exam 3 flashdeck

Body Weight Transfer

Vertebral Column

Sacro-Iliac Joints

Pelvic Girdle

Hip Joints

Femurs

Femurs angle _________ —> Knees directly under the trunk  --- allows bipedal posture (stand upright)

inferomedially

Angle of Inclination: angle between the

femoral neck and femoral shaft

angle of inclination is greatest at what time in life?

birth

angle of inclination between femural neck and shaft

Angle >126° = ?

Angle <126° = ?

as you get older what happens to the angle of inclination?

it decrease

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*The decreasing angle of inclination with age puts greater stress on the neck of the femur

which can result in fractures (femoral neck) in patients with osteoporosis

what is hiltons law?

“nerves supplying the muscles extending directly across and acting at a given joint also innervate the joint”

Femoral head fx’s: always associated with

hip dislocations

major concern with femoral head fx?

avascular necrosis

treatment for femoral head fx?

  Closed (reduction of hip dislocation)

most common hip fx?

femoral head fx

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• 80% occur in women secondary to a fall

• Intracapsular (head and neck)

• Subject to avascular necrosis and non-union

went DONT we provide surgery for femoral head surgery?

for bed bound patients

Intertrochanteric fractures

Anatomy:

• Extracapsular

• Good cancellous bone

• Highly vascular

• Abundant blood supply

Displaced-shortened and externally rotated

Intertrochanteric fractures

Epidemiology:

Epidemiology:

Avg.age = 66-76years

Women>Men

Young: MVA or fall from height

Elderly: 90% caused by simple fall

when dont we operate on Intertrochanteric fractures?

only for extreme medical risk

what is the goal of surgery for Intertrochanteric fractures?

Operative: Goal=stable fixation to allow early weight bearing.

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Implants –

• Sliding compression screw

• Intramedullary Hip Screw

• Prosthetic replacement – used for salvage procedures

femoral head fx surgical treatment is with what type of fixation?

internal fixation

---

is a general class of metal implants placed in or anchored directly alongside the bone

what is a Femoral Shaft Fractures

(specific)

Fracture of the femoral shaft -

between 5cm distal to the lesser trochanter and 5cm proximal to the adductor tubercle

Femoral Shaft Fractures

Epidemiology looks like?

Epidemiology: bimodal

Males 15-24 (high energy trauma)

Females >75yo (falls)

major concern with femural shaft fx’s?

BLEEDING OUT!! many pts will need blood transfusions!!

what is the major blood supply of the femur?

deep (profunda) femoral artery

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Treatment of Femoral Shaft Fractures

screw ‘em

• Intramedullary (IM) nailing

• External fixation

• Plate fixation

—> operative stabilization

A 22 year old football player (kicker) presented to the sports medicine clinic following a game complaining of right groin pain.  The examining physician identified tenderness in the right groin but no evidence of a hernia.  A plain X-ray of the pelvis was obtained.  Which of the following is the most likely diagnosis?

Avulsion injury

As a female ages, the angle of inclination:

Becomes a disadvantage --> more likely to get coxa vara

Hip dislocations can be …

& name a common way we get a hip dislocation

can be reset

• MVA

Pelvic fx

less severe fx’s can often reset themselves w/o surgery needed

what causes Piriformis Syndrome?

Sitting for long periods of time – “wallet neuritis” or “fat wallet syndrome” (ie nerve compression from sitting on a wallet)

what are safe site of injections for Intragluteal Injections

• superolateral quadrant of the gluteal region

• anterolateral thigh in tensor fascia latae

Trendelenburg Sign

is indicative of what type of n injury?

superior gluteal n. injury

Hip drop – abductors are not activating – muscle is paralyzed