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Anatomy > pelvis and hip (brian) > Flashcards

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
Q

how do you take a false profile xray?

what is its utility?

A

standing patient

ER body relative to cassette 65 deg

beam centred on fem head

utility: for anterior CEA: <20=dysplasia, >40=pincer

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26
Q

what spinal level is the aortic bifurcation?

common iliac bifurcation?

A

L4, S1

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27
Q

name the internal iliac artery branches

A

obturator

superior gluteal

inferior gluteal

internal pudendal

vesicular

lateral sacral

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28
Q

what is the corona mortis and where is it?

A

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)

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29
Q

what two major arteries supply the proximal femur?

they are branches of what?

A

MFCA and LFCA

branch of profunda femoris

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30
Q

describe the path of the superficial femoral artery

(start from external iliac artery)

A

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
Q

describe the path of the medial fem circumflex artery

A

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
Q

describe the path of the lateral fem circumflex artery

A

lies deep to rectus and sartorius

ascending br to GT

descending br under lateral rectus

33
Q

what is the cruciate anastomosis?

significance?

A

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
Q

femoral triangle:borders and floor?

A

sartorius, adductor longus, inguinal lig

floor: (lat to med)

iliacus, psoas, pectineus add longus

35
Q

fem triangle contents

A

lat to med:

fem N, A, V, and Lymphatics

NAVAL

36
Q

acetabular zones - what defines them?

A

line from centre of acetab to ASIS

line perpendicular to that one thru centre of acetab

get 4 zones: PS, PI, AS, AI

37
Q

acetabular zone: posterior superior

safe for screws?

risks?

A

safe.

risks: i.e. the stuff in GSN above piriformis and originating above this point

superior gluteal n,a,v

sciatic n

38
Q

acetabular zone: posterior inferior

safe?

risks?

A

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
Q

acetabular zone: anterior superior

safe?

risks?

A

NOT SAFE

risks: external iliac vessels

40
Q

acetabular zone: anterior inferior

safe?

risks?

A

NOT SAFE

risks: obturator n,a,v

41
Q

name the hip flexors

A

iliopsoas

rectus femoris

sartorius

42
Q

name the hip extensors

A

glut max

hamstrings (semi T, semi M, biceps fem)

43
Q

name the hip abductors

A

glut med

glut min

TFL (in flexed hip)

44
Q

name the hip adductors

A

adductor longus/brevis/magnus

pectineus

gracillis

45
Q

list the short external rotators of the hip from superior to inferior (in terms of insertion site)

A

piriformis - ventral sacrum to piriformis fossa

sup gemellus

obt internus

obt externus:

inf gemellus

quad femoris

46
Q

list the hip internal rotators

A

glut medius - anterior fibres

glut min - anterior fibres

TFL

semi-M

semi-T

pectineus

adductor magnus - posterior fibres

47
Q

list the nerves coming off lumbosacral plexus LATERAL to psoas

A

iliohypogastric n

ilioinguinal n

LFCN

48
Q

list the nerves coming off lumbosacral plexus MEDIAL to psoas

A

obturator n

lumbosacral trunk

49
Q

what nerve emerges between psoas and iliacus?

A

femoral n

50
Q

what nerve pierces the psoas and lies anterior to it?

A

genitofemoral n

51
Q

where is the LFCN relative to the ASIS?

A

2cm medially

52
Q

what is most common nerve injury during THA? Which division and why?

A

sciatic n.

peroneal division b/c more lateral

53
Q

what is the only muscle innervated by peroneal n proximal to fibular neck?

A

short head of biceps femoris

54
Q

structure most at risk during posterior ICBG harvest is?

what else is at risk?

A

superior gluteal artery

also: cluneal nerves, sciatic n

55
Q

describe the path of the obturator nerve in the thigh

A

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
Q

after loss of obturator n, how can the hip still adduct?

A

with pectineus. supplied by femoral n.

57
Q

vessel at ligamentum teres comes from what major artery?

A

posterior branch of obturator artery

58
Q
A
59
Q

describe smith peterson approach

A

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
Q

dangers of smith peterson approach

A

femoral n/a/v

ascending branch of LFCA

LFCN

61
Q

dangers of hardinge approach?

A

sup glut n - runs betrween medius and minimus

branches 3-5cm above GT

femoral bundle - watch retractors

tnrasverse branch of LFCA

62
Q

describe watson jones approach

A

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
Q

dangers of moore’s/southern approach?

A

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
Q

describe medial approach to hip

what is the other name for this approach?

A

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
Q

dangers of ludloff approach?

A

anterior obturator n - between add longus and brevis

posterior obturator n - on magnus under brevis

MFCA - medial/distal part of psoas tendon

66
Q

boudaries of the I-I approach lateral window?

A

iliac wing to psoas (and fem n)

67
Q

boundaries of middle window of I-I approach?

A

psoas to external iliac vessels

68
Q

boundaries of medial window of I-I approach?

A

external iliac vessels to rectus abdominus

69
Q

describe modified stoppa approach

A

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
Q

dangers of modified stoppa approach?

A

corona mortis

bladder

spermatic cord (careful laterally)

external iliac vessels

obturator n/a/v

71
Q

describe extended iliofemoral approach

A

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
Q

internervous plane of posterior approach for ICBG?

A

between glut med/TFL(SGN), glut max (IGN)

and

parapsinal muscles (segmetal) and lat dorsi (long thoracic n)

73
Q

dangers of posterior approach for ICBG harvest

A

cluneal nerves - cross crest 8cm aterior to PSIS - stay posterior

sciatic n, superior glut n/a/v (via GSN - stay proximal to it)

74
Q
A

Anatomy (13 decks)

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