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Orthopedic Surgery Ultimate > Pelvis/Hip Anatomy > Flashcards

Pelvis/Hip Anatomy Flashcards

1
Q

what is the inominate bone?

A

the fused pelvis - made up of ilium, ischium and pubis

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2
Q

what is the triradiate cartilage and when does it fuse?

A

the junction of ilium, ischium and pubis

at 14-16 years (puberty)

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3
Q
A

anterior gluteal line

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4
Q
A

ASIS

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5
Q
A

AIIS

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6
Q
A

acetabular margin

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7
Q
A

lunate surface

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8
Q
A

acetabular fossa

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9
Q
A

acetabular notch

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10
Q
A

superior ramus

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11
Q
A

inferior ramus

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12
Q
A

ischial ramus

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13
Q
A

ischial tuberosity

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14
Q
A

lesser sciatic notch

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15
Q
A

ischial spine

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16
Q
A

greater sciatic notch

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17
Q
A

PIIS

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18
Q
A

PSIS

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19
Q
A

posterior gluteal line

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20
Q
A

iliac tuberosity

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21
Q
A

PSIS

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22
Q
A

articular surface

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23
Q
A

PIIS

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24
Q
A

greater sciatic notch

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25
Q
A

ischial spine

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26
Q
A

lesser sciatic notch

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27
Q
A

obturator foramen

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28
Q
A

ischial tuberosity

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29
Q
A

ischiopubic ramus

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30
Q
A

symphyseal surface

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31
Q
A

pubic angle

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32
Q
A

pubic tubercle

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33
Q
A

obturator crest

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34
Q
A

pectineal line

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35
Q
A

pectineal surface

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36
Q
A

arcuate line

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37
Q
A

AIIS

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38
Q
A

ASIS

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39
Q

describe the 2 parts of the ischium

A

body - composed of spine and tuberosity

ramus - forms the obturator foramen when it joins inferior ramus

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40
Q

describe the 3 parts of the pubis

A

body

superior ramus - connects to ilium and ischium

inferior ramus - connects to ischial ramus

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41
Q

what attaches at the pubic tubercle?

A

inguinal ligament

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42
Q

what is the pectineal line?

A

the superior ridge from the pubic tubercle to the superior pubic ramus

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43
Q

describe the symphysis pubis

A

non-synovial amphiarthroidal

composed of fibrocartilagenous disc

2 ligaments - superior pubic (stronger), inferior (arcuate) pubic

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44
Q

how many vertebrae fuse to form the sacrum?

A

5

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45
Q

what makes up the medial sacral crest?

A

fused SPs

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46
Q

what creates the sacral alae?

A

fused TPs

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47
Q

what creates the SI articular processes?

A

fused costal processes!

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48
Q

what exits through the anterior and posterior sacral foraminae?

A

ventral and dorsal primary rami respectively

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49
Q

how many vertebrae fuse to form the coccyx?

A

4-5

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50
Q

what is the difference between male and female coccyx?

A

male = anteriorly directed toward pubis

female = vertically directed

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51
Q

5 signs of sacral dysmorphism

A

sacralized L5

lumbarilized S1

presence of mammillary processes

oval or oblong foramen

“tongue in groove sign”

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52
Q

A patient is undergoing percutaneous S1 SI
screw fixation for a sacroiliac joint diastasis.
What is the most common strength deficit
sequela of this proposed screw trajectory?

A

loss of great toe extension (L5) because this nerve travels along the alar shelf of sacrum

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53
Q

what type of joint is the SI?

A

diarthroidal gliding synovial

interestingly, the sacral side is hyaline cartilage and the ilial side is fibrocartilage

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54
Q

when does the SI fuse?

A

age 50

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55
Q

which superficial landmark corresponds to the SI joint?

A

fossae lumbales laterales (dimples of venus)

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56
Q
A

iliolumbar ligament

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57
Q
A

posterior SI ligaments

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58
Q
A

sacrospinous ligament

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59
Q
A

sacrotuberous ligament

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60
Q
A

interosseous sacroiliac ligaments

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61
Q
A

ALL

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62
Q
A

anterior sacroiliac ligaments

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63
Q

The inferior and superior gluteal nerves are
designated as such based on their
relationship to what structure?

A

piriformis

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64
Q

boundaries of the greater sciatic notch

A

ilium and sacrospinous ligament

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65
Q

contents of greater sciatic notch

A

above piriformis:

superior gluteal artery and nerve

below piriformis (POP’S IQ):

pudendal nerve and internal pudendal vessels

obturator internus nerve

posterior femoral cutaneous nerve

sciatic nerve

inferior gluteal artery and nerve

quadratus femoris nerve

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66
Q

boundaries of the lesser sciatic notch

A

sacrospinous ligament superior

sacrotuberous ligament inferior

ischial spine and ishial tuberosity

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67
Q

contents of the lesser sciatic foramen

A

obturator internus

obturator internus nerve

pudendal nerve

internal pudendal vessels

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68
Q

what is the obturator canal?

