Pelvis/Hip Anatomy Flashcards
1
Q
what is the inominate bone?
A
the fused pelvis - made up of ilium, ischium and pubis
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)
3
Q
A
anterior gluteal line
4
Q
A
ASIS
5
Q
A
AIIS
6
Q
A
acetabular margin
7
Q
A
lunate surface
8
Q
A
acetabular fossa
9
Q
A
acetabular notch
10
Q
A
superior ramus
11
Q
A
inferior ramus
12
Q
A
ischial ramus
13
Q
A
ischial tuberosity
14
Q
A
lesser sciatic notch
15
Q
A
ischial spine
16
Q
A
greater sciatic notch
17
Q
A
PIIS
18
Q
A
PSIS
19
Q
A
posterior gluteal line
20
Q
A
iliac tuberosity
21
Q
A
PSIS
22
Q
A
articular surface
23
Q
A
PIIS
24
Q
A
greater sciatic notch
25
ischial spine
26
lesser sciatic notch
27
obturator foramen
28
ischial tuberosity
29
ischiopubic ramus
30
symphyseal surface
31
pubic angle
32
pubic tubercle
33
obturator crest
34
pectineal line
35
pectineal surface
36
arcuate line
37
AIIS
38
ASIS
39
describe the 2 parts of the ischium
body - composed of spine and tuberosity
ramus - forms the obturator foramen when it joins inferior ramus
40
describe the 3 parts of the pubis
body
superior ramus - connects to ilium and ischium
inferior ramus - connects to ischial ramus
41
what attaches at the pubic tubercle?
inguinal ligament
42
what is the pectineal line?
the superior ridge from the pubic tubercle to the superior pubic ramus
43
describe the symphysis pubis
non-synovial amphiarthroidal
composed of fibrocartilagenous disc
2 ligaments - superior pubic (stronger), inferior (arcuate) pubic
44
how many vertebrae fuse to form the sacrum?
5
45
what makes up the medial sacral crest?
fused SPs
46
what creates the sacral alae?
fused TPs
47
what creates the SI articular processes?
fused costal processes!
48
what exits through the anterior and posterior sacral foraminae?
ventral and dorsal primary rami respectively
49
how many vertebrae fuse to form the coccyx?
4-5
50
what is the difference between male and female coccyx?
male = anteriorly directed toward pubis
female = vertically directed
51
5 signs of sacral dysmorphism
sacralized L5
lumbarilized S1
presence of mammillary processes
oval or oblong foramen
"tongue in groove sign"
52
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?
loss of great toe extension (L5) because this nerve travels along the alar shelf of sacrum
53
what type of joint is the SI?
diarthroidal gliding synovial
interestingly, the sacral side is hyaline cartilage and the ilial side is fibrocartilage
54
when does the SI fuse?
age 50
55
which superficial landmark corresponds to the SI joint?
fossae lumbales laterales (dimples of venus)
56
iliolumbar ligament
57
posterior SI ligaments
58
sacrospinous ligament
59
sacrotuberous ligament
60
interosseous sacroiliac ligaments
61
ALL
62
anterior sacroiliac ligaments
63
The inferior and superior gluteal nerves are
designated as such based on their
relationship to what structure?
piriformis
64
boundaries of the greater sciatic notch
ilium and sacrospinous ligament
65
contents of greater sciatic notch
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
66
boundaries of the lesser sciatic notch
sacrospinous ligament superior
sacrotuberous ligament inferior
ischial spine and ishial tuberosity
67
contents of the lesser sciatic foramen
obturator internus
obturator internus nerve
pudendal nerve
internal pudendal vessels
68
what is the obturator canal?
an opening in the superior part of the obturator foramen through which the nerve, artery and vein pass
69
obturator canal
70
what type of joint is the hip?
synovial spheroidal
71
anteversion of the hip
15°
72
neck-shaft angle of the hip
127°
73
where does the hip capsule attach to the femur?
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
74
what is the zona orbicularis?
circular fibers that form a collar at the femoral neck
75
2 functions of the labrum
stability - it deepens the socket by 30%
seal for fluid, which protects cartilage
76
explain the attachement of the labrum
anteriorly it is marginally attached to cartilage
posteriorly it is continuous with cartilage
77
shape of labrum
triangular in cross-section
horseshoe-shaped and continuous with transverse acetabular ligament
78
what are the 6 fundamental lines of an AP pelvis view?
posterior wall
anterior wall
roof of acetabulum
teardrop
ilioischial line (posterior column)
iliopectineal line (anterior column)
79
4 ways to assess an AP pelvis view for adequacy
coccyx in line with pubis
symmetric teardrops
symmetric obturator foramina
symphysis - coccyx junction = 3 cm in men, 5 cm in women
80
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
81
ischial spine sign
indicative of acetabular retroversion and potential for femoral-acetabular impingement
82
what is the tonnis angle?
horizontal along top of acetabulum
second line from edge of triradiate cartilage to edge of acetabulum
\>10° is abnormal
83
what is CEA?
