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Hip girdle from anatomy to orthopedics
The document provides information on hip anatomy and orthopedic conditions. It discusses: 1) The bones that make up the hip girdle including the hip bone, femur, and sacrum. 2) Joints such as the hip joint and sacroiliac joint. 3) Common hip injuries and conditions like femoral neck fractures, developmental dysplasia of the hip, and labral tears. 4) Imaging appearances of the hip on x-ray, MRI, and MR arthrography that can help identify abnormalities.
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Hip girdle from anatomy to orthopedics
- 1. HIP GIRDLE: FROM ANATOMYTO ORTHOPEDICS PRESENTED BY DR. MARYNA KORNIEIEVA ASST. OF ANATOMY
- 2. BONNY PELVIS Hip bone Femur Sacrum Lumbarvertebrae Hip joint Sacro-iliac joint Pubic symphysis Secondary cartilaginous joint Typical ball-and-socket “Pubic symphysitis”, “osteitis pubis” or adductor longus strain all cause vague pubic pain and tenderness – but the diagnosis is often not clear and may not matter as the treatment is much the same. The SI joint is synovial but with age becomes more fibrous.
- 3. HIP BONE Ilium Pubis Iliac crest Iliacfossa Internal lip of iliac crest External lip of iliac crest Ischium Anterior Superior iliac spine Anterior inferior iliac spine Auricular surface Ischial tuberosity Ischial spine Greater sciatic notch Lesser sciatic notch Pubic tubercle Pubic body Body of ischium Superior pubic ramus Inferior pubic ramus Pubic crest Ischial ramus Obturator foramen Acetabulum
- 4. RADIOGRAPHIC APPEARANCES OF THEBONY PELVIS Anteroposterior radiograph of the male pelvis. Representation of the radiograph of the pelvis.
- 5. SACROILIAC JOINT (SI) Articulation:Adjacent auricular articular surfaces of the Ilium and sacrum; Motion is limited with a mean of 2.5 (0.8-3.6) degree. Type: bicondylar synovial joint, undergoes to gradual sclerosis trough the age; The interosseous sacro-iliac joint is probably the strongest in the body – if it is disrupted it is indicative of a very high energy impact. Capsule: along the margins of articular surfaces;
- 6. LIGAMENTS OF SIJOINT During pregnancy, the ovaries and placenta produce the hormone relaxin which increases flexibility of the ligaments that hold the sacroiliac joint together, resulting in a looser joint and increased range of motion to accommodate the head of the fetus passing through the birth canal.
- 7. OTHER LIGAMENTS OFHIP GIRDLE Sacrotuberous lig. Sacrospinous lig. Greater sciatic foramen Lesser sciatic foramen Boundaries: Antero-lateral: greater sciatic notch of the illium; Postero-medial: sacrotuberous ligament; Inferior: sacrospinous lig and the ischial spine; Superior: anterior sacroilliac ligament. Boundaries: Anterior: the tuberosity of the ischium. Superior: the spine of the ischium and sacrospinous ligament. Posterior: the sacrotuberous ligament.
- 8. TRAUMAS OF SIJOINT Dysfunction in the sacroiliac joint, or SI joint, is thought to cause low back and/or leg pain. The leg pain can be particularly difficult, and may feel similar to sciatica or pain caused by a lumbar disc herniation. Pain in the SI joint occurs as result of excessive motion and in case of excessive immobilization (as in ankylosing spondylitis).
- 9. SI PROCEDURES SI jointinjection X-ray pictures (or ultrasound) are taken throughout to ensure the needle is in the correct area. Once the needle is correctly positioned into the joint a mixture of local anaesthetic with or without a locally acting steroid is injected.
- 10. HIP JOINT Acetabular fossa Labrumacetabulare Acetabular notch Transverse acetabular ligament Ligament of the head of the femur Articular surfaces: the head of the femur and the acetabulum of the pelvic bone. Lunate surface Kind of joint: synovial ball and socket joint.
- 11. HIP JOINT Synovial membrane:lines fibrous capsule from inside and forms a tubular covering around the ligamentum teres. Attachment of the fibrous capsule: medially – along the margins of the acetabulum and transverse acetabular ligament; laterally – along the intertrochanteric line and just proximal to intertrochanteric crest. Acetabular margin Trochanteric line Acetabular margin Neck of the femur
- 12. FEMUR Proximal epiphysis ofthe femur: 1.Head (with the fovea capitis, for the attachment of the ligament of the head), 2. Neck, 3. Greater trochanter, 4. Lesser trochanter, 5. Intertrochanteric line, 6. Intertrochanteric crest, 6. Gluteal tuberosity, 7. Linea aspera; 8. Orthopedic tubercle. The issue to establish in fractured neck of femur is whether the head is at risk of avascular necrosis and therefore will need to be replaced; avascular necrosis will most likely occur when the fracture is proximal to the capsular attachment tearing the retinacular arteries that run up the femoral neck to the head. Capsular attachment
- 13. CLINICAL SOLUTIONS Radiograph (anteroposteriorview) of a displaced femoral neck fracture treated by way of femoral head replacement with a bipolar prosthetic device. The most common internal fixation device used today is the sliding screw-plate device. (A) Femoral neck fracture treated by way of internal fixation with 3 parallel cannulated lag screws. (B) Schematic representation of screw configuration as viewed from the side.
