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pelvis and hip (brian) Flashcards

1
Q

when does trirardiate cartilage fuse?

A

14-16yo

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2
Q

what type of joint is the pubic symphysis?

A

non-synovial amphiarthroidal joint

has fibrocartilagenous disc

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3
Q

what are the pubic symphysis ligaments? which is strongest?

A

superior pubic ligament (strongest)

inferior (arcuate) pubic ligament

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4
Q

coccyx points which way?

A

men: anteriorly
women: vertically

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5
Q

signs of sacral dysmorphism? clinical relevance?

A

sacralization of L5

lumbarization of S1

mamillary processes

oval/oblong foramina

tongue-in-groove sign

narrowed S1 tunnel (for SI screws)

recessed sacral ala puts L5 nerve root at risk when XRays appear to show intraosseous screws

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6
Q

what type of joint is the SI joint? when does it fuse?

A

diarthroidal, gliding synovial

fuses by age 50

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7
Q

list the SI joint ligaments

A

anterior SI ligs

posterior SI ligs

interosseous SI ligs

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8
Q

what ligament runs from:

sacrum to ischial spine

sacrum to ischial tuberosity

iliac crest to L5 transverse process

A

sacrospinous

sacrotuberous

iliolumbar

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9
Q

boundaries of greater sciatic notch?

A

ischial spine

ilium

sacrospinous ligament

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10
Q

greater sciatic notch contents SUPERIOR to piriformis muscle

A

superior gluteal n and a (and v, vena comitantes)

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11
Q

contents of greater sciatic notch INFERIOR to piriformis muscle

A

POPS IQ

pudendal n and internal pudendal a (and v, vena comitantes)

nerve to Obturator internus

posterior femoral cutaneous n

sciatic n

inferior gluteal n and a (and v, vena comitantes)

nerve to Quadratus femoris

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12
Q

boundaries of the lesser sciatic notch

A

ischial spine

ischial tuberosity

sacrospinous lig

sacrotuberous lig

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13
Q

contents of lesser sciatic notch

A

obturator internus

nerve to obturator internus

pudendal n

internal pudendal a (and v)

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14
Q

what is the obturator canal and what does it contain?

A

opening at superior end of obturator membrane

obturator n,a,v pass thru it

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15
Q

normal femoral anteversion as adult and at birth?

A

15 deg. 30-40deg at birth

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16
Q

normal neck shaft angle of femur of adult and at birth?

A

127 deg. 150 at birth.

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17
Q

acetabular anteversion?

A

15 deg

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18
Q

name the ligaments that make up the hip capsule. What is strongest?

A

anterior:

iliofeoral lig (Y-lig of bigelow) - strongest lig in body. from AIIS to intertroch line

pubofemoral lig

posterior:

ischiofemoral lig

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19
Q

what is the zona orbicularis?

A

circular fibres forming a collar at femoral neck - like its own “annular ligament”

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20
Q

acetabular labrum is ____ with the cartilage posteriorly and _____ anteriorly

A

continuous, marginally attached

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21
Q

acetabular labrum functions: name 2

A

deepens socket by 30%

seals fluid - protects cartilage

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22
Q

adequate AP pelvis xray: list criteria

A

coccyx in-line with symphysis

symmetrical teardrops, obturator foramina, iliac wings

symphysis to sacro-coccygeal junction vertical distance (difficult to see): 32mm men, 47mm women

sympysis to tip of cocyx: 1-3cm

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23
Q

what is the utility of frog-leg lateral xray of hip?

A

profile of head/neck junction

see subtle SCFEs

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24
Q

How is the Dunn view taken?

what is its utility?

A

hip flexed to 45 or 90

20 deg abduction, neutral rotation

beam shot straight down at hip

utility: profiles head/neck junction to check alpha angle for FAI (<55 deg=CAM)

