Femur Osteology and Hip Blood Supply PDF

Lower Extremity: Femur Osteology, Blood Supply, and Hip Jason Dring, PT, DPT Contributions By: E. Costello, PT, PhD, Joe Signorino, PT, DPT  Femur Longest, heaviest bone in body Head - projects superomedial & slightly anterior, note the f...

Lower Extremity: Femur Osteology, Blood Supply, and Hip Jason Dring, PT, DPT Contributions By: E. Costello, PT, PhD, Joe Signorino, PT, DPT  Femur Longest, heaviest bone in body Head - projects superomedial & slightly anterior, note the fovea at center Neck - attaches the head to the femoral shaft/body at the intertrochanteric line (from anterior view) Shaft/body – distal end have condyles  Intertrochan teric Crest (posterior) Intertrochanteric Line (anterior) Anterior line between the greater and less trochanter Base of the neck of the femur Transition from neck to shaft Common fracture site Citation: Chapter 34. Overview of the Lower Limb, Morton DA, Foreman K, Albertine KH. The Big Picture: Gross Anatomy; 2011. Available at: https://accessmedicine.mhmedical.com/content.aspx?bookid=381&sectionid=40140045 Accessed: August 28, 2018 Copyright © 2018 McGraw-Hill Education. All rights reserved  Angle of Inclination Angle between long axis of neck/head & long axis of shaft Angle ~126◦ Normal Angle: Average 125◦ (Ranges 115◦ - 140◦)  Coxa vara - angle of inclination is diminished (125◦)  Angle of inclination varies with age, sex, & development  Infant/toddler – the angle is greater until ambulation weightbearing and then angle decreases to adult normal  May be changed by pathology that weakens the femoral neck  Congenital Coxa Vara http://www.clohisyhipsurgeon.com/treatment-options/periacetabular-osteotomy-pao-for-acetabular-dysplasia Coxa valga or vara? Femur (Anterior) Greater trochanter - extends laterally Lesser trochanter - extends posteromedial Intertrochanteric line – joins the trochanters anteriorly Body - bowed slightly anteriorly Femoral condyles (medial/lateral) Patellar surface (on femoral condyles) Medial & lateral epicondyles  Femur (Posterior) Intertrochanteric crest - joins the trochanters posteriorly Quadrate tubercle - rounded elevation on the intertrochanteric crest Gluteal tuberosity (gluteus maximus) Linea aspera - lateral/medial lip Spiral line (vastus medialis) (see next slide) Pectineal line (pectineus) (see next slide) Supracondylar lines (lat and medial) Intercondylar fossa/notch Adductor tubercle  Quadrate tubercle Spiral line (vastus medialis)  Angle of Anteversion Angle of anteversion (angle of femoral torsion): the plane of the femoral neck and head lies anterior to the plane of the femoral condyles  Normal: In adults, average degree of anteversion is 15◦  In infancy, average anteversion is 31◦ and decreases with WBing R Degree of anteversion may be altered in pathological conditions L Excessive Femoral Anteversion: most frequent cause of childhood “in-toeing”  Femoral Anteversion Excessive Femoral Anteversion/torsion: most frequent cause of “in-toeing” in children (ages 3-10). Affected lower extremity is internally rotated. More common in females. Right Most noticeable between the ages of 4-6 years. Left Gait looks clumsy and “in-toeing” will often appear worse with running and at the end of the day when fatigued. Femoral anteversion will decrease naturally in 99% of cases. Studies have repeatedly shown that special shoes, twister cables, and braces make no difference in outcome.  This is a structural (or bone) issue Need to wear braces to encourage boney change during growth/development If severe and without change, surgery indicated In mature skeleton, may need orthopaedic surgery, if symptomatic  Hip Joint Articulation between the spheroidal shaped head of femur and acetabular socket; strong & stable Ball & socket - according to shape Tri-axial - according to degrees of freedom Acetabular labrum - fibrocartilaginous ring, which deepens the cup Transverse acetabular ligament - across acetabular notch Transverse acetabular ligament  Hip Joint con’t More than 1/2 of the femoral head fits within acetabulum Fovea - pit in the head of femur – Ligamentum teres attaches Fovea here – Contains a small artery to the head of the femur Joint capsule – extensive – From margins of  Hip Ligamentous Support Ligamentous Structures - thickened portions of the joint capsule – Iliofemoral Ligament (Y Ligament of Bigelow) - from AIIS to intertrochanteric line; strongest ligament; located anteriorly Becomes taut with hyperextension of hip – Pubofemoral Ligament – runs anterior and inferior; runs from superior ramus of the pubis to the intertrochanteric line Becomes taut with hyperextension and abduction of hip joint – Ischiofemoral Ligament - arises posteriorly but spirals superolaterally to the anterior femoral neck Becomes taut with hyperextension of hip Iliofemoral Ligament (Y Ligament of Bigelow) - from AIIS to intertrochanteric line; strongest ligament; located anteriorly Become taut with Pubofemoral Ligament – runs anterior and inferior; runs from superior ramus of the pubis to the intertrochanteric line Becomes taut with hyperextension and abduction of hip joint Ischiofemoral Ligament - arises posteriorly but spirals superolaterally to the anterior femoral neck Becomes taut with hyperextension of hip  Blood Supply Cruciate Anastomos is – will cover next section Blood supply to the femoral head/neck: - Ligamentum teres acetabular Ligamentum teres Acetabular br. of branch of the Obturator a. obturator aa - Medial circumflex femoral artery Fractures & Repairs of Proximal Femur Pin only ORIF Total Hip Arthoplasty (Replacement) Posterior Hip Replacement (no sound)(3:09) ADLs with THA (18:22mins) Anterior Hip Replacement (no sound)(4:05)  PARAPLEGIA Ambulatory paraplegics “stand” or hang on iliofemoral ligaments for stability Why do we care about learning about hip ligamentous structures? It can only change your patient’s functional life… Questions, Comments or Concerns https://www.google.com/url? sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwip8Ln37qbdAhUJU 98KHe2DBKsQjRx6BAgBEAU&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv %3DEmCf4Xte2g4&psig=AOvVaw2zNg6w1g0QAjBAzD5XqgUD&ust=1536340009354925