HIP Dr. Michael P. Gillespie. OSTEOLOGY Each innominate is the union of three bones: the ilium, pubis, and ischium. The right and left innominates connect

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Text of HIP Dr. Michael P. Gillespie. OSTEOLOGY Each innominate is the union of three bones: the ilium,...

  • HIPDr. Michael P. Gillespie

    Dr. Michael P. Gillespie

  • OSTEOLOGYEach innominate is the union of three bones: the ilium, pubis, and ischium.The right and left innominates connect with each other anteriorly at the pubic symphysis and posteriorly at the sacrum.An osteoligamentous ring known as the pelvis (Latin: basin or bowel) is formed.Functions of the pelvis:Attachment point for many muscles of the lower extremity and trunk.Transmits the weight of the upper body and trunk to the ischial tuberosities during sitting and to the lower extremities during standing or walking.Supports the organs of the bowel, bladder, and reproductive system.*Dr. Michael P. Gillespie

    Dr. Michael P. Gillespie

  • INNOMINATEIliumPubisIschium Acetabulum

    *Dr. Michael P. Gillespie

    Dr. Michael P. Gillespie

  • EXTERNAL SURFACE OF THE PELVISWing (ala) the large fan-shaped wing of the ilium forms the superior half of the innominate.Acetabulum a deep, cup-shaped cavity below the wing.Obturator-foramen the largest foramen in the body. Covered by the obturator membrane.*Dr. Michael P. Gillespie

    Dr. Michael P. Gillespie

  • OSTEOLOGIC FEATURES OF THE ILIUMExternal SurfacePosterior, anterior, and inferior gluteal linesAnterior-superior iliac spineAnterior-inferior iliac spineIliac crestPosterior-superior iliac spinePosterior-inferior iliac spineGreater sciatic notchGreater sciatic foramenSacrotuberous and sacrospinous ligaments

    Internal SurfaceIliac fossaAuricular surfaceIliac tuberosityDr. Michael P. Gillespie*

    Dr. Michael P. Gillespie

  • OSTEOLOGIC FEATURES OF THE PUBISSuperior pubic ramusBodyCrestPectineal linePubic tubercle Pubic symphysis joint and discInferior pubic ramus*Dr. Michael P. Gillespie

    Dr. Michael P. Gillespie

  • OSTEOLOGIC FEATURES OF THE ISCHIUMIschial spineLesser sciatic notchLesser sciatic foramenIschial tuberosity Ischial ramus *Dr. Michael P. Gillespie

    Dr. Michael P. Gillespie

  • ANTERIOR ASPECT: PELVIS, SACRUM, RIGHT PROXIMAL FEMUR*Dr. Michael P. Gillespie

    Dr. Michael P. Gillespie

  • LATERAL VIEW RIGHT INNOMINATE BONE*Dr. Michael P. Gillespie

    Dr. Michael P. Gillespie

  • POSTERIOR ASPECT OF PELVIS, SACRUM, & PROXIMAL FEMUR*Dr. Michael P. Gillespie

    Dr. Michael P. Gillespie

  • FEMUR The longest and strongest bone in the human body.The femoral head projects medially and slightly anterior to articulate with the acetabulum.The femoral neck connects the head with the shaft.The neck displaces the proximal shaft of the femur laterally away from the joint, thereby reducing the likelihood of bony impingement.Distal to the neck, the shaft of the femur courses slightly medially, placing the knees and feet closer to the midline of the body.The femur bows slightly when subjected to the weight of the body. Stress along the bone is dissipated through compression along the posterior shaft and through tension along the anterior shaft.

    *Dr. Michael P. Gillespie

    Dr. Michael P. Gillespie

  • OSTEOLOGIC FEATURES OF THE FEMURFemoral HeadFemoral NeckIntertrochanteric LineGreater trochanterTrochanteric fossaIntertrochanteric crestQuadrate tubercleLesser trochanterLinea asperaPectineal (spiral) lineGluteal tuberosity Lateral and medial supracondylar linesAdductor tubercleDr. Michael P. Gillespie*

    Dr. Michael P. Gillespie

  • ANTERIOR ASPECT RIGHT FEMUR*Dr. Michael P. Gillespie

    Dr. Michael P. Gillespie

  • MEDIAL & POSTERIOR SURFACES RIGHT FEMURDr. Michael P. Gillespie*

    Dr. Michael P. Gillespie

  • ANGLE OF INCLINATIONThe angle of inclination of the proximal femur describes the angle within the frontal plane between the femoral neck and the medial side of the femoral shaft.At birth this angle is about 140 150 degrees; however, the loading across the femoral neck during walking usually decreases this to the normal adult value of about 125 degrees.Coxa = hip, vara = to bend inward, valga = to bend outwardCoxa vara an angle of inclination markedly less than 125 degrees.Coxa valga an angle of inclination markedly greater than 125 degrees.Abnormal angles can lead to dislocation or stress-induced degeneration of the joint.*Dr. Michael P. Gillespie

