Hip girdle from anatomy to orthopedics

Osteology, Anatomy of Joints, Radiologic Anatomy, Clinical Considerations

1. HIP GIRDLE:
FROM ANATOMY TO ORTHOPEDICS
PRESENTED BY
DR. MARYNA KORNIEIEVA
ASST. OF ANATOMY

2. BONNY PELVIS
Hip bone
Femur
Sacrum
Lumbar vertebrae
Hip joint
Sacro-iliac joint
Pubic symphysis
Secondary cartilaginous joint
Typical ball-and-socket
“Pubic symphysitis”, “osteitispubis”
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
Iliac fossa
Internal lip of iliac crest
External lip of iliac crest
Ischium
Anterior
Superior
iliac spine
Anterior
inferior
iliac spine
Auricular
surface
Ischial
tuberosity
Ischialspine
Greater sciatic notch
Lesser sciatic notch
Pubic
tubercle
Pubic body
Body of
ischium
Superior pubic ramus
Inferior pubic ramus
Pubic crest
Ischialramus
Obturatorforamen
Acetabulum

4. RADIOGRAPHIC APPEARANCES
OF THE BONY PELVIS
Anteroposteriorradiograph 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;
Motionis limited with a mean
of 2.5 (0.8-3.6) degree.
Type: bicondylarsynovial
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 relaxinwhich
increases flexibility of the ligaments that hold the sacroiliac joint together, resulting in
a looser joint and increased range of motionto accommodate the head of the fetus
passing through the birth canal.

7. OTHER LIGAMENTS OF HIP GIRDLE
Sacrotuberouslig.
Sacrospinouslig.
Greater sciatic foramen
Lesser sciatic foramen
Boundaries:
Antero-lateral:greater sciatic
notchof theillium;
Postero-medial:sacrotuberous
ligament;
Inferior: sacrospinousligand
the ischialspine;
Superior: anterior sacroilliac
ligament.
Boundaries:
Anterior:thetuberosityoftheischium.
Superior:thespineoftheischiumand
sacrospinousligament.
Posterior:thesacrotuberousligament.

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. SIPROCEDURES
SI joint injection
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
Acetabularfossa
Labrum acetabulare
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 ligamentumteres.
Attachment of the fibrous
capsule:
medially–along the margins of
the acetabulum and transverse
acetabularligament;
laterally–along the
intertrochanteric line and just
proximal to intertrochanteric
crest.
Acetabularmargin
Trochanteric line
Acetabularmargin
Neck of the femur

12. FEMUR
Proximal epiphysis of the 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
retinaculararteries 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
cannulatedlag screws. (B) Schematic
representation of screw configuration
as viewed from the side.

14. BLOOD SUPPLY OF THE HIP

15. PERTHE’SDISEASE
CAUSES: SYMPTOMS:

16. MOVEMENTS IN THE HIP
LATERAL
ROTATORS:
ABDUCTORS:
Gluteus
medius
Gluteus minimus
Piriformis
Obturator
externus
Obturator
internus
Superior
and
Inferior
gemelli
Quadratus
femoris

17. MOVEMENTS IN THE HIP
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 hip usually occurs
posteriorly due to anatomy (the
acetabulum is directed posteriorly).
Central dislocation through the acetabulum
is also possible.

19. LIGAMENTS OF THE HIP JOINT

20. BURSAEAROUND HIP
Trochanteric
bursitis
pain pattern
Hip arthroscopy for trochanteric
bursitis –bursectomy.

21. X-RAY OF NORMAL HIP
AN ADULT A CHILD

22. DEVELOPMENTAL DYSPLASIA OF HIP
The cause is unknown.
Low levels of amniotic fluidin the womb
during pregnancy and immaturitycan 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 (AP view) showing left
sided dysplastic hip with femur head lying
in the upper outer quadrant and disrupted
Shenton's line.
Shenton's line
Thegoaloftreatmentistokeepthefemoral
headingoodcontactwiththeacetabulum.

24. ANGLE BETWEEN THE NECK AND
SHAFT OF THE FEMUR
COXAVALGA COXAVARA
Normaladult:
The normal NS angle is about 160°in the young child.
› 130 ‹ 120

25. CROSS-SECTION THROUGH THE HIP
Trochanteric bursa
Obturator externus
Gluteus medius
Iliopsoas
Tensor fasciae lata
Rectus femoris
SartoriusFemoral vessels
Femoral nerve
Ilio-psoas bursa
Obturator internus
Gemellusinferior
Sciatic nerve

26. T1FS CORONAL IMAGE OF A NORMAL HIP .

27. T1FS AXIAL IMAGE OF A NORMAL HIP

28. T1FS SAGITTAL IMAGE OF A NORMAL HIP

29. APPEARANCE OF THE ACETABULAR
LABRUM AT MR ARTHROGRAPHY
T1FS axial image demonstrating the
normal anterior and posterior labrum
(arrows).
•Triangular in cross section, but some
individual variation in labralmorphology,
especially in older patients
(?degenerative)
•It measures 3-11 mm in width and 2-5
mm in height
•Normal labrum is hypointenseon all
sequences
•Increased signal intensity may represent
labraltears or myxoiddegeneration
•Intra-articular gadolinium solution is
hyperintenseon T1 weighted images
and may extend into sub-labral
sulci/recesses

30. SUBLABRALSULCI
•Normal recesses
adjacent to labrum that
fill with contrast
•May be mistaken for
labraltears/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),
acetabularnotch (arrow) and
posterior sulcus (double arrow).
PD axial image demonstrating a
posterior sublabralrecess
(arrow).

31. LABRALPATHOLOGY -LABRALTEARS
Imaging Features:
•Extension of contrast into the labraltissue
•Associated features include labralblunting, deformity and hypertrophy
•Look for bucket handle tears, especially in cases of labro-acetabular
separation
T1FS axial image demonstrating
labro-acetabularseparation (arrow)
PD image demonstrating a tear at
the chondro-labraljunction
Aetiology:
1) Post-traumatic
•hyperextension,
external rotation:
anterosuperior
labrum
•axial loading of
flexed hip:
posterior labrum
2) Degenerative
3) Associated with
acetabulardysplasia
4) Following
posterior hip
dislocation.