32 Questions
What type of joint is the hip joint?
Synovial, polyaxial ball and socket joint
Which ligament attaches to the anterior inferior iliac spine of the pelvis and the intertrochanteric line of the femur?
Iliofemoral ligament
What is the main blood supply to the hip joint?
All of the above
What is the purpose of the transverse acetabular ligament?
To cover the acetabular notch
Which nerve supplies the hip joint?
All of the above
What is the most mobile joint in the body?
Shoulder joint
Which artery is most vulnerable in the hip joint?
Lateral branches of the lateral circumflex femoral artery
What is the function of the femoral head ligament?
To join the femoral head with the transverse ligament and acetabular notch
What percentage of hip dislocations occur posteriorly?
80%
What is the most common mechanism of injury leading to hip dislocation?
High-energy trauma
What is the typical direction of force vector applied in posterior hip dislocation?
Axial force applied to the flexed knee
What is the result of impaction injuries in hip dislocation?
Fractures of the femoral head
What is the typical anatomy of anterior hip dislocation?
Disruption of the capsule anteriorly and inferiorly
What is the typical outcome of central fracture dislocations?
Treated as an acetabular fracture
What is the common injury pattern in hip dislocation?
Capsule disruption and labral tears
What is the typical position of the hip at the time of injury in posterior hip dislocation?
Neutral or adducted position
What is the first step in treating a patient with a hip dislocation?
Applying traction in line with the femur
What percentage of hip dislocations are irreducible?
2-15%
What is the goal of traction in the first 1-2 weeks after hip dislocation?
To reduce the risk of intra-articular adhesions
When can patients start bearing weight on their hip after dislocation?
After 4-6 weeks of partial weight bearing
What is a common complication of hip dislocation?
Sciatic nerve injury
What is the typical time frame for achieving full muscle strength after hip dislocation?
3 months
What is the percentage of patients who develop avascular necrosis (AVN) after hip dislocation?
1.7-40%
What is the recommended time frame for delaying running and jogging after hip dislocation?
9-12 months
What is the characteristic position of the leg in posterior hip dislocations?
Internally rotated, flexed, and adducted
What is the most common associated injury with hip dislocations?
Sciatic nerve injury
What is the primary investigation used to confirm the diagnosis of hip dislocations?
Single AP plain radiograph
What is the characteristic appearance of the femoral head in posterior hip dislocations on a radiograph?
Small and superiorly placed
What is the indication for operative treatment in hip dislocations?
Irreducible dislocations
What is the final method of closed reduction in posterior hip dislocations?
The Bigelow maneuver
What is the purpose of the assistant applying pressure to the anterior spines of the pelvis during the Bigelow maneuver?
To provide stability to the pelvis
What is the consequence of unsuccessful closed reduction in posterior hip dislocations?
Open reduction is performed
Study Notes
Hip Joint Anatomy
- The hip joint is a synovial, polyaxial ball and socket joint.
- It is formed by the articulation of the head of the femur and the acetabulum of the pelvis.
- The hip joint is very mobile, second only to the shoulder joint.
- It sacrifices mobility for stability, unlike the shoulder joint.
Anatomy
- The hip joint consists of articulation, type, capsule, ligaments, synovial membrane, nerve supply, blood supply, movements, and relations.
- Ligaments attaching the femur to the acetabulum include the iliofemoral, pubofemoral, ischiofemoral, and transverse acetabular ligaments.
- The femoral head ligament joins the femoral head with the transverse ligament and acetabular notch.
- The hip joint has three sources of blood supply: extracapsular ring, lateral circumflex femoral, and ascending branches.
Causes of Hip Pain
- Causes of hip pain can be related to joint disorders, periarticular soft tissue disorders, or extrinsic factors.
- Traumatic causes of hip pain include dislocations, fractures, and soft tissue injuries.
- Non-traumatic causes of hip pain include Perthes disease, SCFE, and infections.
Traumatic Causes of Hip Pain
- Hip dislocations occur due to high-energy trauma, such as RTA, falls from a height, or industrial accidents.
- Posterior dislocations are the most common type, accounting for 80% of hip dislocations.
- Anterior dislocations occur in 10-15% of cases.
Dislocations of the Hip
- Dislocations of the hip can be classified into posterior, anterior, and central fracture dislocations.
- Pathoanatomy of hip dislocations involves disruption of the capsule and ligamentum teres, labral tears, and muscular injury.
- The direction of dislocation depends on the position of the hip and the direction of the force vector applied.
- Posterior dislocations occur when the hip is in flexion and the force vector is applied axially.
- Anterior dislocations occur when the hip is in abduction and external rotation.
Clinical Presentation of Hip Dislocations
- Patients with hip dislocations typically present with inability to move their lower extremity, numbness, or distal pain.
- The position of the leg is key to diagnosis, with posterior dislocations characterized by shortening, flexion, internal rotation, and adduction.
- Anterior dislocations are characterized by external rotation, flexion, and abduction.
Investigations and Treatment of Hip Dislocations
- Single AP plain radiograph is needed to confirm the diagnosis.
- Treatment involves non-operative or operative management, with closed reduction being the first line of treatment.
- Open reduction may be necessary in cases of irreducible dislocations or unstable fracture-dislocations.
- Post-reduction care involves acute, recovery, and rehabilitation phases.
Complications of Hip Dislocations
- Associated injuries, such as femoral head or neck fractures, acetabular fractures, pelvic fractures, and sciatic nerve injury.
- AVN may develop up to 3 years post-injury, especially in anterior dislocations.
- Heterotopic ossification occurs in 2% of cases, especially after open reduction.
This quiz covers the anatomy of the hip joint and the different causes of hip pain, including traumatic and non-traumatic causes such as hip dislocations, fractures, Perthes disease, and infections.
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