- 14. BLOOD SUPPLY OFTHE HIP
- 15.
- 16. MOVEMENTS IN THEHIP LATERAL ROTATORS: ABDUCTORS: Gluteus medius Gluteus minimus Piriformis Obturator externus Obturator internus Superior and Inferior gemelli Quadratus femoris
- 17. MOVEMENTS IN THEHIP FLEXORS: EXTENSORS: Sartorius Iliacus Psoas major Rectus femoris Pectineus Gluteus Maximus Biceps femoris Semiten- dinous Semimem- branous ADDUCTORS: Adductor magnus Adductor brevis Gracilis Adductor longus Pectineus
- 18. HIP DISLOCATIONS Dislocated hipusually occurs posteriorly due to anatomy (the acetabulum is directed posteriorly). Central dislocation through the acetabulum is also possible.
- 19. LIGAMENTS OF THEHIP JOINT
- 20. BURSAE AROUND HIP Trochanteric bursitis painpattern Hip arthroscopy for trochanteric bursitis – bursectomy.
- 21. X-RAY OF NORMALHIP AN ADULT A CHILD
- 22. DEVELOPMENTAL DYSPLASIA OFHIP The cause is unknown. Low levels of amniotic fluid in the womb during pregnancy and immaturity can increase baby's risk of DDH. DDH is a disruption in the normal relationship between the head of the femur and the acetabulum. Symptoms:
- 23. DIAGNOSTICS Pelvis X-Ray (APview) showing left sided dysplastic hip with femur head lying in the upper outer quadrant and disrupted Shenton's line. Shenton's line The goal of treatment is to keep the femoral head in good contact with the acetabulum.
- 24. ANGLE BETWEEN THENECK AND SHAFT OF THE FEMUR COXA VALGA COXA VARANormal adult: The normal NS angle is about 160° in the young child. › 130 ‹ 120
- 25. CROSS-SECTION THROUGH THEHIP Trochanteric bursa Obturator externus Gluteus medius Iliopsoas Tensor fasciae lata Rectus femoris SartoriusFemoral vessels Femoral nerve Ilio-psoas bursa Obturator internus Gemellus inferior Sciatic nerve
- 26. T1FS CORONAL IMAGEOF A NORMAL HIP.
- 27. T1FS AXIAL IMAGEOF A NORMAL HIP
- 28. T1FS SAGITTAL IMAGEOF A NORMAL HIP
- 29. APPEARANCE OF THEACETABULAR LABRUM AT MR ARTHROGRAPHY T1FS axial image demonstrating the normal anterior and posterior labrum (arrows). • Triangular in cross section, but some individual variation in labral morphology, especially in older patients (?degenerative) • It measures 3-11 mm in width and 2-5 mm in height • Normal labrum is hypointense on all sequences • Increased signal intensity may represent labral tears or myxoid degeneration • Intra-articular gadolinium solution is hyperintense on T1 weighted images and may extend into sub-labral sulci/recesses
- 30. SUBLABRAL SULCI • Normalrecesses adjacent to labrum that fill with contrast • May be mistaken for labral tears/detachments • Anterosuperior • Posterinferior • Anteroinferior • Posterosuperior • A tear generally has irregular edges and extends more than 50% across the depth of the labrum PD sagittal image demonstrating the anterior labrum (arrowhead), acetabular notch (arrow) and posterior sulcus (double arrow). PD axial image demonstrating a posterior sublabral recess (arrow).
- 31. LABRAL PATHOLOGY -LABRAL TEARS Imaging Features: • Extension of contrast into the labral tissue • Associated features include labral blunting, deformity and hypertrophy • Look for bucket handle tears, especially in cases of labro-acetabular separation T1FS axial image demonstrating labro-acetabular separation (arrow) PD image demonstrating a tear at the chondro-labral junction Aetiology: 1) Post-traumatic • hyperextension, external rotation: anterosuperior labrum • axial loading of flexed hip: posterior labrum 2) Degenerative 3) Associated with acetabular dysplasia 4) Following posterior hip dislocation.