Hip Anatomy and Pathologies Flashcards

responsible for blood supply to femoral head

within ligament to head of femur

acetabular lip or labrum

fibrous capsule strong @ dense

covers entire femoral head and neck

capsule thinner and looser posterio-inferiorly

deeper circular fibers form collar around neck

longitudinal fibers thicker anteriorly

trochanters are extracapsular

ligaments to head of femur

fat pad in acetabalum

partial vaccum within joint

iliofemoral ligament

pubofemoral ligament

ischiofemoral ligament

iliofemoral ligament

least important for stability & fat pad changes shape with movement of femoral head

flex, extend, abduct, adduct, circumduction, medial and lateral rotation

125 degrees, angle often decreases with age due to loss of bone mass (osteopersosis, arthritis, etc.)

coxa valga (away from center)

coxa varum (towards center)

twisting or turning, usually 15 degrees

> 15 degrees of torsion, toe in when hip aligned

< 15 degrees of torsion, toe out when hip aligned

sports, torsional movements, idiopathic

normal radiographs, anterior hip or groin pain, clicking/locking/giving way, normal ROM, pain w/ hip flex, adduction, IR, and SLR

NSAIS, rest, protective WB, surgery

primary- unknown

secondary- trauma, infection, hemarthrosis, osteonecrosis

gradual onset of pain that may radiate to groin/knee, altered gain, limited ROM IR and extension, general weakness @ hip

NSAIDS, lose weight @ hip (obesity), strengthening, hip replacement, assistive devices, hip resurfacing (newer treatment)

trauma, friction

lateral hip pain(may radiate to groin, glutes, knee), increased pain over greater trochanter especially with side lying on affected side, ^ pain with abduction and rotations

remove irritating cause, heat, stretching/strengthening, steroid injection

12% of population gets it, common fibular nerve pierces piriformis which may cause entrapment

pain in ass, restricted IR and ER, sciatic nerve pain, increased pain w/ sitting

stretching, ice, NSAIDS, botox to nerve

8:1 female to male, ligamentous laxity, in utero positioning, breach presentation @ birth

unilateral (L>R) or bilateral

range of severity: acetabular dysplasia, subluxation, dislocation

physical exam, asymmetrical thigh/inguinal folds, flex hip & knee in supine, abducts thigh, resistance to abduction or adductor spasm , Ortolani's sign (clicking), telescoping of femur

ultrasound of hip joint

reduce hip w/ positioning or bracing, double/triple diapers, Pavlick harness or abduction splint, pressure of femoral head in acetabalum promotes growth and deepening of socket in time. or surgery

damage or injury to the growth portion of bone in a growing child. (epiphysitis, aseptic necrosis, osgood schlatter, legg calve parthes)

fibrous capsule ruptures inferiorly and posteriorly when femur driven rearward, femoral head lies posterior to acetabalum, potential damage to sciatic nerve

forces hip into extension, abduction, and lateral rotation

femoral head lies inferior to acetabalum

frequently fractures acetabalum margins

blow to lateral aspect of hip especially in abduction, femoral head driven deeper into acetabalum, comminuted fracture of acetabular wall

depends on severity, closed/open reduction, immobilization, compensatory methods to resume ADL's, remobilization and strengthening

20's, as we age there is more calcium release and less rebuilding which leads to bone loss... happens more to women due to hormones

4-6% loss per decade > age of 40, decrease in total fibers, fiber size, and excitation

loss of ROM, increased stiffness!!

^ fibrin and macrophages leads to ^ adhesions and stiffness

aging collagen causes ^ muscle stiffness. articular cartilage breaks down and there is less water to distribute forces across the joint. Tendons lose tensile strength, decreased integrity of joint capsule and increase in calcium crystal formation

> 50% of injuries in US are MSK, of that 50%... 50% are sprains, fractures, and dislocations.

pattern of the fracture is determined by viscoelastic properties of bone and biomechanics of load

load can be compressive, bending, or torsional

diaphyseal, metaphyseal, epiphyseal, intra-articular

complete or incomplete

transverse, oblique, spiral

easy to reduce, heals well, straight across

angled across, unstable, more difficult to reduce

torsional

bone has moved on either side of the fracture

compound/bone sticks out of skin

2 fracture parts, comminuted

bone has been shattered w/ two or more fragments

incomplete, occurs in children bc flexible bone

fracture due to tumor or pathologic process, decrease of bone density in imaging as well

fragment of bone torn off at site of tendon or ligament insertion

caused by repeated stress, x ray often normal, movement is painless but increases with WB, fracture line becomes more visible after inflammatory phase

2 bones crushing a bone between

specific to distal radius

specific to 5th metatarsal

pain/tenderness, deformity, edema, ecchymosis, loss of general function and mobility, radiographs reveal break in continuity

hematoma formation, cellular proliferation, callus formation, ossification, consolidation/remodeling

inflammatory stage: disruption of periosteum, blood vessels and cortex, 48-72 hours, formation of hematoma, can last 1-2 weeks, clotting factors initiate fibrin meshwork @ each bony end of fracture site

osteogenic cells proliferate, osteoblasts and chondroblasts differentiate from granulation tissue and form fibrocartilage collar around the fracture

osteoblasts move in and cartilage is replaced by bone

thickened deposition of calcium and osteoblasts move to site

callus reabsorbed, woven bone transformed into mature bone and reshaping occurs in response to stresses, can last months to years

4-6 weeks

6-8 weeks

10-18 weeks

traction & non-operative realignment

traction: weights applied to fracture to attain proper realignment (Buck's traction), immobilization

surgical intervention, ORIF, replacement hemi or total joint, external fixation

casting and functional bracing, biomechanics of fixation devices

casts, rods, pinscrews, wires, external fixators are all stress sharing devices, callus then forms, heals fast, usually enables early WB, plates are stress yielding devices

visceral injury, vascular injury, compartment syndrome (swelling/disruption of blood flow), etc

advanced age, osteoperosis, arthritis, etc.

infection, avascular necrosis of femoral head, nonunion/fusion, degenerative joint disease of hip, chronic pain

hip dislocation, decompression sickness (bends), sickle cell, radiotherapy, Gaucher's disease, diabetes, corticosteroids

head and neck of femur removed, joint disarticulated, metal or ceramic prosthesis inserted in femur, acetabalum replaced with metal or plastic cup in THR not partial HR

no hip flex > 90 degrees, no hip IR, no adduction beyond neutral, no crossing legs

ANTERIOR APPROACH ALLOWS immediate flexion and less precautions