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
84
how do you take a cross-table lateral view?
supine
contralateral knee and hip flexed to \>80° total
internal rotation of leg 15°
tube 45° to limb, parallel to table
85
how do you take a frog leg lateral and what is it good for?
supine
hip abducted 45°
knee flexed
foot on contralateral knee
aim between ASIS and symphysis
\*this shows the head-neck junction very well (SCFE)
86
what is a Dunn view and why is it useful?
supine
hip flexed to 45° or 90°
20° abduction, neutral rotation
good for acquiring alpha angle
87
what is alpha angle?
normal is \< 57° (according to recent papers, despite what this says)
greater than this suggests impingement
88
how do you take a false profile view?
standing
rotated 65°
beam centred on femoral head
89
how do you take inlet and outlet views?
what are they good for?
inlet: beam parallel to sacrum
outlet: beam perpendicular to sacrum
inlet shows pelvic ring
outlet shows rami
90
5 elementary fractures of the acetabulum according to Letournel
AC
AW
PC
PW
transverse
91
5 associated fractures of the acetabulum according to Letournel
T-type
transverse + PW
PC + PW
anterior and posterior hemitransverse
both column
92
anterior column
93
anterior wall
94
posterior column
95
posterior wall
96
transverse
97
T-type
98
transverse + PW
99
PC + PW
100
anterior-posterior hemitransverse
101
both column
102
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
young-burgess
LC 1
104
young-burgess
LC 2
105
young-burgess
LC 3
106
young-burgess
APC 1
107
young-burgess
APC 2
108
young-burgess
APC 3
109
young-burgess
vertical shear
110
level of the aortic bifurcation
L4
111
level of the common iliac bifurcations
S1
112
5 branches of the internal iliac artery
obturator
superior and inferior gluteals
internal pudendal
vesicular
lateral sacral
113
what is the corona mortis?
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
branches of the profunda femoris artery
lateral femoral circumflex
medial femoral circumflex
3 perforating branches
115
course of the superficial femoral artery
medial thigh
between vastus medialis and adductor longus
deep to sartorius
into the adductor canal
116
course of lateral circumflex
deep to rectus and sartorius
ascending branch supplies the GT
descending branch under lateral part of rectus
117
course of medial circumflex artery
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
primary blood supply to femoral head
medial circumflex artery
119
secondary blood supply to femoral head
obturator artery through ligamentum teres
120
what is the cruciate anastomosis?
inferior gluteal artery
MFCA
LFCA
first perforator ascending branch
\*allows distal flow if there is a blockage of the external iliac
121
borders of the femoral triangle
sartorius
adductor longus
inguinal ligament
122
contents of the femoral triangle lateral to medial
NAVEL
123
floor of the femoral triangle lateral to medial
iliacus
psoas
pectineus
adductor longus
124
how do you define the four quadrants of the acetabulum?
line from ASIS to center of acetabulum, another perpendicular to this
125
where is the safe zone for acetabular screws?
posterior superior
126
when is the posterior inferior corner safe for acetabular screws?
when they are less than 20 mm
127
why should you avoid acetabular screws in the anterior inferior quadrant?
obturator nerve
obturator artery
obturator vein
128
why should you avoid screws in the anterior superior quadrant of the acetabulum?
