Hip (467-478)

Question 1

Name the extracapsular ligaments of the hip joint and their attachments;

Answer 1

Iliofemoral ligament- Anterior inferior iliac spine then bifurcates before inserting into the interrochanteric line of the femur (Y shaped appearance, prevent hyperextension of hip joint [strongest ligament]).
Pubofemoral- Superior pubic rami to intertrochanteric line of femur (Triangular shape, prevents excessive abduction and extension).
Ischiofemoral ligament - body of the ischium to greater trochanter of femur (reinforces capsule posteriorly)

Question 2

Name the structures that attach to the anterior superior iliac spine;

Answer 2

Inguinal ligament, sartorius, (some books say tensor fascia latae)

Question 3

Name the structures that attach to the anterior inferior iliac spine;

Answer 3

Straight head of rectus femoris, ileofemoral ligament

Question 4

What structures are attached to the iliotibial band?;

Answer 4

Tensor fascia lata. Fibres of gluteus maximus.

Question 5

What is the function of the iliotibial band?;

Answer 5

It is a thickening in the fascia lata. IT band contributes to lateral knee stabilisation (keeps knee extended when off the ground)

Question 6

Describe the blood supply to the hip joint;

Answer 6

Medial and lateral circumflex arteries - branches of profunda femoris artery (branch of femoral artery).

Question 7

How can fractures of the femoral neck be classified?;

Answer 7

Intra-capsular (within hip capsule- subcapital, transcervical, basicervical)

Extra-capsular (inter-trochanteric [between greater & lesser tronchanter], sub-tronchanteric [within 5cm of lesser trochanter], reverse oblique)

Question 8

Describe the Garden classification of intrascapular fractures of the femoral neck;

Answer 8

Grade I - non-displaced, incomplete. Grade II - complete but non-displaced. Grade III - complete fracture, partial displacement. Grade IV - complete fracture fully displaced.

Question 9

How are extrascapular fractures managed?;

Answer 9

DHS or intramedullary nail.

Question 10

What is a Girdlestone procedure?;

Answer 10

(aka femoral head ostectomy) Is an excision arthroplasty of the hip. The procedure inevitably results in limb shortening.

Question 11

What is expected blood loss in bilateral fractures of the femur?;

Answer 11

around 2.5 litres (Class III or IV shock). [Isolated femur - 1.5 litres, Isolated tibia or humerus - 750mls]

Question 12

How are different types of fractures of the femoral shaft managed?;

Answer 12

Intramedullary nail usually for straight forward mid shaft fracture. If fragmented or near joint plate and screws.

Question 13

How are intrascapular fractures managed?;

Answer 13