A

an opening in the superior part of the obturator foramen through which the nerve, artery and vein pass

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69
Q
A

obturator canal

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70
Q

what type of joint is the hip?

A

synovial spheroidal

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71
Q

anteversion of the hip

A

15°

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72
Q

neck-shaft angle of the hip

A

127°

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73
Q

where does the hip capsule attach to the femur?

A

anteriorly to the intertrochanteric line via the ligament of bigelow (iliofemoral, Y-shaped, strongest in body) and the pubofemoral ligament

posteriorly to the femoral neck via the ischiofemoral ligament

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74
Q

what is the zona orbicularis?

A

circular fibers that form a collar at the femoral neck

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75
Q

2 functions of the labrum

A

stability - it deepens the socket by 30%

seal for fluid, which protects cartilage

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76
Q

explain the attachement of the labrum

A

anteriorly it is marginally attached to cartilage

posteriorly it is continuous with cartilage

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77
Q

shape of labrum

A

triangular in cross-section

horseshoe-shaped and continuous with transverse acetabular ligament

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78
Q

what are the 6 fundamental lines of an AP pelvis view?

A

posterior wall

anterior wall

roof of acetabulum

teardrop

ilioischial line (posterior column)

iliopectineal line (anterior column)

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79
Q

4 ways to assess an AP pelvis view for adequacy

A

coccyx in line with pubis

symmetric teardrops

symmetric obturator foramina

symphysis - coccyx junction = 3 cm in men, 5 cm in women

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80
Q
A

crossover sign - where the proximal anterior wall projects more laterally than the proximal posterior wall

this is a sign of acetabular retroversion and could lead to femoral-acetabular impingement

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81
Q
A

ischial spine sign

indicative of acetabular retroversion and potential for femoral-acetabular impingement

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82
Q

what is the tonnis angle?

A

horizontal along top of acetabulum

second line from edge of triradiate cartilage to edge of acetabulum

>10° is abnormal

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83
Q

what is CEA?

A

the center-edge angle

best acquired on false profile view

normal is between 25° and 40°

essentially it is the line from the middle of the femoral head vertically and the line from the middle of the femoral head to the anterolateral edge of the acetabulum

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84
Q

how do you take a cross-table lateral view?

A

supine

contralateral knee and hip flexed to >80° total

internal rotation of leg 15°

tube 45° to limb, parallel to table

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85
Q

how do you take a frog leg lateral and what is it good for?

A

supine

hip abducted 45°

knee flexed

foot on contralateral knee

aim between ASIS and symphysis

*this shows the head-neck junction very well (SCFE)

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86
Q

what is a Dunn view and why is it useful?

A

supine

hip flexed to 45° or 90°

20° abduction, neutral rotation

good for acquiring alpha angle

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87
Q

what is alpha angle?

A

normal is < 57° (according to recent papers, despite what this says)

greater than this suggests impingement

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88
Q

how do you take a false profile view?

A

standing

rotated 65°

beam centred on femoral head

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89
Q

how do you take inlet and outlet views?

what are they good for?

A

inlet: beam parallel to sacrum
outlet: beam perpendicular to sacrum

inlet shows pelvic ring

outlet shows rami

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90
Q

5 elementary fractures of the acetabulum according to Letournel

A

AC

AW

PC

PW

transverse

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91
Q

5 associated fractures of the acetabulum according to Letournel

A

T-type

transverse + PW

PC + PW

anterior and posterior hemitransverse

both column

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92
Q
A

anterior column

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93
Q
A

anterior wall

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94
Q
A

posterior column

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95
Q
A

posterior wall

96
Q
A

transverse

97
Q
A

T-type

98
Q
A

transverse + PW

99
Q
A

PC + PW

100
Q
A

anterior-posterior hemitransverse

101
Q
A

both column

102
Q
A

obturator oblique of R hip = will show PC and AW

*note this is also an iliac oblique of the L hip = will show AC and PW

103
Q
A

young-burgess

LC 1

104
Q
A

young-burgess

LC 2

105
Q
A

young-burgess

LC 3

106
Q
A

young-burgess

APC 1

107
Q
A

young-burgess

APC 2

108
Q
A

young-burgess

APC 3

109
Q
A

young-burgess

vertical shear

110
Q

level of the aortic bifurcation

A

L4

111
Q

level of the common iliac bifurcations

A

S1

112
Q

5 branches of the internal iliac artery

A

obturator

superior and inferior gluteals

internal pudendal

vesicular

lateral sacral

113
Q

what is the corona mortis?

