Hip and Thigh Fractures

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

image Nerves: superior and inferior gluteal nerves and branches from sciatic roots, nerve to quadratus femoris

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Aug 12, 2016 | Posted by in ANATOMY | Comments Off on Hip and Thigh Fractures

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