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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
Q

Describe the ligament of head of femur.

A
  • relatively small
  • runs from acetabular fossa to fovea of the femur
  • encloses a branch of the obturator artery
26
Q

What are the extracapsular ligaments of the hip joint?

A
  • iliofemoral ligament
  • pubofemoral ligament
  • ischiofemoral ligament
27
Q

Describe the iliofemoral ligament.

A
  • 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
Q

Describe the pubofemoral ligament.

A
  • covers hip joint anteriorly and inferiorly
  • spans between superior pubic rami and intertrochanteric line of the femur
  • prevents excessive abduction
29
Q

Describe the ischiofemoral ligament.

A
  • 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
Q

What arteries supply the hip joint?

A
  • mainly the medial circumflex femoral artery
  • lateral circumflex femoral artery
  • artery to head of femur
  • superior and inferior gluteal arteries
31
Q

What plexus innervates the hip joint?

A

Lumbosacral plexus

32
Q

List the three main nerves which innervate the hip joint.

A
  • femoral
  • obturator
  • sciatic
33
Q

What are the stabilising factors of the hip joint?

A
  • acetabulum
  • acetabular labrum
  • extracapsular ligaments - ilio/pubo/ischiofemoral
  • muscles - medial rotators of the hip
34
Q

List the medial rotators of the hip joint. (3)

A
  • gluteus medius
  • gluteus minimus
  • tensor fascia latae
35
Q

List the flexors of the hip joint. (9)

A
  • iliopsoas
  • sartorius
  • tensor fascia latae
  • rectus femoris and recturs femoris tendon
  • pectineus
  • adductor longus
  • adductor brevis
  • adductor magnus
  • gracilis
36
Q

List the adductors of the hip joint.

A
  • pectineus
  • adductor longus
  • adductor brevis
  • adductor magnus
  • obturator externus
  • gracilis
37
Q

List the lateral rotators of the hip joint.

A
  • obturator externus
  • piriformis
  • obturator internus
  • gemelli
  • quadratus femoris
  • gluteus maximus
38
Q

List the extensors of the hip joint.

A
  • gluteus maximus
  • hamstrings:
    • semitendinosus
    • semimembranosus
    • long head of biceps femoris
  • adductor magnus
39
Q

List the abductors of the hip joint.

A
  • glutus medius
  • gluetues minimus
  • tensor fascia latae
40
Q

What movements can occur at the hip joint?

A
  • flexion
  • extension
  • abduction
  • adduction
  • medial rotation
  • lateral rotation
41
Q

What does the femoral triangle contain?

A
  • femoral nerve
  • femoral artery
  • femoral vein
  • femoral canal
42
Q

How can hip fractures be broadly categorised?

A
  • intracapsular

- extracapsular (intertrochanteric, subtrochanteric)

43
Q

Describe an intracapsular hip fracture.

A
  • fracture line is between the blood supply and femoral head
  • potentially severs blood supply to neck
  • leads to a risk of avascular necrosis
44
Q

Describe an extracapsular hip fracture.

A
  • the femoral head remains in continuity with its blood supply
  • no risk of avascular necrosis
45
Q

What is a trochanteric fracture and list some classifications.

A
  • 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
Q

How can intracapsular fractures be divided?

A

Undisplaced and displaced.

47
Q

Describe an undisplaced intracapsular fracture.

A
  • low chance of disruption to blood supply
  • can be treated with internal fixation
  • a third will develop avascular necrosis or nonunion
48
Q

Describe a displaced intracapsular fracture.

A
  • normally treated with hemiarthroplasty

- femoral head is removed, leaving artificial head articulating with acetabulum

49
Q

How are extracapsular fractures usually treated?

A

Internal fixation either with a dynamic hip screw or an intermedullary nail

50
Q

Describe the Garden 1 classification of an intracapsular fracture.

A
  • 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
Q

Describe the Garden 2 classification of intracapsular fracture.

A
  • the fracture is complete but undisplaced

- the trabeculae remain aligned

52
Q

Describe the Garden 3 classification of intracapsular fracture.

A
  • the fracture is moderately displaced with disturbance of the trabecular pattern.
53
Q

Describe the Garden 4 classification of intracapsular fracture.

A
  • the fracture is displaced but trabeculae line up to indicate that the head lies in neutral rotation.
54
Q

How might a hip fracture be treated?

A
  • fixation (screws or plates)
  • urgent reduction and fixation (in the young)
  • total hip replacement
  • hemiarthroplasty
  • dynamic hip screw
  • nail
55
Q

How will physiotherapy be used following treatment for a hip fracture?

A
  • 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
Q

List the risk factors for a hip fracture.

A
  • 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
Q

What are the outcome measures following a hip fracture?

A
  • Functional Independece measure
  • Berg balance scale
  • timed up and go test
  • patient specific functional scale
  • falls risk assessment tool
58
Q

What are the risk factors for a fall?

A
  • recent falls
  • medications
  • psychological
  • cognitive status
  • impaired vision
  • poor mobility
  • erratic behaviours
  • unsafe footwear
  • unsafe use of equipment
  • inappropiate environment
  • nutrition
59
Q

What types of home modifications may be offered by a local council?

A
  • 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
Q

How can home modifications be funded?

A
  • 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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