Hip and Thigh Fractures

Published on 16/04/2015 by admin

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Last modified 16/04/2015

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24 Hip and Thigh Fractures

Anatomy of the Hip and Thigh

image

Hip Joint and Ligaments

image

Femur

Femur

• Parts and landmarks: head; fovea (for round ligament); neck; greater trochanter; lesser trochanter; intertrochanteric line, crest, and fossa; pectineal line; gluteal tuberosity; linea aspera; shaft (body); popliteal surface; adductor tubercle; medial epicondyle; lateral epicondyle; medial condyle; lateral condyle; intercondylar fossa; patellar surface

Coxal (Hip) Bones

• Ilium, ischium, and pubis are fused in adults. (See Chapter 17, Pelvic Fractures, for more bone information.)
• Coxal bone epiphyseal plates intersect in the center of the acetabulum.
• Acetabulum

image Peripheral lunate surface lined with hyaline cartilage
image Fat within central acetabular fossa surfaced with synovial membrane

Hip Joint

• Synovial ball-and-socket, deepened by circumferential, fibrocartilaginous acetabular labrum
• Synovial membrane

image Runs from edges of acetabular hyaline cartilage
image Along inside of fibrous capsule
image Extends to distal neck and periphery of articular cartilage of head

• Round ligament (ligamentum teres) of head of femur

image Intraarticular, covered by synovium
image Runs from fovea to transverse acetabular ligament

• Transverse acetabular ligament: spans acetabular notch, extending rim for a complete socket
• (Collateral) ligaments: spiraling thickenings of fibrous joint capsule, passing from acetabular rim to intertrochanteric line or trochanters

image Iliofemoral (Bigelow): anterior-superior, Y-shaped, very strong, prevents hyperextension by screwing femoral head tightly into acetabulum
image Pubofemoral: anterior-inferior, prevents hyperabduction
image Ischiofemoral: posterior, weakest of three

• Retinacula

image Retinacular fibers surround neck proximal to head, binding down nutrient arteries to head.
image Anatomical basis for head ischemia with neck fracture

image

Thigh: Serial Cross Sections

Compartments of the Thigh

• Circumferential deep fascia of lower limbs

image Like strong elastic stockings
image Limits expansion of muscles during contraction, important in upright gait

• Fascia lata: investing deep fascia of thigh

image Attaches proximally to inguinal ligament, pubic rim, Scarpa’s fascia, iliac crest, sacrum, coccyx, sacrotuberous ligament, ischial tuberosity
image Attaches to exposed bone at knee and to crural fascia
image Strengthened laterally by vertical-running fibers of iliotibial tract, a conjoint aponeurosis of gluteus maximus and tensor fascia lata

• Intermuscular septa separate groups of muscles in thigh.

image Septa attach to linea aspera and fascia lata.
image Lateral intermuscular septum strongest

• Gluteal compartment

image Primarily hip joint abductor and rotator muscles: gluteus maximus, medius, and minimus; piriformis, superior and inferior gemellus, quadratus femoris
image Vessels: superior and inferior gluteal (internal iliac branches) arteries and veins
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