A

an anatomical variant anastomosis between the obturator artery and the external iliac artery OR inferior epigastric artery

located behind superior pubic ramus 2-10 cm from the symphysis

114
Q

branches of the profunda femoris artery

A

lateral femoral circumflex

medial femoral circumflex

3 perforating branches

115
Q

course of the superficial femoral artery

A

medial thigh

between vastus medialis and adductor longus

deep to sartorius

into the adductor canal

116
Q

course of lateral circumflex

A

deep to rectus and sartorius

ascending branch supplies the GT

descending branch under lateral part of rectus

117
Q

course of medial circumflex artery

A

between pectineus and iliopsoas

then between obturator externus and adductor brevis

then between adductor magnus and brevis

then along superior edge of quadratus femoris

ascending branch runs over obturator externus and under piriformis

118
Q

primary blood supply to femoral head

A

medial circumflex artery

119
Q

secondary blood supply to femoral head

A

obturator artery through ligamentum teres

120
Q

what is the cruciate anastomosis?

A

inferior gluteal artery

MFCA

LFCA

first perforator ascending branch

*allows distal flow if there is a blockage of the external iliac

121
Q

borders of the femoral triangle

A

sartorius

adductor longus

inguinal ligament

122
Q

contents of the femoral triangle lateral to medial

A

NAVEL

123
Q

floor of the femoral triangle lateral to medial

A

iliacus

psoas

pectineus

adductor longus

124
Q

how do you define the four quadrants of the acetabulum?

A

line from ASIS to center of acetabulum, another perpendicular to this

125
Q

where is the safe zone for acetabular screws?

A

posterior superior

126
Q

when is the posterior inferior corner safe for acetabular screws?

A

when they are less than 20 mm

127
Q

why should you avoid acetabular screws in the anterior inferior quadrant?

A

obturator nerve

obturator artery

obturator vein

128
Q

why should you avoid screws in the anterior superior quadrant of the acetabulum?

A

external iliac artery

external iliac vein

129
Q

3 hip flexors

A

iliopsoas

sartorius

rectus femoris

130
Q

4 hip extensors

A

glut max

semi T

semi M

biceps femoris

131
Q

3 abductors of the hip

A

glut med

glut min

TFL

132
Q

5 adductors of the hip

A

adductor longus

adductor brevis

adductor magnus

pectineus

gracilis

133
Q

6 short external rotators of the hip

A

piriformis

superior gemellus

obturator internus

obturator externus

inferior gemellus

quadratus femoris

134
Q

7 internal rotators of the hip

A

glut med (anterior fibres)

glut min (anterior fibres)

TFL

semi M

semi T

pectineus

adductor magnus (posterior fibres)

135
Q

origin and insertion of iliacus

A

iliac fossa to lesser T

136
Q

origin and insertion of psoas

A

TP of L1-5 to lesser T

137
Q

origin and insertion of pectineus

A

pectineal line of pubis to pectineal line of femur

138
Q

origin and insertion of rectus femoris

A

AIIS and acetabular rim to patella

139
Q

origin and insertion of adductor magnus

A

inferior pubic ramus/ischial tuberosity to linea aspera/adductor tubercle

140
Q

origin and insertion of adductor brevis

A

inferior pubic ramus to linea aspera/pectineal line

141
Q

origin and insertion of adductor longus

A

anterior pubic ramus to linea aspera

142
Q

origin and insertion of gracilis

A

inferior symphysis to proximal medial tibia

143
Q

origin and insertion of glut max

A

ilium above gluteal line to IT band

144
Q

origin and insertion of piriformis

A

anterior sacrum to proximal GT

145
Q

origin and insertion of obturator externus

A

ishiopubic rami/obturator membrane to trochlear fossa (posterior groove between GT and LT)

