L11: Bones, ligaments and joints of the pelvic girdle and thigh

Question 1

Bones in lower limb

Answer 1

femur
tibia and fibula
tarsals
metatarsals
phalanges

Question 2

lower limb is designed for:

Answer 2

locomotion
- carries heavy load of torso above
- exerts large forces
- resists large forces
- larger muscles than upper limb

Question 3

movements of the hip

Answer 3

Flexion and Extension
Abduction and Adduction
Internal and External Rotation
Circumduction

Question 4

knee movements

Answer 4

flexion and extension

Question 5

ankle movements:

Answer 5

dorsiflexion and plantarflexion

Question 6

foot movements

Answer 6

inversion and eversion

Question 7

toes movements

Answer 7

flexion and extension

Question 8

pelvic girdle consist of :

Answer 8

1x sacrum
2x hip bones

posteriorly, each hip forms a joint with the sacrum [sacroiliac joint]

anteriorly, each hip is joined at the pubic symphysis

Question 9

hip bone is formed by 3 bones:

Answer 9

Ilium
Ischium
Pubis

Question 10

what holds the hip bones together in children

Answer 10

a Y-shaped hyaline cartilage named ‘triradiate cartilage’

Question 11

male vs. female pelvis ; general structure

Answer 11

in males the pelvis is heavy and thick, in females thin and light

Question 11

hip bone ball and socket joint:

Answer 11

ball - head of femur
socket - acetabulum

Question 12

male vs female pelvis ; pelvic brim

Answer 12

in females larger and more oval, in males smaller and heart shaped

Question 13

male vs female pelvis ; pubic arch

Answer 13

in females the angle is bigger than in males

Question 14

male vs female pelvis ; distance between ischial spines

Answer 14

less in males

Question 15

sacrum

Answer 15

• distal part of spine
• formed by 5 fused vertebra
• forms sacroiliac joints with left and right iliac bones
• auricular surface of sacrum articulates with auricular surface of iliac bones

Question 16

femur ; articulation

Answer 16

long bone of the thigh
articulates with acetabulum proximally and tibial plateau distally
Longest + heaviest + possibly strongest bone of the body

Question 17

Sacroiliac joint

Answer 17

• connects pelvis to spine
• atypical plane synovial joint
• reinforced by ligaments within the joint capsule that pass from sacrum to each ilium
• very sting joint

Question 18

Hip joint [ Acetabulofemoral Joint]

Answer 18

synovial ball and socket joint - has a fibrous capsule
Head of femur articulates with the acetabulum

Question 19

What parts of hip joint are covered in cartilage?

Answer 19

Head of femur covered in hyaline cartilage except fovea
Lunate surface of acetabulum covered with hyaline cartilage

Question 20

fibrous capsule

Answer 20

Lined by synovial membrane
Synovial membrane does not cover cartilage

Question 21

Name extrascapular ligaments

Answer 21

> Iliofemoral ligament
- y shaped appearance
- limits hip extension

> Pubofemoral ligament
- limits hip abduction and extension

> Ischiofemoral ligament
- limits hip extension with its spiral fibres

Question 22

Intracapuslar Ligaments

Answer 22

> Ligamentum Teres
- aka Ligamentum capitis
- aka Ligament of head of femur

Question 23

Ligamentum Teres

Answer 23

Passes from the acetabular fossa to the fovea of the femoral head
*Carries a small branch from the obturator artery
*“Branch of the femoral head”
*Provides arterial supply to head of femur
*Very important during early life

Question 24

Arterial Supply of the Hip Joint

Answer 24

the femoral neck and head receive most of their blood supply from circumflex branches of the femoral artery

NOT foveolar artery in ligamentum teres

Question 25

Hip Dislocation

Answer 25

• uncommon
• usually due to a high energy event e.g. road
  traffic collisions
• A force from anterior, applied along the longitudinal axis of femur, can push it posteriorly out of the acetabulum
• Posterior dislocation of the femur can damage the sciatic nerve, which normally is located just posterior to the proximal femur

Question 26

Hip Fracture

Answer 26

Hip fracture = fracture of the femoral neck

usually in older patients after a fall
higher risk if patient has osteoporosis

Question 27

Avascular Necrosis [AVN] of Femoral Head

Answer 27

• Interruption of blood supply due to vessels being severed along fractured femoral neck
• Artery of ligamentum teres does not provide enough supply to femoral head
• Femoral head becomes ischaemic, then necrotic
  *AVN of femoral head, just like AVN of scaphoid

Question 28

total hip replacement:

Answer 28

artificial femoral head
artificial acetabulum

Question 29

“The Arthritic Hip”
Osteoarthritis

Answer 29

Osteoarthritis in the hip is 2nd most common joint affected by this disease behind thumb CMC joint

Osteoarthritis is a degenerative disease whereby joint cartilage breaks down and bone starts to grind on bone during joint movement
*Stiff and painful, swollen joints

Joint repair : arthroplasty. Hip arthroplasty