from crestinner: detach direct head of rectus and stay under iliacus back to sciatic notchto access posterior column, detach medius and minimums from GT
internervous plane of posterior approach for ICBG?
between glut med/TFL(SGN), glut max (IGN)andparapsinal muscles (segmetal) and lat dorsi (long thoracic n)
dangers of posterior approach for ICBG harvest
cluneal nerves - cross crest 8cm aterior to PSIS - stay posteriorsciatic n, superior glut n/a/v (via GSN - stay proximal to it)
