Elderly falls (hip and knee anatomy + rehab)

Question 1

What deepens the hip acetabulum?

Answer 1

Fibrocartilaginous collar (mostly type 1 collagen) of the acetabulur labrum

Question 2

Describe the intracapsular ligament of the femur (name + where it runs from)

Answer 2

Ligament of the head of the femur

Runs from the acetabular fossa to the fovea of the femoral head (little depression)

Question 3

List the extracapsular ligaments of the femur

Answer 3

there are 3:
Iliofemoral
pubofemoral
Ischiofemoral

Question 4

Describe where the Iliofemoral ligament runs from and its shape

Answer 4

Runs from between the anterior inferior iliac spine to the intertrochanteric line (on femur)
It is Y shaped and strongest of the 3

Question 5

Describe where the pubofemoral ligament runs from and its shape

Answer 5

Runs from the superior pubic rami (on pubis) to the intertrochanteric line of the femur. It has a triangular shape.

Question 6

Describe where the Ischiofemoral ligament runs from and its shape and where it lies

Answer 6

Runs from the body of the ischium to the greater trochanter of the femur. It has a spiral orientation and lies posteriorly.

Question 7

Describe the main arterial supply to the hip joint

Answer 7

Largely via the lateral and medial circumflex arteries which are branches of the deep femoral artery
(MOSTLY - medial)

Question 8

What is the primary innervation of the hip joint and what ares does each nerve supply?

Answer 8

Sciatic nerve: lateral
Femoral nerve: anterior
Obturator: inferiorly/medially

Question 9

What are the 2 articulations of the knee joint? describe them briefly

Answer 9

Tibiofemoral - articulation between the femoral condyles and the tibial condyles
Patellofemoral - articulation between the patella and femur

Question 10

What are the two menisci in the knee, their shape and their functions?

Answer 10

Lateral and medial
C-shaped
Functions:
Deepen the articulation of the tibia to increase joint stability
Act as shock absorbers by increasing surface area for force to dissipate over

Question 11

Out of the 2 menisci in the knee, which is larger ?

What are they both attached to?

Answer 11

Medial is larger
Medial meniscus is attached to the tibial collateral ligament
Lateral meniscus is unattached to the capsule, making it quite mobile.

Question 12

what is bursa?

Answer 12

a synovial fluid filled sac

Question 13

How many bursa does the knee joint have, list them

Answer 13

4
Suprapatella
Prepatella
Infrapatella
Semimembranosus

Question 14

what are the 3 major ligaments in the knee?

Answer 14

Patellar
Cruciate
Collateral

Question 15

what are the 2 collateral ligaments, describe them

Answer 15

Medial/tibial - wide and flat, running from medial epicondyle of femur to medial tibial condyle.
Lateral/fibular - thin and round, running from lateral epicondyle of femur to the lateral surface of fibular head.

Question 16

In what direction do the anterior and poster cruciate ligaments run?

Answer 16

ACL: runs from lateral to medial (down), posteriorly (anterior = starts outward)
PCL: runs from medial to lateral, anteriorly

The POSTERIOr one forms a A shape and Anterior forms a V SHAPE

Question 17

List risk factors for falls in elderly

Answer 17

History of falls
Age
Gender - females
Living alone
Medications: benzodiazepine
Medical problems: arthritis, circulation issues, osteoporosis 
Impaired mobility
Visual impairments
Foot problems e.g. bunions

Question 18

List preventative measures of falls in the elderly

Answer 18

Review and modification of medication
Exercise training - balance problems e.g. tai chi
Uses of assistive devices e.g. alarm
Hand rail 
Using walking aids

Question 19

Describe the surgical treatment for an elderly patient with a hip fracture

Answer 19

Internal fixation - use of rods, pins, screws and plates to hold the bone in place.

Hemiarthroplasty: replacement of femoral head with artificial head

complete hip replacement: replacement of femoral heck and socket of hip joint

Question 20

What type of fracture is internal fixation used for ?

Answer 20

Used for intracapsular fractures more but can be used for extracapsular as well if it is stable and not displaced.

Question 21

What type of fracture is hemi-arthroplasty usually used for ?

Answer 21

intercapsular

Question 22

Describe the rehabilitation for an elderly patient with a hip fracture

Answer 22

Physiotherapy to achieve mobility
Occupational therapy
Social worker for support at home if required

Question 23

Discuss the psycho-social impact of falls and fractures on elderly people

Answer 23

• Loss of independence can cause lack of confidence
• Depression
• Anxiety and increased fear of falling
• Lack of mobility can cause Isolation
• Less willing to go out and socialise due to decline in mental health and physical health
• Financial burden of having a carer