Clinical anatomy of the pelvis, hip and femur Flashcards
How do pelvic fractures occur in a) young people b) old people?
a) High energy collisions e.g. RTA
b) low energy secondary to osteoporosis
If the pelvic ring is disrupted at one point, what is invariably the result?
Disruption at another point e.g. the sacroiliac joint (can’t break a polo mint in only one place)
What blood vessels are at risk in a high-energy pelvic fracture?
Branches of the internal iliac, presacral venous plexus
How are minimally displaced (usually low energy secondary to osteoporosis) pelvic fractures managed?
Generally stable and settle with conservative measures
What kind of fracture does the image show? What is the main complication of this?
“Open book” anteroposterior compression fracture. Massive haemorrhage into the pelvis
What are the names of the three ligaments which reinforce the femoral head?
Ileofemoral, pubofemoral, ischiofemoral
What is the blood supply to the femoral head?
Medial and lateral branches of the femoral circumflex artery
What are these muscles, what is their role and where do they insert?
Hip flexors
Insert onto lesser trochanter of femur
What is the role of these muscles and what is their common origin?
Adductors of the hip; inferior pubic rami
Name the muscles/groups of muscle responsible for
a) Hip abduction
b) Hip extension
a) gluteus minimus and medius, tensor fascia lata
b) gluteus maximus, hamstring muscles (biceps femoris, semimebranosus, semitendinosus)
What is the pattern of hip pain and what explains this?
Pain in the groin which may radiate to the knee- common path of the obdurator nerve
What two important clinical signs may be seen in hip pathology?
Loss of internal rotation
Weakness of abduction (Trendellenburg)
What might avascular necrosis of the femoral head be secondary to?
Alcohol abuse, hyperlipidaemia, thrombophilia, steroids, trauma
Where is the broad tendinous insertion of the hip abductors and what pathology is often seen here?
Greater trochanter of the femur
Trochanteric bursitis
How would trochanteric bursitis appear on clinical examination?
Tenderness over the affected area, pain on resisted abduction
How is trochanteric bursitis treated?
Analgesia, NSAIDs, steroids injections, physiotherapy
How are hip (femoral head) fractures classified?
Intra or extra capsular
What is the potential risk/complication of an intracapsular fracture of the femoral head?
Avascular necrosis and non-union due to disrupted blood supply.
How are a) intracapsular and b) extracapular hip fractures managed?
a) usually hip replacement- either hemiarthroplasty or THR
b) Dynamic hip screw, retaining the patient’s native hip joint
What is a developmental dysplasia of the hip?
Aberrant development of the hip due to abnormal relationship of the femoral head to the acetabulum
What are the risk factors for DDH?
Being female, FH, breech birth, Down Syndrome, first-borns
What signs may be seen in examination of a neonate with a DDH?
Shortening, asymmetric skin creases, “click or clunk”, positive Olotani/Barlow tests
Why is X-ray not a useful investigation in newborns with a suspected DDH? What is the alternative investigation?
Femoral head epiphysis is unossified until around 4-6 months
