Trauma and orthopaedics (3): The hip Flashcards
name the bones which fuse to form the hip
ilium
ischium
pubis
do a purpose games
3 main articulations of the hip
- 3 main articulations
- Sacroiliac joints- articulation with the sacrum
- Pubic symphysis- articulation between the left and right bones
- Hip joint- articulation with head of femur
what type of joint is the hip
Ball (femoral head) and socket (acetabulum of hip bone)
the ilium ischium and pubis are separated by
triradiate cartilage
- Fuses begins at 15-17, complete by 20-25
Acetabulum
- Socket of joint
- Where hip bones converge
- Margin of acetabulum is incomplete inferiorly- acetabulum notch (where ligaments attach to produce foramen)
factors which stabilise the hip joint
- Labrum
- Capsule
- Ligaments
the labrum
Fibrocartilaginous rim attached to margin of acetabulum.
- Increases articular contact area by 10%
- More than 50% of head of femur fits in
- Transverse acetabular ligaments strengthens inferior portion of acetabulum
- Where acetabular notch is
joint capsule
- Capsular fibres take a spiral course
- During extremes of movement the fibres are spiralled so can twist, increasing force that draws the joint in
joint ligaments
Capsule is strengthened by 3 strong ligaments
- Illiofemoral- illium and femur
- Pubofemoral- pubis and femur
- Ischiofemoral – ishium and femur
Accessory ligaments
- Ligament of heat of femur- ligamentum teres
- Transverse acetabular ligament
Hip flexion
iliopsoas
assisted. by
- rectus femoris
- sartorius
- pectineus
hip extensors
posterior muscles
- gluteus maximus
- long head of the biceps femoris
- semimembranosus
- semitendinosus
hip adduction
-
Adductor magnus
- 2 portion (adductor and hamstrings)
- Gap in muscle fibres (adductor hiatus)
- Transmits femoral vessels (popliteal fossa)
-
Adductor brevis
- Smallest (briefest)
-
Adductor longus
- Medium
hip abduction
gluteus medius
gluteus minimus
assisted by
- tensor fascia lata
- sartorius
anterior thigh muscles
do purpose games
mainly flexion and adduction
-
Quadriceps
- Rectus femoris
- Vastus lateralis
- Vastus intermedius
- Vastus medialis
- Sartorius
- Gracilis
- Pectinius
-
Adductors
- adductor magus
- adductor brevis
- adductor longus
posterior thigh muscle
do a purpose games
mainly extension and abduction
-
Hamstrings
- semimembranosus (most medial)
- semitendinosus
- bicep femoris
- long head
- and short head
-
Gluteus muscles
- gluteus maximus
- gluteus medius
- gluteus minimus
gluteus muscles (superficial)
gluteus maximus, medius and minimus
gluteus maximus innervated by
inferior gluteal nerve (i know confusing) and artery
gluteus medius and minimus innervated by
superior gluteal nerve and artery
gluteal muscles (deep)
- Lateral rotation of the femur
- Located underneath gluteus minimus
- Also stabilise the hip joint- pulling the femoral head into the acetabulum of the pelvis
Piriformis- important anatomical landmark
- Dived up the gluteal region into an superior and inferior part
-
Sciatic nerve usually enters the gluteal region directly inferior to the piriformis
- Visible as a flat band- 2cm wide
superior gluteal nere damage
Superior gluteal nerve supplies the gluteus medius and minimus- hip abductors
Causes
- Damaged as a complication of hip surgery
- Injections to buttock
- Fracture of greater trochanter
- Dislocation of hip join
Damage to SFN leads to:
- Weakened abduction of lower limb
- Abnormal stance phase of gait
- Trandelenburgs sign
bony landmarks of the proximal femur
hip bony landmarks
blood supply of the femoral head- major source
- Deep femoral (femoral artery)
- Medial circumflex femoral artery
- Lateral circumflex femoral artery
blood supply of the femoral head- minor source (adult)
Ligamentum teres artery- branch of the obturator artery (via ligament of head of femur/ligamentum teres)
Blood supply to the femoral head in children vs adults
In the child, the artery of the ligamentum teres is the major blood supply to the femoral epiphysis (femoral head).
In the adult, after epiphyseal fusion, only a small volume of the femoral head near the fovea is adequately nourished by this artery. The blood supply of the remainder of the femoral head arises primarily from the ascending cervical branches of the medial circumflex femoral artery (MFCA).
Hence, disruption of the ascending cervical branches (retinacular arteries coming from the MFCA), for example in an intracapsular fracture of the femoral neck, carries a high risk of avascular necrosis of the bone.
areas in the hip region
lumbar plexus
sacral plexus