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Limbs And Back - Week 6 > PBL > Flashcards

PBL Flashcards

1
Q

Which bones make up the innominate (hip) bone?

A
  • ilium
  • ischium
  • pubis
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2
Q

Describe the acetabulum of the hip bone.

A
  • 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
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3
Q

Describe the ‘columns’ of the ilium.

A
  • thick medial portions for weight bearing
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4
Q

Describe the ala (wings) of the ilium.

A
  • posterolateral portions of the ilium

- provide broad surfaces for fleshy attachment of muscles

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5
Q

List the landmarks of the ilium. (10)

A
  • 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
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6
Q

What is the ischiopubic ramus?

A
  • 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
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7
Q

List the landmarks of the ischium. (6)

A
  • body of the ischium
  • ramus of the ischium
  • greater sciatic notch
  • ischial spine
  • lesser sciatic notch
  • ischial tuberosity
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8
Q

List the landmarks of the pubis. (7)

A
  • body of pubis
  • superior and inferior rami
  • symphysial surface of the body
  • pubic symphysis
  • pubic crest
  • pubic tubercles
  • pecten pubis
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9
Q

What is the obturator foramen?

A
  • 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
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10
Q

What is the obturator canal?

A

A small passageway for the obturator nerves and vessels.

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11
Q

Describe the proximal aspect of the femur.

A

Consists of a head, neck and 2 trochanters

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12
Q

Describe the head of the femur.

A
  • 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
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13
Q

Describe the neck of the femur.

A
  • 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
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14
Q

Describe the greater trochater of the femur.

A
  • most lateral, palpable projection of the bone
  • attachment site for gluteus medius, gluteus minimus and piriformis
  • origin site of vastus lateralis
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15
Q

Describe the lesser trochanter of the femur.

A
  • projects from posteromedial side of femur

- attachment site for iliopsoas

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16
Q

What is the angle of inclination in the femur?

A

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.

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17
Q

Describe the intertrochanteric line of the femur.

A
  • 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
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18
Q

Describe the intertrochanteric crest of the femur.

A
  • 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
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19
Q

What type of joint is the hip joint?

A

A ball and socket synovial joint.

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20
Q

What is synovial joint made up of?

A
  • outer fibrous layer of articular capsule
  • inner synoval layer (synovium) of articular capsule
  • articular cartilage
  • synovial fluid
  • accessory ligaments
  • bursae
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21
Q

What is the main function of the hip joint?

A

Stability and weight bearing

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22
Q

What is the acetabular labrum?

A

A fibrocartilaginous collar

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23
Q

Where does the capsule of the hip joint attach?

A
  • proximally: edge of the acetabulum

- distally: intertrochanteric line anteriorly and femoral neck posteriorly

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24
Q

What is the only intracapsular ligament of the hip joint?

A

The ligament of head of femur

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25
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
26
What are the extracapsular ligaments of the hip joint?
- iliofemoral ligament - pubofemoral ligament - ischiofemoral ligament
27
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
28
Describe the pubofemoral ligament.
- covers hip joint anteriorly and inferiorly - spans between superior pubic rami and intertrochanteric line of the femur - prevents excessive abduction
29
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
30
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
31
What plexus innervates the hip joint?
Lumbosacral plexus
32
List the three main nerves which innervate the hip joint.
- femoral - obturator - sciatic
33
What are the stabilising factors of the hip joint?
- acetabulum - acetabular labrum - extracapsular ligaments - ilio/pubo/ischiofemoral - muscles - medial rotators of the hip
34
List the medial rotators of the hip joint. (3)
- gluteus medius - gluteus minimus - tensor fascia latae
35
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
36
List the adductors of the hip joint.
- pectineus - adductor longus - adductor brevis - adductor magnus - obturator externus - gracilis
37
List the lateral rotators of the hip joint.
- obturator externus - piriformis - obturator internus - gemelli - quadratus femoris - gluteus maximus
38
List the extensors of the hip joint.
- gluteus maximus - hamstrings: - semitendinosus - semimembranosus - long head of biceps femoris - adductor magnus
39
List the abductors of the hip joint.
- glutus medius - gluetues minimus - tensor fascia latae
40
What movements can occur at the hip joint?
- flexion - extension - abduction - adduction - medial rotation - lateral rotation
41
What does the femoral triangle contain?
- femoral nerve - femoral artery - femoral vein - femoral canal
42
How can hip fractures be broadly categorised?
- intracapsular | - extracapsular (intertrochanteric, subtrochanteric)
43
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
44
Describe an extracapsular hip fracture.
- the femoral head remains in continuity with its blood supply - no risk of avascular necrosis
45
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
46
How can intracapsular fractures be divided?
Undisplaced and displaced.
47
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
48
Describe a displaced intracapsular fracture.
- normally treated with hemiarthroplasty | - femoral head is removed, leaving artificial head articulating with acetabulum
49
How are extracapsular fractures usually treated?
Internal fixation either with a dynamic hip screw or an intermedullary nail
50
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
51
Describe the Garden 2 classification of intracapsular fracture.
- the fracture is complete but undisplaced | - the trabeculae remain aligned
52
Describe the Garden 3 classification of intracapsular fracture.
- the fracture is moderately displaced with disturbance of the trabecular pattern.
53
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.
54
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
55
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
56
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
57
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
58
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
59
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
60
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

Limbs And Back - Week 6 (7 decks)

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