3. Femur Osteology and Hip Blood Supply

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Questions and Answers

What is the normal average degree of femoral anteversion in adults?

  • 20°
  • 10°
  • 25°
  • 15° (correct)

Which structure is located on the posterior aspect of the femur and joins the trochanters?

  • Femoral condyles
  • Intertrochanteric crest (correct)
  • Intertrochanteric line
  • Pectineal line

What is the typical appearance of the gait in a child with excessive femoral anteversion?

  • Toe-out gait
  • Clumsy and (correct)
  • Normal and balanced

Which of the following features is described as a rounded elevation on the intertrochanteric crest?

<p>Quadrate tubercle (D)</p> Signup and view all the answers

What is the typical degree of anteversion in infants?

<p>31° (C)</p> Signup and view all the answers

Which line is associated with the vastus medialis on the posterior aspect of the femur?

<p>Spiral line (B)</p> Signup and view all the answers

What condition is often indicated by excessive femoral anteversion in children?

<p>In-toeing (D)</p> Signup and view all the answers

What clinical intervention has been shown to have no difference in outcome for excessive femoral anteversion?

<p>Braces (C)</p> Signup and view all the answers

What is the average angle of inclination for the femur in adults?

<p>125° (B)</p> Signup and view all the answers

Which condition is defined by a diminished angle of inclination in the femur?

<p>Coxa vara (D)</p> Signup and view all the answers

Which part of the femur serves as the transition from the neck to the shaft?

<p>Intertrochanteric line (A)</p> Signup and view all the answers

In which age group is the angle of inclination greater than the adult normal of approximately 125°?

<p>Infants (D)</p> Signup and view all the answers

What is the gender and developmental influence on the angle of inclination according to the provided content?

<p>It can vary with age, sex, and development. (D)</p> Signup and view all the answers

Which of the following best describes excessive femoral anteversion?

<p>An anteriorly rotated femoral neck (B)</p> Signup and view all the answers

What anatomical feature of the femur is commonly identified as the site of fractures?

<p>Intertrochanteric line (C)</p> Signup and view all the answers

What feature is located at the center of the femoral head that serves as an important landmark?

<p>Fovea (A)</p> Signup and view all the answers

What structural change indicates the need for braces during growth and development?

<p>Severe immature skeleton conditions (D)</p> Signup and view all the answers

Which ligament becomes taut during hyperextension of the hip joint?

<p>Ischiofemoral Ligament (B), Iliofemoral Ligament (C)</p> Signup and view all the answers

What is the primary feature of the hip joint's shape?

<p>Spheroidal head of the femur (D)</p> Signup and view all the answers

What does excessive femoral anteversion typically lead to in terms of leg positioning?

<p>Inward rotation of the femur (C)</p> Signup and view all the answers

Which aspect of femoral anatomy contains the small artery to the head of the femur?

<p>Ligamentum teres (A)</p> Signup and view all the answers

What angle refers to the inclination of the femoral neck relative to the shaft?

<p>Angle of Inclination (A)</p> Signup and view all the answers

What condition may require orthopedic surgery in a mature skeleton?

<p>Severe arthritis in the hip (D)</p> Signup and view all the answers

What anatomical structure deepens the cup of the acetabulum?

<p>Acetabular labrum (A)</p> Signup and view all the answers

Flashcards

Femur (Anterior)

The bone in the upper leg (thigh).

Greater Trochanter

Large bony protrusion on the femur's lateral side.

Lesser Trochanter

Smaller bony protrusion on the femur's posterior and medial side.

Intertrochanteric line

Connects trochanters (anterior)

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Femoral condyles

Rounded surfaces at the distal end of the femur, where it connects to the tibia.

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Femur (Posterior)

Back side of the femur bone.

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Intertrochanteric crest

Connects trochanters (posterior).

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Quadrate tubercle

Rounded elevation on the intertrochanteric crest.

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Linea aspera

A roughened line on the posterior femur.

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Femoral Anteversion (angle)

Angle between the femoral neck and the femoral condyles.

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Excessive Femoral Anteversion

An abnormally large angle that causes inward-turning of the legs (in-toeing).

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Normal Femoral Anteversion (angle)

Average angle of 15 Degrees (in adults).

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Femur

The longest and heaviest bone in the human body.

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Femur Head

The rounded upper end of the femur that projects superomedially, and slightly anterior, containing a fovea.

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Femur Neck

Connects the head to the femoral shaft, characterized by the intertrochanteric line (anterior view).

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Intertrochanteric Line

Anterior line between the greater and lesser trochanters; base of the femur neck; a common fracture site.

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Angle of Inclination

The angle between the long axis of the femur's neck/head and the long axis of the shaft, typically around 125 degrees.

