PBL Flashcards
Which bones make up the innominate (hip) bone?
- ilium
- ischium
- pubis
Describe the acetabulum of the hip bone.
- a large cup-shaped cavity or socket on the lateral aspect the hip bone that articulates with the head of the femur to form the hip joint
- fusion of ilium, ischium and pubis
Describe the ‘columns’ of the ilium.
- thick medial portions for weight bearing
Describe the ala (wings) of the ilium.
- posterolateral portions of the ilium
- provide broad surfaces for fleshy attachment of muscles
List the landmarks of the ilium. (10)
- iliac crest
- anterior superior iliac spine (ASIS)
- anterior inferior iliac spine (AIIS)
- posterior superior iliac spine (PSIS)
- posterior inferior iliac spine (PIIS)
- tubercle of iliac crest/iliac tubercle
- posterior, anterior and inferior gluteal lines of the ala
- iliac fossa
- the auricular surface
- iliac tuberosity
What is the ischiopubic ramus?
- a bar of bone formed by the ramus of the ischium and the inferior ramus of the pubis
- constitutes the inferomedial boundary of the obturator foramen
List the landmarks of the ischium. (6)
- body of the ischium
- ramus of the ischium
- greater sciatic notch
- ischial spine
- lesser sciatic notch
- ischial tuberosity
List the landmarks of the pubis. (7)
- body of pubis
- superior and inferior rami
- symphysial surface of the body
- pubic symphysis
- pubic crest
- pubic tubercles
- pecten pubis
What is the obturator foramen?
- large or irregularly triangular opening in the hip bone
- bounded by pubis, ischium and their rami
- aside from the obturator canal the foramen is enclosed by the thin, strong obturator membrane
- presence of the foramen reduces bony mass while membrane still provides attachment site for muslces
What is the obturator canal?
A small passageway for the obturator nerves and vessels.
Describe the proximal aspect of the femur.
Consists of a head, neck and 2 trochanters
Describe the head of the femur.
- found proximally
- articulates with acetabulum of pelvis to form hip joint
- smooth surface covered in articular cartilage
- small depression not covered in articular cartilage = fovea where ligamentum teres attaches
Describe the neck of the femur.
- connects head of the femur with the shaft
- cylindrical, projecting superiorly and medially
- angle of inclination = approx 126 degrees
- this angle allows for increased range of movement at the hip joint
Describe the greater trochater of the femur.
- most lateral, palpable projection of the bone
- attachment site for gluteus medius, gluteus minimus and piriformis
- origin site of vastus lateralis
Describe the lesser trochanter of the femur.
- projects from posteromedial side of femur
- attachment site for iliopsoas
What is the angle of inclination in the femur?
The angle resulting from the intersection of a line down the long shaft of the femur and a line drawn through the neck of the femur. Approx 126 degrees.
Describe the intertrochanteric line of the femur.
- a ridge of bone that runs in an inferomedial direction on the anterior surface of the femur
- spans between greater and lesser trochanter
- after passing lesser trochanter on posterior suface it becomes the pectineal line
- attachment site for iliofemoral ligament
- anterior attachment of hip joint capsule
Describe the intertrochanteric crest of the femur.
- ridge of bone that connects the greater and lesser trochanters on the posterior aspect of the femur
- contains rounded tubercle on superior half called the quadrate tubercle
- quadratus femoris attaches to quadrate tubercle
What type of joint is the hip joint?
A ball and socket synovial joint.
What is synovial joint made up of?
- outer fibrous layer of articular capsule
- inner synoval layer (synovium) of articular capsule
- articular cartilage
- synovial fluid
- accessory ligaments
- bursae
What is the main function of the hip joint?
Stability and weight bearing
What is the acetabular labrum?
A fibrocartilaginous collar
Where does the capsule of the hip joint attach?
- proximally: edge of the acetabulum
- distally: intertrochanteric line anteriorly and femoral neck posteriorly
What is the only intracapsular ligament of the hip joint?
The ligament of head of femur
Describe the ligament of head of femur.
- relatively small
- runs from acetabular fossa to fovea of the femur
- encloses a branch of the obturator artery
What are the extracapsular ligaments of the hip joint?
- iliofemoral ligament
- pubofemoral ligament
- ischiofemoral ligament
Describe the iliofemoral ligament.
- arises from anterior inferior iliac spine and bifurcates before inserting into intertrochateric line of the femur
- covers hip joint superiory and anteriorly
- strongest hip ligament
- prevents hyperextension of the hip while standing
Describe the pubofemoral ligament.
- covers hip joint anteriorly and inferiorly
- spans between superior pubic rami and intertrochanteric line of the femur
- prevents excessive abduction
Describe the ischiofemoral ligament.
- covers the hip posteriorly
- spans between body of ischium and greater trochanter of the femur
- weakest of hip ligaments
- prevents hyperextension and holds the femoral head in the acetabulum
What arteries supply the hip joint?
