Hips and Fractures Flashcards
what kind of joint is the hip joint
ball and socket synovial
which joint connects the lower limb to the axial skeleton
hip bone
function of synovial fluid
Acts as shock absorber and prevents friction
what area of the acetabulum articulates with the head of the femur
lunate surface (and acetabular labrum)
what ligament is found at the inferior side of the acetabulum
transverse acetabular ligament
what does the ligament of the head of the femur attach to
the fovea
what is the labrum
fibrocartilaginous ring that contains type 1 collagen. It deepens the socket of the acetabulum and helps with joint stability, allowing articulated surfaces to have larger surface area. Also acts a seal around the head of the femur, and equally distributes forces/loads.
function of the fat pad in the hip joint
better accommodates movement at the joint
what is the hip joint surrounded by
fibrous capsule.
The fibres form the zona orbicularis which helps prevent hip destruction and reinforce strength against stress.
explain the fibre structure when the hip is extended
the fibres become twisted to push the femoral head into the acetabulum
explain the fibre structure when the hip is flexed
the fibres untwist allowing for more mobility
where do the capsular ligaments originate from
the bony acetabular rim of the hip
function of the capsular ligaments
they surround the femur head and neck. They surround the joint capsule to restrain the motion in order to stabilise the bones and prevent damage
describe the iliofemoral ligament
crosses the anterior surface, y shaped, connects the ilium to the femur, the strongest ligament in the body,
acts as a reinforcement of the joint and prevents hyperextension of the joint in standing position
describe the pubofemoral ligament
connects the pubis to the femur, blends with the medial part of the IF ligament, prevents hyperabduction of the hip and facilitates adduction
describe the ischiofemoral ligament
crosses the posterior surface of the joint, connects ishea to the femur, weakest and thinnest of the 3 ligaments, helps to stabilise joint during extension.
what ligament divides the greater and lesser sciatic foramen
the sacrospinous ligamanet
function of greater sciatic formaen
allows passage of structures entering/leaving the pelvis, ie the sciatic nerve
function of the lesser sciatic foramen
allows passage of structures entering/leaving the perineum, ie the pudendal nerve
what is the largest nerve of the body
sciatic nerve
where does the sciatic nerve originate
lumbral sacral plexus
anterior rami of spinal nerves L4 to S3
where does the sciatic nerve travel
originates from lumbral sacral plexus then leaves the pelvis via the greater sciatic foramen. Then enters the gluteal region where it passes under the piriformis muscle before entering posterior compartment of the thigh
what does the sciatic nerve divide into
tibial nerve and the common fibular nerve
safest region to perform an injection in the gluteal region
into the gluteus medius or the upper region of gluteus maximus
place hand on lateral gluteus and have middle finger touching the tubercle of the iliac crest. Abduct fingers, the area between middle and index is best for injection
what are the four superficial muscles of the gluteal region
tensor fascia latae
gluteus maximus
gluteus medius
gluteus minimus
what are the five deep muscles of the gluteal region
piriformis
obturator internus
superior and inferior gemelli
quadratus femoris
origin of tensor fascia latae
anterior superior iliac spine (ASIS) and the anterior aspect of the iliac crest
insertion of tensor fascia latae
iliotibial tract, which inserts into the lateral condyle of the tibia
functions of the tensor fascia latae
medially rotates the thigh (at the hip joint)
abducts the thigh (at the hip joint)
innervation of the tensor fascia latae
superior gluteal nerve (L5, S1)
origin of the gluteus maximus
ilium posterior to posterior gluteal line, dorsal surface of sacrum and coccyx, sacrotuberous ligament
insertion of the gluteus maximus
radiates into iliotibial tract and gluteal tuberosity (of the femur)
functions of the gluteus maximus
-extends the thigh (at the hip joint) - especially from flexed position
-assists in lateral rotation of the thigh (at the hip joint)
-steadies the thigh and assists in rising from the sitting position
innervation of the gluteus maximus
inferior gluteal nerve (L5, S1, S2)
origin of gluteus medius
external surface of ilium between anterior and posterior gluteal lines
insertion of gluteus medius
lateral surface of greater trochanter of the femur
functions of gluteus medius
medially rotates the thigh (at the hip joint)
abducts the thigh (at the hip joint)
origin of the gluteus minimus
gluteal area of the ilium
insertion of the gluteus minimus
anterior surface of greater trochanter of the femur
functions of gluteus minimus
(same as gluteus medius, but weaker abductor)
medially rotates the thigh (at the hip joint)
abducts the thigh (at the hip joint)
innervation of the gluteus medius and gluteus minimus
superior gluteal nerve (L5, S1)
origin of the piriformis
anterior surface of sacrum and sacrotuberous ligament
insertion of the piriformis
superior border of greater trochanter of femur
functions of piriformis
laterally rotates the extended thigh
abducts when thigh is flexed
steadies femoral head in acetabulum
innervation of piriformis
nerve to piriformis (anterior rami of S1-S2)
origin of obturator internus
pubis and ischium at obturator foramen
insertion of obturator internus
medial surface of greater trochanter (trochanteric fossa) of femur
functions of obturator internus
laterally rotates the extended thigh
abducts when thigh is flexed
steadies femoral head in the acetabulum
innervation of obturator internus
nerve to obturator internus (L5-S1)
origin of the superior gemellus
ischial spine
insertion of the superior gemelli
medial surface of greater trochanter of femur
innervation of superior gemelli
