Gluteal, hip and thigh Flashcards
1
Q
Describe pelvic fractures
A
- fractures of superior and inferior rami are stable, can be treated conservatively
- similarly, fractures of the iliac wing, although high energy, can also be managed conservatively
- by contrast, distruption of sacroiliac joint (and pubic symphysis is more serious)
- The most serious of these is a pelvic diastasis, with risk of rupture of retroperitoneal veins, bleeding, and haemodynamic instability. MUST BE CLOSED
2
Q
Describe acetabular dysplasia
A
- The normal hip has good cover of the femoral head by the acetabulum
- This helps bear the weight and distribute it evenly
- Acetabular angle can be measured
- Changes in angle can indicate dysplasia to subluxation and full dislocation
- dysplasia in adults, subluxation more of a paediatric issue
3
Q
Describe Trendelenburg sign
A
- occurs if medius and minimus fail to fire, as they work to stabilise and keep pelvis level when opposite leg is raised
- result is opposite end drops
- causes include: loss of hip abductors, L5 radiculopathy, polio, detachment of abductors, fracture or operation on greater trochanter
4
Q
Describe psoas abscess
A
- swell from vertebrae pushes into psoas and causes irritability and infection to hip joint=esptic arthritis risk
5
Q
Describe sciatic foramen contents
A
- Sacrospinous ligament- spine of ischium to side of lower sacrum and coccyx – bounds greater sciatic foramen
Sciatic Foramen
- Greater and lesser sciatic notches
- Converted to Foramen by ligaments
- Sacrospinous converts Greater
- Sacrotuberous ligament converts Lesser
- Piriformis exits through greater foramen, sciatic nerve can be located inferior to Piriformis
List of nerves at greater sciatic notch
* 7 nerves:
* Sciatic Nerve
* Superior Gluteal Nerve
* Inferior Gluteal Nerve
* Pudendal Nerve
* Posterior Femoral Cutaneous Nerve
* Nerve to Quadratus Femoris
* Nerve to Obturator Internus
* 3 Vessel Sets:
* Superior Gluteal Artery & Vein
* Inferior Gluteal Artery & vein
* Internal Pudendal Artery & vein
* 1 Muscle:
* **Piriformis
List of nerves at lesser sciatic notch
* 2 nerves:
* Pudendal Nerve
* Nerve to Obturator Internus
* 1 Vessel Set:
* Internal Pudendal Artery & vein
* 1 Muscle:
* Obturator Internus
6
Q
Describe how to inject in the gluteal region to avoid the sciatic nerve
A
- Sciatic Nerve can be located at the top of thigh, just medial to midpoint of GT and Ischial tuberosity ^[important NOT to inject here]
-
piriformis
- origin: anterior surface of sacrum and sacrotuberous ligament
- insertion:GT superior border
- innervation: : branches of ventral rami S1/S2
- action: laterally rotates extended thigh, abducts flexed thigh, steady femoral head in acetabulum (with other small rotator muscles)
- note: use to find sciatic nerve, emerges below lower edge
7
Q
Describe femoral fractures
A
- note: intracapsular fractures e.g. subcapital and transcervical will jeopardise the vascular supply of the head as it is retrograde ^[similar to scaphoid bone]
- blood supply is two-fold
- interosseous, travelling up to the head
- travels through capsule around neck to the head
- blood supply is two-fold
8
Q
List the clinically relevant movements of the hip
A
- Flexion
- Extension
- Abduction
- Adduction
- Internal Rotation
- External Rotation
9
Q
List the bones of the hip region
A
- The Pelvis: a basin-shaped structure that supports the spinal column and protects the abdominal organs
- Sacrum: spade-shaped bone formed by fusion of five sacral vertebrae
- Coccyx: fusion of four coccygeal bones
- The Pelvis Components: Innominate, Sacrum, Coccyx
- Innominate Bone Composition: ilium, ischium, pubis, which meet at the acetabulum
10
Q
Describe the contents of the ilium
A
- superior portion of hip
- Large wing like, or fan shaped Ala
- Key features include: Iliac crest ,tubercle, four spines ASIS AIIS, PSIS, PIIS
- Like the scapula, it has flat surfaces for muscle origin
- Main weight bearer along with ischium
- Another key feature is the iliopubic eminence is junction with pubic bone
- the gluteal Surface has three lines separating gluteus max, med and min
- Tensor Fascia sits between ASIS and tubercle
- Reflected head of Rectus femoris sits above acetabulum
- ASIS is a point of attachment for Inguinal lig , Sartorius
- AIIS is a point of attachment for Straight head RF and iliofemoral lig
11
Q
Describe the features of the pubis
A
- Smallest Section of the Hip
- Forms anterior inferior section of the acetabulum.
- Upper surface of body is the pubic crest which terminates laterally at the pubic tubercle
- Key features include: Superior and inferior pubic rami, pubic tubercle, obturator foramen
- Pubis and ischium border the obturator foramen
- obturator foramen is covered in a membrane, is a site of muscle attachment
- Body is quadrilateral
- Projected Laterally as Superior Ramus, joining Ilium and Ischium at Acetabulum and Inferiorly as Inferior Ramus, fuses with Ischial Ramus
- Symphysis medially located, coated with fibrocartilage, secondary cartilaginous joint ^[enables expansion during delivery for infant head]
- Upper border Body is convex
- Laterally is pubic tubercle
- 2 ridges go out laterally, upper sharp, pectineal line continues into Arcuate line
- Below this is Obturator crest, Nerve ( on Bone ) and Vessels below, over the obturator foramen
12
Q
Describe the features of the ischium
A
- L shaped bone, upper portion “Body”, joins with Ilium and Pubis at acetabulum, extends down to ischial tuberosity, for sitting and Hamstrings, and lower medial, thinner bar , ischial ramus, joins the pubic ramus to enclose the Obturator foramen
- Key features: ischial tuberosity and ramus, spine
- Tuberosity has oval upper and crest below
- Hamstrings attached oval area Semimembranosus laterally and Semitendinosis and Biceps medially
- Spine of Ischium , extends medially to separate the Greater and Lesser sciatic notches
13
Q
Describe the features of the femur
A
- articulates with hip at aceatbulum
- Key features include: head, neck, greater and lesser trochanter, intertrochanteric crest, shaft, linea aspera, gluteal tuberosity, patellar surface, lateral and medial epicondyles, lateral and medial condyles,
14
Q
Describe the acetabulum
A
- Hip Socket
- Confluence of the three innominate bones
- Cartilage thickest over Ilium, superiorly
- Notch is confluence of Pubis and Ischium. No cartilage
- Hemisphere, or cup, directed backward to meet femur head coming forward
- Issues of the acetabulum include arthritis (treat by replacement), fractures and dysplasia
15
Q
Briefly describe the features of the sacrum and coccyx
A
-
Dorsal Surface
- Median, intermediate, and lateral crests
- Fused spinous, articular, and transverse processes
- Dorsal sacral foramina
-
Sacrum
- Nerves exit foramina
-
Coccyx
- Fracture
- Coccydynia