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25
how do you take a false profile xray? what is its utility?
standing patient ER body relative to cassette 65 deg beam centred on fem head utility: for anterior CEA: \<20=dysplasia, \>40=pincer
26
what spinal level is the aortic bifurcation? common iliac bifurcation?
L4, S1
27
name the internal iliac artery branches
obturator superior gluteal inferior gluteal internal pudendal vesicular lateral sacral
28
what is the corona mortis and where is it?
anatomic variant anastomosis between obturator artery and either external iliac or inf epigastric artery ocurs variable distance from symphysis, behind sup pub ramus (40-96mm from symphysis)
29
what two major arteries supply the proximal femur? they are branches of what?
MFCA and LFCA branch of profunda femoris
30
describe the path of the superficial femoral artery (start from external iliac artery)
external iliac artery crosses under inguinal ligament into femoral triangle becomes common femoral artery divides into profunda femoris and superficial femoral artery SFA runs along anteromedial thigh under sartorius in hunter's canal between vastus med and adductor longus exits through adductor hiatus goes through adductor hiatus and becomes popliteal artery
31
describe the path of the medial fem circumflex artery
between pectineus and psoas anteriorly then btw obt externus and adductor brevis then btw adductor magnus and brevis then along superior edge of quad fem ascending branch runs over obturator externus, deep to piriformis into piriformis fossa
32
describe the path of the lateral fem circumflex artery
lies deep to rectus and sartorius ascending br to GT descending br under lateral rectus
33
what is the cruciate anastomosis? significance?
anastomosis of: inferior gluteal a MFCA LFCA first perforator of profunda (ascending branch) allows collateral flow in case blockage between ext iliac and femoral arteries
34
femoral triangle:borders and floor?
sartorius, adductor longus, inguinal lig floor: (lat to med) iliacus, psoas, pectineus add longus
35
fem triangle contents
lat to med: fem N, A, V, and Lymphatics NAVAL
36
acetabular zones - what defines them?
line from centre of acetab to ASIS line perpendicular to that one thru centre of acetab get 4 zones: PS, PI, AS, AI
37
acetabular zone: posterior superior safe for screws? risks?
safe. risks: i.e. the stuff in GSN above piriformis and originating above this point superior gluteal n,a,v sciatic n
38
acetabular zone: posterior inferior safe? risks?
safe risks: (the stuff in GSN below piriformis) sciatic n inf gluteal n,a,v pudendal n internal pudendal a,v (not posterior fem cutaneous n or n to quad fem)
39
acetabular zone: anterior superior safe? risks?
NOT SAFE risks: external iliac vessels
40
acetabular zone: anterior inferior safe? risks?
NOT SAFE risks: obturator n,a,v
41
name the hip flexors
iliopsoas rectus femoris sartorius
42
name the hip extensors
glut max hamstrings (semi T, semi M, biceps fem)
43
name the hip abductors
glut med glut min TFL (in flexed hip)
44
name the hip adductors
adductor longus/brevis/magnus pectineus gracillis
45
list the short external rotators of the hip from superior to inferior (in terms of insertion site)
piriformis - ventral sacrum to piriformis fossa sup gemellus obt internus obt externus: inf gemellus quad femoris
46
list the hip internal rotators
glut medius - anterior fibres glut min - anterior fibres TFL semi-M semi-T pectineus adductor magnus - posterior fibres
47
list the nerves coming off lumbosacral plexus LATERAL to psoas
iliohypogastric n ilioinguinal n LFCN
48
list the nerves coming off lumbosacral plexus MEDIAL to psoas
obturator n lumbosacral trunk
49
what nerve emerges between psoas and iliacus?
femoral n
50
what nerve pierces the psoas and lies anterior to it?
genitofemoral n
51
where is the LFCN relative to the ASIS?
2cm medially
52
what is most common nerve injury during THA? Which division and why?
sciatic n. peroneal division b/c more lateral
53
what is the only muscle innervated by peroneal n proximal to fibular neck?
short head of biceps femoris
54
structure most at risk during posterior ICBG harvest is? what else is at risk?
superior gluteal artery also: cluneal nerves, sciatic n
55
describe the path of the obturator nerve in the thigh
passes through obturator foramen to enter thigh divides into anterior and posterior branches anterior: travels anterior to obturator externus then lies between adductor brevis and longus/pectineus posterior branch: pierces obturator externus, then between adductor brevis and magnus
56
after loss of obturator n, how can the hip still adduct?
with pectineus. supplied by femoral n.
57
vessel at ligamentum teres comes from what major artery?
posterior branch of obturator artery
58
59
describe smith peterson approach
incision from ASIS curved downwards between sartorius (femoral n) and TFL (sup gluteal n) between rectus medially (femoral n) and glut medius laterally (sup gluteal n)
60
dangers of smith peterson approach
femoral n/a/v ascending branch of LFCA LFCN
61
dangers of hardinge approach?
sup glut n - runs betrween medius and minimus branches 3-5cm above GT femoral bundle - watch retractors tnrasverse branch of LFCA
62
describe watson jones approach
incision along anterior GT curve incision towards ASIS at GT tip split ITB curving towards ASIS retract medius+minimums posteriorly, TFL anteriorly IM plane - abductors and TFL - both sup glut n PRN GT osteotomy
63
dangers of moore's/southern approach?
AKA posterior approach to hip sciatic n inf glut a when splitting maximus MFCA branch along top of quad fem - can release maximum proximal 1cm
64
describe medial approach to hip what is the other name for this approach?
Ludloff approach. supine with hip in figure-4 incision 3cm below pubic tubercle, longitudinal down longus plane: between adductor longus and gracillis (IM plane, both obturator n anterior division) then between adductor brevis and magnus (IN plane?? posterior magnus=sciatic n)
65
dangers of ludloff approach?
anterior obturator n - between add longus and brevis posterior obturator n - on magnus under brevis MFCA - medial/distal part of psoas tendon
66
boudaries of the I-I approach lateral window?
iliac wing to psoas (and fem n)
67
boundaries of middle window of I-I approach?
psoas to external iliac vessels
68
boundaries of medial window of I-I approach?
external iliac vessels to rectus abdominus
69
describe modified stoppa approach
surgeon stands on contralateral side pfannenstiel incision 1-2cm above symphysis split rectus, incise transversalis enter space of retzius, potect bladder subperiosteal dissection along sup pubic ramus/brim up to internal iliac fossa identify corona mortis - ligate detach iliopectineal fascia expose quad plate
70
dangers of modified stoppa approach?
corona mortis bladder spermatic cord (careful laterally) external iliac vessels obturator n/a/v
71
describe extended iliofemoral approach
extension to smith peterson smith pete incision, but extend proximally along crest and distally along femur as needed expose both tables of pelvis outer: from reflected head of rectus to sciatic notch, detach medius and minimus from crest inner: detach direct head of rectus and stay under iliacus back to sciatic notch to access posterior column, detach medius and minimums from GT
72
internervous plane of posterior approach for ICBG?
between glut med/TFL(SGN), glut max (IGN) and parapsinal muscles (segmetal) and lat dorsi (long thoracic n)
73
dangers of posterior approach for ICBG harvest
cluneal nerves - cross crest 8cm aterior to PSIS - stay posterior sciatic n, superior glut n/a/v (via GSN - stay proximal to it)
74

Anatomy (13 decks)

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