146
Q

origin and insertion of obturator internus

A

ishiopubic rami/obturator membrane to medial GT

147
Q

origin and insertion of superior gemellus

A

outer ischial spine to MGT

148
Q

origin and insertion of inferior gemellus

A

ischial tuberosity to MGT

149
Q

origin and insertion of quadratus femoris

A

ischial tuberosity to quadrate line of femur

150
Q

origin and insertion of glut med

A

ilium between posterior and anterior gluteal lines to GT

151
Q

origin and insertion of glut min

A

ilium between anterior and inferior gluteal lines to anterior border of GT

152
Q

origin and insertion of TFL

A

anterior iliac crest to IT band

153
Q
A

piriformis

154
Q
A

psoas minor

155
Q
A

pectineus

156
Q
A

adductor longus

157
Q
A

adductor brevis

158
Q
A

gracillis

159
Q
A

obturator externus

160
Q
A

vastus intermedius

161
Q
A

articularis genus

162
Q
A

patellar ligament

163
Q
A

sartorius

164
Q
A

gracillis

165
Q
A

semi T

166
Q
A

adductor magnus

167
Q
A

iliopsoas

168
Q
A

biceps femoris

169
Q
A

IT band

170
Q
A

vastus medialis

171
Q
A

vastus lateralis

172
Q
A

glut min

173
Q
A

piriformis

174
Q
A

rectus femoris

175
Q
A

sartorius

176
Q
A

TFL

177
Q
A

iliacus

178
Q
A

psoas major

179
Q
A

glut med

180
Q
A

glut min

181
Q
A

TFL

182
Q
A

sartorius

183
Q
A

rectus femoris

184
Q
A

glut med

185
Q
A

obturator internus

186
Q
A

long head biceps femoris

187
Q
A

quadratus femoris

188
Q
A

glut max

189
Q
A

vastus medialis

190
Q
A

vastus intermedius

191
Q
A

vastus lateralis

192
Q
A

short head biceps femoris

193
Q
A

biceps femoris

194
Q
A

semi M

195
Q
A

adductor magnus

196
Q
A

adductor longus

197
Q
A

vastus intermedius

198
Q
A

adductor brevis

199
Q
A

pectineus

200
Q
A

iliopsoas

201
Q
A

adductor magnus

202
Q
A

semi M

203
Q
A

semi T

204
Q
A

inferior gemellus

205
Q
A

obturator internus

206
Q
A

superior gemellus

207
Q
A

glut max

208
Q

location of the lumbosacral plexus

A

deep to psoas on the anterior surface of quadratus lumborum

209
Q

nerves that compose the lumbar plexus

A

L1-4

210
Q

nerves that compose the sacral plexus

A

L4-S4

211
Q

what is the order of the 8 nerves arising from the lumbosacral plexus anteriorly with respect to psoas?

A

subcostal

IH

II

LFCN

femoral

genitofemoral

obturator

lumbosacral trunk

212
Q

where is the LFCN vulnerable?

A

as it emerges under the inguinal ligament 2 cm medial to ASIS

213
Q

During total hip arthroplasty (THA) via a posterior
approach, where is the sciatic nerve most likely to
be found?

A

deep to piriformis and superficial to the short external rotators

214
Q

course of obturator nerve

A

exits pelvis through obturator foramen

anterior division goes anterior to externus and posterior to pectineus to supply longus, brevis, gracillis,skin of medial thigh

posterior division supplies obturator externus, brevis, upper part of magnus and the knee joint

215
Q

what nerve is at risk with retraction behind the transverse acetabular ligament in THA?

A

posterior division of the obturator nerve

216
Q

from where does the saphenous nerve arise?

A

a terminal branch of the femoral nerve arising at the apex of the femoral triangle and travelling deep to sartorius

217
Q

most common nerve injured during THA

A

sciatic, peroneal division (because it is more lateral i.e. closer to the retractor)

218
Q

only muscle innervated by the common peroneal nerve?

A

short head of biceps

219
Q

During a posterior approach to the acetabulum, the nerve exiting above piriformis is damaged. This will lead
to weakness in:

A

glut med

glut min

TFL

(they are talking about superior gluteal nerve)

220
Q

When harvesting posterior iliac bone graft, the structure most at risk is:

A

superior gluteal artery

221
Q

Following an intrapelvic obturator neurectomy, continued hip adduction is possible because of:

A

pectineus (femoral nerve)

222
Q

What structure do you need to take down to access the quadrilateral plate through an ileo-inguinal incision?

A

insertion of rectus abdominus

223
Q

In the ilioinguinal approach, which interval exposes the quadrilateral plate?

A

between iliopsoas and neurovascular bundle

224
Q

In the Smith-Peterson anterior approach to the hip, the most common injury is to the:

A

LFCN

225
Q

In the anterior Smith-Peterson approach the deep interval is between rectus femoris and:

A

glut med

226
Q

Often during total hip replacement there is a vessel at the insertion of the ligamentum teres that
bleeds. This vessel arises from:

A

posterior branch of the obturator artery

227
Q

Which vessel would be most likely involved
adult avascular necrosis of the hip

A

lateral epiphyseal vessels of the MFCA

228
Q

draw the lumbosacral plexus

A
229
Q

innervation of piriformis

A

S1-2

230
Q

innervation of superior gemellus

A

nerve to obturator internus

L5-S2

231
Q

innervation of obturator internus

A

nerve to obturator internus

L5-S2

232
Q

innervation of gemellus inferior

A

nerve to quadratus femoris

L4-S1

233
Q

innervation of quadratus femoris

A

nerve to quadratus femoris

L4-S1

234
Q

innervation of obturator externus

A

posterior branch of obturator nerve

L3-4

235
Q

innervation of psoas

A

L1-3

236
Q

innervation of iliacus

A

femoral nerve

Orthopedic Surgery Ultimate (88 decks)

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