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Dr P K Sharma Professor Department of Anatomy K G M U, Lucknow
INTRODUCTION Ball and socket type of synovial joint Multiaxial Range of motion restricted (weight bearing )
BONES Femoral head - >1/2 of sphere-Ball Acetabulum- vinegar cup-Socket Head of the femur articulates with acetabulum
ARTICULAR SURFACES Head of Femur- hyaline cartilage Nonarticular-fovea capitis Acetabulum- Articular surface - horse shoe shaped hyaline cartilage covered
LIGAMENTS OF HIP JOINT Capsular ligament(joint capsule) Ilifemoral ligament-ligament of Bigelow(strongest) Pubofemoral ligament Ischiofemoral ligament Transverse acetabular ligament Acetabular labrum Ligamentum teres femoris.
CAPSULAR LIGAMENT Strong dense fibrous sac Inner fibres circular, outer fibres longitudnal ATTACHMENTS Hip Bone- Femur -.
posterior view of right hip ischiofemoral ligament Hip Ligaments Resists adduction and internal rotation. Note: none of these ligaments restrict flexion.
ILIOFEMORAL LIGAMENT Ligament of Bigelow strongest Y shaped Stem Medial (vertical) Lateralband(oblique) intermediate thin stratum. Anteriorly blends with capsule Prevents hyperextension of hip
PUBOFEMORAL LIGAMENT Resists abduction and some external rotation. Base –iliopubic eminence,superior pubic ramus,obturator crest. Blends with capsule deep to medial band of iliofemoral.
ISCHIOFEMORAL LIGAMENT Weak Supports capsule from behind From ischium, fibres spiral behind femoral neck attach to greater trochanter
OTHER LIGAMENTS A B A-Round lig/lig.teres femoris B-Acetabular labrum C-transverse acetabular ligament C
STABILITY OF HIP JOINT Depth of articular socket Strong lig.- Muscles- Length,obliquity of femur neck.
BURSAE AROUND HIP JOINT Subgluteal/ischial bursa Subpsoas/iliopsoas
ARTERIAL SUPPLY Medial circumflex femoral Lateral circumflex femoral Obturator artery Superior Inferior gluteal Nutrient artery
MOVEMENTS AND RANGE
LATERAL ROTATORS MEDIAL ROTATORS
APPLIED ASPECTS Dislocation(congenital,acquired) Perthes disease(pseudocoxalgia) Coxa vera and coxa valga Osteoarthritis Fracture neck femur
CONGENITAL DISLOCATION Loose joint capsule Hypoplastic head Externally rotated short limb Inability to abduct Assymmetry of skin folds of thigh
AQUIRED DISLOCATION Posterior(most common) Joint flexed, adducted, medially rotated – Traumatic- Car driver, dashboard strike-Femur head forced out of acetabulum,capsule tear is posterioinferiorly.
PERTHES DISEASE Destruction,flattening of head of femur Increased joint space
COXA VARA In case of Fracture femur neck Perthes disease
COXA VALGA Seen in congenital dislocation of hip,rickets- softening neck of femur
OSTEOARTHRITIS Old age Osteophytes grow on articular ends- painful, limiting movement.
FRACTURE NECK OF FEMUR Intracapsular- Subcapital(avascular necrosis most common) Cervical Basal/intertrochantric Extracapsular-old age
SHENTON’S LINE In case of dislocation and in fracture neck femur. DISRUPTED CURVE
SHOEMAKER’S LINE Straight line from tip of greater trochanter to ASIS upto umblicus. If G.T. elevated in fracture neck Line passes below umblicus.
Iliofemoral ligament takes origin from A. Iliopubic rami B. Posterior inferior iliac spine C. Anterior superior iliac spine D. Anterior inferior iliac spine
Lurching gait is seen and trendelenburg sign is positive in paralysis of all EXCEPT A. Gluteus maximus B. Gluteus minimus C. Gluteus medius D. Tensor fasciae latae
Amongst the following muscles which muscle is a medial rotator of thigh A. Quardratus femoris B. Piriformis C. Gluteus medius D. Obturator internus
The hip joint most commonly dislocates in the following direction A. anterior B. posterior C. superior D. inferior
Hyperextension at hip joint is prevented by A. Iliofemoral ligament B. Ischiofemoral ligament C. Pubofemoral ligament D. Capsular ligament
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