external iliac artery
external iliac vein
129
3 hip flexors
iliopsoas
sartorius
rectus femoris
130
4 hip extensors
glut max
semi T
semi M
biceps femoris
131
3 abductors of the hip
glut med
glut min
TFL
132
5 adductors of the hip
adductor longus
adductor brevis
adductor magnus
pectineus
gracilis
133
6 short external rotators of the hip
piriformis
superior gemellus
obturator internus
obturator externus
inferior gemellus
quadratus femoris
134
7 internal rotators of the hip
glut med (anterior fibres)
glut min (anterior fibres)
TFL
semi M
semi T
pectineus
adductor magnus (posterior fibres)
135
origin and insertion of iliacus
iliac fossa to lesser T
136
origin and insertion of psoas
TP of L1-5 to lesser T
137
origin and insertion of pectineus
pectineal line of pubis to pectineal line of femur
138
origin and insertion of rectus femoris
AIIS and acetabular rim to patella
139
origin and insertion of adductor magnus
inferior pubic ramus/ischial tuberosity to linea aspera/adductor tubercle
140
origin and insertion of adductor brevis
inferior pubic ramus to linea aspera/pectineal line
141
origin and insertion of adductor longus
anterior pubic ramus to linea aspera
142
origin and insertion of gracilis
inferior symphysis to proximal medial tibia
143
origin and insertion of glut max
ilium above gluteal line to IT band
144
origin and insertion of piriformis
anterior sacrum to proximal GT
145
origin and insertion of obturator externus
ishiopubic rami/obturator membrane to trochlear fossa (posterior groove between GT and LT)
146
origin and insertion of obturator internus
ishiopubic rami/obturator membrane to medial GT
147
origin and insertion of superior gemellus
outer ischial spine to MGT
148
origin and insertion of inferior gemellus
ischial tuberosity to MGT
149
origin and insertion of quadratus femoris
ischial tuberosity to quadrate line of femur
150
origin and insertion of glut med
ilium between posterior and anterior gluteal lines to GT
151
origin and insertion of glut min
ilium between anterior and inferior gluteal lines to anterior border of GT
152
origin and insertion of TFL
anterior iliac crest to IT band
153
piriformis
154
psoas minor
155
pectineus
156
adductor longus
157
adductor brevis
158
gracillis
159
obturator externus
160
vastus intermedius
161
articularis genus
162
patellar ligament
163
sartorius
164
gracillis
165
semi T
166
adductor magnus
167
iliopsoas
168
biceps femoris
169
IT band
170
vastus medialis
171
vastus lateralis
172
glut min
173
piriformis
174
rectus femoris
175
sartorius
176
TFL
177
iliacus
178
psoas major
179
glut med
180
glut min
181
TFL
182
sartorius
183
rectus femoris
184
glut med
185
obturator internus
186
long head biceps femoris
187
quadratus femoris
188
glut max
189
vastus medialis
190
vastus intermedius
191
vastus lateralis
192
short head biceps femoris
193
biceps femoris
194
semi M
195
adductor magnus
196
adductor longus
197
vastus intermedius
198
adductor brevis
199
pectineus
200
iliopsoas
201
adductor magnus
202
semi M
203
semi T
204
inferior gemellus
205
obturator internus
206
superior gemellus
207
glut max
208
location of the lumbosacral plexus
deep to psoas on the anterior surface of quadratus lumborum
209
nerves that compose the lumbar plexus
L1-4
210
nerves that compose the sacral plexus
L4-S4
211
what is the order of the 8 nerves arising from the lumbosacral plexus anteriorly with respect to psoas?
subcostal
IH
II
LFCN
femoral
genitofemoral
obturator
lumbosacral trunk
212
where is the LFCN vulnerable?
as it emerges under the inguinal ligament 2 cm medial to ASIS
213
During total hip arthroplasty (THA) via a posterior
approach, where is the sciatic nerve most likely to
be found?
deep to piriformis and superficial to the short external rotators
214
course of obturator nerve
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
what nerve is at risk with retraction behind the transverse acetabular ligament in THA?
posterior division of the obturator nerve
216
from where does the saphenous nerve arise?
a terminal branch of the femoral nerve arising at the apex of the femoral triangle and travelling deep to sartorius
217
most common nerve injured during THA
sciatic, peroneal division (because it is more lateral i.e. closer to the retractor)
218
only muscle innervated by the common peroneal nerve?
short head of biceps
219
During a posterior approach to the acetabulum, the nerve exiting above piriformis is damaged. This will lead
to weakness in:
glut med
glut min
TFL
(they are talking about superior gluteal nerve)
220
When harvesting posterior iliac bone graft, the structure most at risk is:
superior gluteal artery
221
Following an intrapelvic obturator neurectomy, continued hip adduction is possible because of:
pectineus (femoral nerve)
222
What structure do you need to take down to access the quadrilateral plate through an ileo-inguinal incision?
insertion of rectus abdominus
223
In the ilioinguinal approach, which interval exposes the quadrilateral plate?
between iliopsoas and neurovascular bundle
224
In the Smith-Peterson anterior approach to the hip, the most common injury is to the:
LFCN
225
In the anterior Smith-Peterson approach the deep interval is between rectus femoris and:
glut med
226
Often during total hip replacement there is a vessel at the insertion of the ligamentum teres that
bleeds. This vessel arises from:
posterior branch of the obturator artery
227
Which vessel would be most likely involved
adult avascular necrosis of the hip
lateral epiphyseal vessels of the MFCA
228
draw the lumbosacral plexus
229
innervation of piriformis
S1-2
230
innervation of superior gemellus
nerve to obturator internus
L5-S2
231
innervation of obturator internus
nerve to obturator internus
L5-S2
232
innervation of gemellus inferior
nerve to quadratus femoris
L4-S1
233
innervation of quadratus femoris
nerve to quadratus femoris
L4-S1
234
innervation of obturator externus
posterior branch of obturator nerve
L3-4
235
innervation of psoas
L1-3
236
innervation of iliacus
femoral nerve
