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MBCHB MSS > Lecture 24: Hip Joint > Flashcards

Lecture 24: Hip Joint Flashcards

1
Q

at what joint do hip bones articulate with the sacrum?

A

sacroiliac joint

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2
Q

what is the name of the cartilage covering most of the articular surface of the acetabulum?

A

lunate surface
covers 2/3 of acetabulum
increases SA for articulation
(worn out in Osteosrthiritis)

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3
Q

what is located in the acetabular fossa?

A

-fat
-no cartilage

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4
Q

ligament that connects the acetabular fossa to the fovea of femoral head…

A

ligamentum teres
( has an artery that runs through it)

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5
Q

what artery does the artery of ligament of head branch off from?

A

obturator artery

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6
Q

what does the artery of ligament of head supply

A

head of femur
* Important in infant: supplying head of femur
* Reduced in size greatly in early teens
* In adult it provides very little - zero blood to
femoral head

can be damaged in fractures

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7
Q

function of ligamentum teres

A

sturdy structure that prevents hip dislocation( debated on )

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8
Q

transverse acetabular ligament : locatin, function

A
  • Transverse Acetabular Ligament
    (TAL) covers the acetabular notch
    inferiorly where there is no cartilage
  • Helps suspend femoral head in
    acetabulum
  • Important clinically to orient hip
    replacements

* important in surgical placements clinically!

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9
Q

acetabular foramen: function

A

allows blood vessel of
ligamentum teres to come through

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10
Q

why is the axis of femoral neck is 125 degrees to long axis instead of just being straight 90?

A

allows a greater range of movement superiorly/abduction + maintains strength of the bone

-a lot of stress is put on the lower half of the femoral neck-> bone is thicker in the inferior part of the neck.

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11
Q

joint capsule of the hip: function, structure

A
  • The hip has a very strong thick
    joint capsule
  • Unlike the shoulder the hip is
    designed to bear weight
  • Needs to be held together tightly
    or will dislocate
  • The capsule is attached proximally
    to the acetabulum and transverse
    acetabular ligament and distally into
    the intertrochateric line of the
    femu

Some fibers run diagonally- increases strength of capsule + limits the amount of flexion & extension( allow more flexion than extension)

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12
Q

flexion of hip joint:
muscles( & myotomes)?

A

psoas major
iliacus
rectus femoris
sartorius
pectineus
TFL

myotomes: L2, L3

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13
Q

extension of hip joint:
muscles( & myotomes)

A

G.Maximus
Semitendinosis
Semimembranosis
Biceps femoris

Myotomes: L4, L5

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14
Q

Adduction of hip joint:
muscles( & myotomes)

A

Adductor longus
Adductor brevis
Adductor magnus
Pectineus
Gracilis
Myotomes: L4-S2

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15
Q

Abduction of the hip joint:
muscles( & myotomes)

A

G.Medius
G.Minimus
TFL
Myotomes: L4-S1

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16
Q

Describe the arterial supply to the hip

A
  • The arteries supplying the hip joint
    are the Medial and Lateral
    Circumflex Arteries, which are
    branches off the Profunda Femoris
    Artery
  • The medial circumflex femoral
    artery runs posteriorly; the lateral
    circumflex femoral artery runs
    anteriorly around the femoral neck
    to form a lateral anastomosis
  • Also anastomose with gluteal
    vessel anastomoses. Can supply the hip if inadequate supply from femoral artery.
17
Q
A
18
Q

arterial supply to the femoral head and neck

A
  • Off the circumflex arteries come
    the retinacular arteries, pierce the
    capsule and run in the retinacular
    folds of the synovial membrane and
    run up into the femoral head
  • These retinacular vessels are crucial
    for vascular supply to the femoral
    head and neck

if these are damaged-> ischemia in the head

19
Q

Hiltons law

A

a joint tends to be innervated by a branch of a motor nerve which also supplies a muscle extending and acting across the joint.

20
Q

application of Hilton’s Law to hip joint

A

For hip joint:
the Femoral Nerve (iliacus ), the Obturator Nerve (medial compartment adductors)
and the Superior Gluteal Nerve (gluteus medius) and Nerve to Quadratus Femoris
(posteriorly)

Many nerves supply the hip joint:
Clinical application: problem with femoral nerve block that other nerves also supply the hip joint so not completely blocked. But femoral nerve block DOES block most of the pain.

21
Q

what happens if femur fractures are not repaired?

A
  • Bone is more sensitive to ischemia
    than cartilage
  • Ischemic bone develops avascular
    necrosis

the fractured side appers more translucent- osteoporotic. Probably due to the patient putting less weight on that leg due to pain.

22
Q

Neck of femur fracture: mechanism of injury

A
  • High energy in young patients
  • low energy falls in older patients
  • Esp. women with osteoporosis
  • High Mortality (40 % by one year, 50-
    60% at 2 years) Indicates high level of
    frailty.
23
Q

types of fracture(femoral head and neck)

A

group 1: risk of vessels being interrupted-> avascular necrosis

group 2: fracture line is distal to the blood supply-> lower risk of vessels being interrupted

24
Q

type of fracture? How can it be repaired?

A

intertrochanteric fracture
less worried about blood supply being interrupted

25
Q

type of fracture? How can it be repaired?

A

transcervical -risk of arteries being damaged

need to replace the head of femur( hemi or full arthroplasty.)

26
Q

what can lead to neck of femur fractures?

A

Trauma, osteoporosis and tumour can all lead to fractures of the femoral neck

27
Q

clinical importance: neck of femur fractures

A
  • Trauma, osteoporosis and tumour can all lead to fractures of the
    femoral neck
  • Depending on the location of the fracture the blood supply to the
    head of the femur may be disrupted
  • A subcapital (under the head) fracture is most likely to disrupt the
    blood supply to the head, while a more distal intertrochanteric
    fracture usually leaves the vascular supply intact.
  • The choice of treatment depends on the head viability
28
Q

what is the most common mechanism of hip dislocation?

A

The hip joint can dislocated anteriorly or posteriorly (90% posterior)
* The usual position for this to occur is with the hip flexed, adducted and
internally rotated (as when seated in a car)
* The femoral head then moves superiorly, resulting in a short, internally rotated leg.

29
Q

posterior dislocation : causes, consequences

A

Causes:
- Car crashes
- Falls from height
- Sports injuries

Serious Injury!
- Soft tissue damage( disrupt the capsule)
- risk of avascular necrosis from
arterial damage

Somewhat common result
of hip replacement surgeries

30
Q

Anterior Hip Joint Dislocation: causes, consequences

A

Causes:
- Forceful abduction with external
rotation of the thigh
- Car crashes
- Falls from height
- Sports injuries

Serious Injury!
- Soft tissue
damage
- risk of avascular necrosis from
arterial damage

MBCHB MSS (28 decks)

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