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Coxa Vara

A condition where the angle of inclination of the femur is decreased (less than 125 degrees.

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Coxa Valga

A condition where the angle of inclination of the femur is increased (greater than 125 degrees).

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Hip Joint Articulation

The connection between the head of the femur and the acetabulum (hip socket).

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Hip Joint Shape

The hip joint is characterized by its spheroidal shape, allowing for tri-axial movement.

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Acetabular Labrum

A fibrocartilaginous ring that deepens the acetabulum.

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Transverse Acetabular Ligament

Connects and stabilizes the acetabular notch.

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Femoral Head Coverage

More than half of the femoral head fits within the acetabulum.

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Fovea Capitis Femoris

A small pit on the head of the femur.

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Ligamentum Teres

A ligament within the hip joint that attaches to the fovea.

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Iliofemoral Ligament

Strongest hip ligament, located anteriorly, and resists hyperextension.

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Pubofemoral Ligament

Hip ligament that resists hyperextension and abduction.

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Ischiofemoral Ligament

Hip ligament that resists hyperextension, located posteriorly.

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Cruciate Anastomosis

A network of blood vessels crucial for supplying the femoral head/neck.

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Study Notes

Lower Extremity: Femur Osteology, Blood Supply, and Hip

  • The femur is the longest and heaviest bone in the body.
  • Head: Projects superomedially and slightly anteriorly, with a fovea at the center.
  • Neck: Attaches the head to the femoral shaft/body at the intertrochanteric line (from the anterior view).
  • Shaft/Body: The distal end has condyles.

Intertrochanteric Line (anterior)

  • The anterior line runs between the greater and lesser trochanter.
  • The base of the femur's neck.
  • Transition from the neck to the shaft.
  • A common fracture site.

Angle of Inclination

  • The angle between the long axis of the femoral neck/head and the long axis of the shaft.
  • Normal angle: Average 125° (range 115° - 140°)
  • Coxa vara: Diminished angle of inclination (<125°).
  • Coxa valga: Increased angle of inclination (>125°).
  • Angle of inclination varies with age, sex, and development.
  • In infants/toddlers, the angle is larger than in adults, decreasing with weight-bearing.

Congenital Coxa Vara

  • Excessive genu valgum (knock-knee).
  • Excessive pronation (dropped medial arch) .
  • Hip muscle weakness.

Femur (Anterior)

  • Greater trochanter: Extends laterally.
  • Lesser trochanter: Extends posteromedially.
  • Intertrochanteric line: Joins the trochanters anteriorly.
  • Femoral condyles (medial/lateral): Distal end.
  • Patellar surface (on femoral condyles): Anterior.
  • Medial and lateral epicondyles: Distal end.
  • Body: Bowed slightly anteriorly.

Femur (Posterior)

  • Intertrochanteric crest: Joins the trochanters posteriorly.
  • Quadrate tubercle: Rounded elevation on the intertrochanteric crest.
  • Gluteal tuberosity: Gluteus maximus attachment.
  • Linea aspera: Lateral/medial lip
  • Spiral line (vastus medialis): (see next slide)
  • Pectineal line (pectineus): (see next slide)
  • Supracondylar lines: Lateral and medial.
  • Intercondylar fossa/notch

Hip Joint

  • Articulation between the spheroidal head of the femur and acetabular socket.
  • Strong and stable ball and socket joint.
  • Tri-axial according to degrees of freedom.
  • Acetabular labrum: Fibrocartilaginous ring that deepens the cup.
  • Transverse acetabular ligament: Across acetabular notch.

Hip Joint con't

  • More than half of the femoral head fits within the acetabulum.
  • Fovea: Pit in the head of the femur.
  • Ligamentum teres: Attaches here; contains a small artery to the head of the femur.
  • Joint capsule: Extensive; from margins of acetabulum to the femur.

Hip Ligamentous Support

  • Iliofemoral ligament (Y ligament): From AIIS to intertrochanteric line; strongest ligament, located anteriorly.
  • Pubofemoral ligament: Anterior and inferior; from superior ramus of pubis to intertrochanteric line.
  • Ischiofemoral ligament : Arise posteriorly; spirals superolaterally to the anterior femoral neck.

Blood Supply to the femoral head/neck

  • Ligamentum teres: Acetabular branch of the obturator a.
  • Medial circumflex femoral artery.

Fractures & Repairs of Proximal Femur

  • Different types of femoral neck and intertrochanteric fractures.
  • Various repair methods: Pin only or ORIF (Open Reduction Internal Fixation)

Total Hip Arthroplasty (Replacement)

  • Posterior hip replacement (no sound).
  • Anterior hip replacement (no sound).

Why do we care about hip ligamentous structures?

  • Functional changes in patients.
  • Ambulatory paraplegia.

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