Hip Joint Ligaments and Movements

Hip Flexion and Mobility

• Ascending stairs requires approximately 60-70 degrees of hip flexion.
• Tying a shoe with the foot on the floor necessitates around 120 degrees of hip flexion.

Rehabilitation Phase 1 Exercises

• For a femoral shaft fracture treated with an intramedullary nail, initial rehabilitation emphasizes isometric quadriceps and gluteal exercises.
• For open tibial shaft fractures during Phase 1, suggested exercise includes non-weight bearing ankle pumps to maintain circulation.

Discharge and Recovery Criteria

• Discharge criteria for upper femur fractures include the ability to perform safe transfers, adequate pain control, and independent mobility with assistive devices.
• Days 3-7 after upper femur fractures should focus on bed mobility and gentle range of motion exercises.

Post-Fracture Recommendations

• 1-2 weeks following a femoral shaft fracture treated with an intramedullary nail, gentle active range of motion of the hip and knee can be initiated.
• The primary goal of treating lower extremity injuries is to restore functional mobility.

Rehabilitation Phases Overview

• Rehabilitation Phase 2 emphasizes strengthening, endurance exercises, and progressive weight-bearing activities.
• During the final rehabilitation phase, focus shifts to full weight-bearing, agility, endurance training, and reintegration into daily activities.

Fracture Types and Classification

• A subtrochanteric fracture involving the lesser trochanter indicates a more complex fracture pattern with a significant detachment.
• Trochanteric fractures can be classified into basic types; those between the greater and lesser trochanters are a distinct category.

Hip Joint Anatomy and Testing

• The ligament that elongates the most in the close-packed position of the hip joint is the iliofemoral ligament.
• The normal center-edge angle in the frontal plane of the hip joint is between 25-39 degrees, significant for assessing hip stability.
• The acetabular anteversion angle indicates the orientation of the acetabulum and influences hip joint biomechanics.
• The angle of inclination typically ranges from 125-135 degrees, representing the relationship between the femoral neck and shaft.

Capsular Pattern and Weight-Bearing Status

• The close-packed position of the hip joint is characterized by a capsular pattern of limited flexion, abduction, and internal rotation.
• During Phase 1 of intramedullary nailing rehabilitation for open tibial shaft fractures, weight-bearing is typically non-weight bearing.

Exercise Recommendations for Tibial Shaft Fractures

• For tibial shaft fractures treated with biplanar Ilizarov external fixation, retro walking on a treadmill serves to promote balance and coordination.
• Addressing contractures during Phase 2 of rehabilitation may involve targeted stretching during physical therapy.
• Functional activities and return to sports can commence approximately 3 months post-injury for intramedullary nailing cases.
• During Phase 1 of stable tibial plateau fracture rehabilitation after internal fixation, recommended exercises include isometric exercises and gentle range of motion activities.

Stair Climbing and Rehabilitation Protocols

• The recommended order for stair climbing during Phase 3 involves progressing from step ascent to descent, beginning with ascending leading with the stronger leg.
• Full weight-bearing is typically permitted as rehabilitation progresses into later stages once adequate healing is evidenced.
• In the late stages of rehabilitation (6-8 weeks), more challenging exercises can involve gradual impact activities depending on clinical assessment.

Activity Considerations

• Certain exercises may be contraindicated during Phase 2 for a stable tibial plateau fracture after internal fixation, particularly high-impact or twisting motions.
• Injuries not associated with lateral knee force might include certain types of medial collateral ligament injuries.

This quiz covers the ligaments of the hip joint such as the Iliofemoral ligament, Pubofemoral ligament, and Ischiofemoral ligament. It also discusses the close-packed position, capsular pattern, and articular congruence of the hip joint.