nerve to obturator internus
(L5-S1)
origin of inferior gemelli
ischial tuberosity
insertion of inferior gemelli
medial surface of the greater trochanter of femur
innervation of the inferior gemelli
nerve to quadratus femoris (L5-S1)
Functions of both superior and inferior gemelli
laterally rotates the extended thigh
abducts when thigh is flexed
steadies femoral head in acetabulum
where do the hamstring (ischiocrural) muscles originate from
ischial tuberosity (exceptt short head biceps femoris and so not a true hamstring)
what are the 4 muscles of the posterior thigh
long head biceps femoris
short head biceps femoris
semitendinosus
semimembranosus
origin of the long head biceps femoris
ischial tuberosity (true hamstring)
origin of the short head biceps femoris
linea aspera and lateral supracondylar line of femur (not a true hamstring)
insertion of the biceps femoris
lateral side of head of fibula
functions of the biceps femoris
flexes the leg and rotates it laterally when knee is flexed
extends the thigh (at hip joint)
innervation of the long head biceps femoris
tibial division of sciatic nerve (L5, S1, S2)
innervation of the short head biceps femoris
common fibular division of sciatic nerve (L5, S1, S2)
origin of the semitendinosus muscle
ischial tuberosity (true hamstring)
insertion of the semitendinosus muscle
medial surface of proximal tibia
(pes anserinus superficialis)
function of semitendinosus muscle
extends the thigh (at hip joint)
flexes the leg (at knee joint)
medially rotates the leg when knee is flexed
innervation of the semitendinosus muscle
tibial division of sciatic nerve (L5, S1, S2)
what is pes anserinus
common insertion of sartorius, gracilis and semitendinosus muscles
medial aspect of tibial tuberosity
means “goose’s foot”
origin of semimembranosus muscle
ischial tuberosity (true hamstring)
insertion of semimembranosus muscle
posterior part of medial condyle of tibia
functions of semimembranosus muscle
extends the thigh (at the hip joint)
flexes the leg (at the knee joint)
medially rotates the leg when the knee is flexed
innervation of the semimembranosus muscle
tibial division of sciatic nerve 9L5, S1, S2)
who most commonly have femoral fractures
over 60yo (due to osteoporosis normally)
especially in women^
if under 40, usually due to high energy impact
what can fractures to the femoral neck result in
damage to the medial circumflex artery
(one of the retinacular arteries = supply blood to head of femur)
what most commonly causes femoral dislocation
car accidents
impact forcing head of femur posteriorly, this can damage sciatic nerve
what does the sciatic nerve supply sensory wise
posterior thigh and sole of foot
what does sciatic nerve supply motor wise
entire leg (lower leg, upper is thigh)
when is femoral triangle most visible
when leg is flexed, abducted and laterally rotated
what does the inguinal ligament connect
the ASIS to the pubic tubercle
superior boundary of femoral triangle
inguinal ligament
lateral border or femoral triangle
medial border of sartorius
medial border of femoral triangle
medial border of adductor longus
what forms the roof of the femoral triangle
fascia lata, cribriform fascia, subcutaneous tissue and skin
what forms the floor of the femoral triangle
muscle
lateral - iliopsoas
medial - pectineus
what is contained in the femoral triangle
femoral nerve
and femoral sheath containing:
femoral artery
femoral vein
femoral canal (lymphatics)
NAVL (lateral to medial)
describe the femoral nerve
largest branch of lumbar plexus
anterior rami L2-L4
motor innervation to quadriceps and flexors of the hip
describe the femoral artery
continuation of the external iliac artery
main branches within the triangle:
- profunda femoris artery
- circumflex femoral arteries
- obturator artery
what is the femoral artery used for
to draw blood and point of entrance for catheterisation
describe the femoral vein
continuation of the popliteal vein
it ends posterior to the inguinal ligament -> external iliac vein
joined by great saphenous vein at the femoral triangle
what is the femoral vein used for
to draw blood and to perform right cardiac angiography
What are the 5 Rs of fracture healing
Resuscitate ABC
Reduce the fracture
retain the reduction
Reduce complications and respect the soft tissues
Rehab
Describe primary fracture healing
Direct, no callous, cutting core.
Slow process
Requires close reduction and rigidity.
What are the four stages of secondary fracture healing
Haematoma
Soft callus
Hard callus
Remodelling
Describe osteoarthritis diagnosis
No imaging required
- are 45 or over
- have activity related joint pain
- have either no morning joint stiffness or it doesn’t last for longer than 30 mins
treatments for osteoarthritis
- core treatments are therapeutic exercise and weight management
- topical NSAIDs for knee OA
- consider joint replacement
- paracetamol or weak opioids for short term pain relief
define osteoporosis
a progressive bone disease characterised by low bone mass and microarchitectural deterioration of bone which leads to an increased risk of fragility fractures
Define sarcopenia
progressive and generalised skeletal muscle disorder that is associated with increased likelihood of adverse outcomes including falls, fractures, physical disability and mortality
what ligament forms part of the greater foramen
sacrospinous - runs from the ischial spine to the sacrum, thus creating the greater sciatic foramen through which lower limb neurovasculature (including the sciatic nerve) transcends.
which ligament forms part of the lesser foramen
sacrotuberous - runs from the sacrum to the ischial tuberosity, forming the lesser sciatic foramen.
What is the function of an adnexal structure in wound healing
Serve as a reservoir of epithelial cells to repopulate the wound
In positive trendelenburg’s sign, what nerve is damaged if when standing on the right leg, the left hip drops?
Right superior gluteal
What muscle is the main flexor of the hip
Iliopsoas