- mainly the medial circumflex femoral artery
- lateral circumflex femoral artery
- artery to head of femur
- superior and inferior gluteal arteries
What plexus innervates the hip joint?
Lumbosacral plexus
List the three main nerves which innervate the hip joint.
- femoral
- obturator
- sciatic
What are the stabilising factors of the hip joint?
- acetabulum
- acetabular labrum
- extracapsular ligaments - ilio/pubo/ischiofemoral
- muscles - medial rotators of the hip
List the medial rotators of the hip joint. (3)
- gluteus medius
- gluteus minimus
- tensor fascia latae
List the flexors of the hip joint. (9)
- iliopsoas
- sartorius
- tensor fascia latae
- rectus femoris and recturs femoris tendon
- pectineus
- adductor longus
- adductor brevis
- adductor magnus
- gracilis
List the adductors of the hip joint.
- pectineus
- adductor longus
- adductor brevis
- adductor magnus
- obturator externus
- gracilis
List the lateral rotators of the hip joint.
- obturator externus
- piriformis
- obturator internus
- gemelli
- quadratus femoris
- gluteus maximus
List the extensors of the hip joint.
- gluteus maximus
- hamstrings:
- semitendinosus
- semimembranosus
- long head of biceps femoris
- adductor magnus
List the abductors of the hip joint.
- glutus medius
- gluetues minimus
- tensor fascia latae
What movements can occur at the hip joint?
- flexion
- extension
- abduction
- adduction
- medial rotation
- lateral rotation
What does the femoral triangle contain?
- femoral nerve
- femoral artery
- femoral vein
- femoral canal
How can hip fractures be broadly categorised?
- intracapsular
- extracapsular (intertrochanteric, subtrochanteric)
Describe an intracapsular hip fracture.
- fracture line is between the blood supply and femoral head
- potentially severs blood supply to neck
- leads to a risk of avascular necrosis
Describe an extracapsular hip fracture.
- the femoral head remains in continuity with its blood supply
- no risk of avascular necrosis
What is a trochanteric fracture and list some classifications.
- a fracture involving the greater and/or lesser fractures of the femur
- an extracapsular injury
- intertrochanteric fracture
- pertrochanteric fracure
- subtrochanteric fracture
- greater trochanteric avulsion fracture
- lesser trochanteric avulsion fracture
How can intracapsular fractures be divided?
Undisplaced and displaced.
Describe an undisplaced intracapsular fracture.
- low chance of disruption to blood supply
- can be treated with internal fixation
- a third will develop avascular necrosis or nonunion
Describe a displaced intracapsular fracture.
- normally treated with hemiarthroplasty
- femoral head is removed, leaving artificial head articulating with acetabulum
How are extracapsular fractures usually treated?
Internal fixation either with a dynamic hip screw or an intermedullary nail
Describe the Garden 1 classification of an intracapsular fracture.
- the fracture is Valgus impacted i.e. the apex of the fracture points medially
- classically, the medial corticalfracture is not seen on the radiograph
Describe the Garden 2 classification of intracapsular fracture.
- the fracture is complete but undisplaced
- the trabeculae remain aligned
Describe the Garden 3 classification of intracapsular fracture.
- the fracture is moderately displaced with disturbance of the trabecular pattern.
Describe the Garden 4 classification of intracapsular fracture.
- the fracture is displaced but trabeculae line up to indicate that the head lies in neutral rotation.
How might a hip fracture be treated?
- fixation (screws or plates)
- urgent reduction and fixation (in the young)
- total hip replacement
- hemiarthroplasty
- dynamic hip screw
- nail
How will physiotherapy be used following treatment for a hip fracture?
- usually begins the day after the operation
- increasing walking distance on a daily basis
- leg exercises
- step/stair practice
- the amount of weight that can be placed on the injured leg depends on the surgery that was performed
List the risk factors for a hip fracture.
- gender - women more likely
- reduced bone density
- falls
- medications - may cause decrease in bone density like cortisone
- nutrition - lack of calcium and vitamin D
- age
- medical problems e.g. endocrine disorders
- physcial inactivity
- stroke
- Parkinson’s
What are the outcome measures following a hip fracture?
- Functional Independece measure
- Berg balance scale
- timed up and go test
- patient specific functional scale
- falls risk assessment tool
What are the risk factors for a fall?
- recent falls
- medications
- psychological
- cognitive status
- impaired vision
- poor mobility
- erratic behaviours
- unsafe footwear
- unsafe use of equipment
- inappropiate environment
- nutrition
What types of home modifications may be offered by a local council?
- stairlift or bannister
- adding a bath life, walk in shower or rail in bathroom
- widening doorways
- lowering kitchen worktops
- putting in an outdoor ramp or step rail
- security such as outside lights and intercome systems
How can home modifications be funded?
- council will cover if they cost less than 1000
- grants available from Disabled Facilities Grant or Independence at home
- Home Improvement Agency can help find schemes to cover costs