    Dr. Michael P. Gillespie

  • ANGLE OF INCLINATION*Dr. Michael P. Gillespie

    Dr. Michael P. Gillespie

  • FEMORAL TORSIONFemoral torsion describes the relative rotation (twist) between the bones shaft and neck.Normally, as viewed from above, the femoral neck projects about 15 degrees anterior to a mid-lateral axis through the femoral condyles (normal anteversion).Femoral torsion significantly different than 15 degrees is considered abnormal.Excessive anteversion significantly greater than 15 degreesRetroversion approaching 0 degreesHealthy infants are born with about 40 degrees of femoral anteversion*Dr. Michael P. Gillespie

    Dr. Michael P. Gillespie

  • EXCESSIVE FEMORAL ANTEVERSIONExcessive anterversion that persists into adulthood can increase the likelihood of hip dislocation, articular incongruence, increase joint contact force, and increased wear on the cartilage.This can lead to secondary osteoarthritis of the hip.It may be associated with an abnormal gait pattern called in-toeing, a walking pattern with exaggerated posturing of hip internal rotation.The amount of in-toeing is generally related to the amount of femoral anteversion.It is a compensatory mechanism used to guide the excessively anteverted femoral head more directly into the acetabulum.Over time, shortening of the internal rotator muscles and ligaments occurs, thereby reducing external rotation.Most children with in-toeing eventually walk normally.Excessive femoral anteversion is common in persons with cerebral palsy. It typically does not resolve in this population.*Dr. Michael P. Gillespie

    Dr. Michael P. Gillespie

  • NORMAL ANTEVERSION*Dr. Michael P. Gillespie

    Dr. Michael P. Gillespie

  • EXCESSIVE ANTEVERSION*Dr. Michael P. Gillespie

    Dr. Michael P. Gillespie

  • RETROVERSION*Dr. Michael P. Gillespie

    Dr. Michael P. Gillespie

  • INTERNAL ROTATION IMPROVING JOINT CONGRUITYDr. Michael P. Gillespie*

    Dr. Michael P. Gillespie

  • IN-TOEING*Dr. Michael P. Gillespie

    Dr. Michael P. Gillespie

  • FUNCTIONAL ANATOMY OF THE HIP JOINTThe hip is a classic ball-and-socket joint secured within the acetabulum by an extensive set of connective tissues and muscles.Articular cartilage, muscle, and cancellous bone in the proximal femur help dampen the large forces that cross the hip.*Dr. Michael P. Gillespie

    Dr. Michael P. Gillespie

  • FEMORAL HEADThe head of the femur forms about two-thirds of a nearly perfect sphere.The entire surface of the femoral head is covered by articular cartilage except for the region of the fovea, which is slightly posterior to the center of the head. The fovea is a prominent pit that serves as the attachment point for the ligamentum teres.The ligamentum teres is a tubular sheath that runs between the transverse acetabular ligament and the fovea of the femoral head. It is a sheath that contains the acetabular artery.*Dr. Michael P. Gillespie

    Dr. Michael P. Gillespie

  • ACETABULUMThe acetabulum (Latin vinegar cup) is a deep, hemispheric cuplike socket that accepts the femoral head.The femoral head contacts the acetabulum along the horseshoe-shaped lunate surface, which is covered with thick articular cartilage.During walking, hip forces fluctuate from 13% of body weight to over 300% of body weight during the mid-stance phase.During stance phase, the lunate surface flattens slightly as the acetabular notch widens. This serves as a dampening mechanism to reduce peak pressure.The acetabular fossa is a depression located deep within the floor of the acetabulum. It does not normally come into contact with the femoral head.*Dr. Michael P. Gillespie

    Dr. Michael P. Gillespie

  • HIP JOINT COMPRESSION AS A PERCENT OF GAIT CYCLE*Dr. Michael P. Gillespie

    Dr. Michael P. Gillespie

  • ANATOMIC FEATURES OF THE HIP JOINTFemoral HeadFoveaLigamentum teresAcetabulumAcetabular notchLunate surfaceAcetabular fossaLabrumTransverse acetabular ligament*Dr. Michael P. Gillespie

    Dr. Michael P. Gillespie

  • INTERNAL ANATOMY OF HIP JOINT*Dr. Michael P. Gillespie

    Dr. Michael P. Gillespie

  • ACETABULAR LABRUMThe acetabular labrum is a flexible ring of fibrocartilage that surrounds the outer circumference (rim) of the acetabulum.The acetabular labrum projects about 5 mm toward the femoral head.It provides significant stability to the hip by gripping the femoral head and deepening the volume of the socket by approximately 30%.The seal formed by the labrum maintains a negative intra-articular pressure, thereby creating a modest suction that resists distraction of the joint surfaces.It also helps to hold synovial fluid within the joint space.It decreases the contact stress (force / area) by increasing the surface area of the acetabulum.Poor blood supply limited ability to healWell supplied with afferent nerves proprioceptive feedback / pain

    *Dr. Michael P. Gillespie

    Dr. Michael P. Gillespie

  • ACETABULAR ALIGNMENTIn the anatomic position, the acetabulum typically projects laterally from the pelvis with a varying amount of inferior and anterior tilt.Congenital or developmental conditions can result in an abnormally shaped acetabulum.A dysplastic acetabulum that does not adequately cover the femoral head can lead to chronic dislocation and increased stress, which can lead to osteoarthritis. Two measurements are used to describe the extent to which the acetabulum naturally covers and helps to sec