3. THE HIP JOINT IS A MULTIAXIAL
SYNOVIAL JOINT OF BALL-AND-SOCKET
TYPE.
5. ACETABULUM
APPROXIMATELY HEMISPHERICAL
CAVITY CENTRAL ON THE LATERAL
ASPECT OF THE INNOMINATE BONE.
FACING ANTEROINFERIORLY.
SURROUNDED BY AN IRREGULAR
MARGIN DEFICIENT INFERIORLY AT
THE ACETABULAR NOTCH.
STARTS TO OSSIFY AT 12 YEARS
FUSE AT 17 YEARS
6. THE ACETABULAR FOSSA FORMS THE
CENTRAL FLOOR-ROUGH AND NON
ARTICULAR.
THE ARTICULAR LUNATE SURFACE IS
WIDEST ABOVE (THE 'DOME'), WHERE
WEIGHT IS TRANSMITTED TO THE
FEMUR.
7. THE HIP JOINT IS A MULTIAXIAL
SYNOVIAL JOINT OF BALL-AND-SOCKET
TYPE
8. ARTICULAR SURFACES
THE FEMORAL HEAD ARTICULATES WITH
THE CUP-SHAPED ACETABULUM, ITS
CENTRE LYING A LITTLE BELOW THE
MIDDLE THIRD OF THE INGUINAL
LIGAMENT.
THE ARTICULAR SURFACES ARE
RECIPROCALLY CURVED.
10. THE CLOSE-PACKED POSITION IS IN FULL
EXTENSION, WITH SLIGHT ABDUCTION
AND MEDIAL ROTATION.
LEAST PACK SEMIFLEXION
11. THE FEMORAL HEAD IS COVERED BY
ARTICULAR CARTILAGE, EXCEPT FOR
A ROUGH PIT FOR THE LIGAMENTUM
TERES
IN FRONT, THE CARTILAGE EXTENDS
LATERALLY OVER A SMALL AREA ON
THE ADJOINING NECK
13. CARTILAGE THICKNESS IS MAXIMAL
ANTEROSUPERIORLY IN THE
ACETABULUM AND ANTEROLATERALLY
ON THE FEMORAL HEAD
14. THE ACETABULAR ARTICULAR SURFACE
IS AN INCOMPLETE RING, THE LUNATE
SURFACE
DEFICIENT INFERIORLY OPPOSITE THE
ACETABULAR NOTCH
15. THE ACETABULAR FOSSA IS DEVOID OF
CARTILAGE BUT CONTAINS
FIBROELASTIC FAT LARGELY COVERED BY
SYNOVIAL MEMBRANE
17. ACETABULAR DEPTH IS INCREASED BY
THE ACETABULAR LABRUM
DEEPENS THE CUP AND BRIDGES THE
ACETABULAR NOTCH AS THE
TRANSVERSE ACETABULAR
LIGAMENT.
DIAMETER OF THE ACETABULAR
CAVITY IS CONSTRICTED BY THE
LABRAL RIM
EMBRACES THE FEMORAL HEAD,
MAINTAINING JOINT STABILITY
19. ATTACHMENT
ANTERIORLY TO THE
INTERTROCHANTERIC LINE
SUPERIORLY TO THE BASE OF THE
FEMORAL NECK,
POSTERIORLY 1 CM ABOVE THE
INTERTROCHANTERIC CREST
INFERIORLY TO THE FEMORAL NECK
NEAR THE LESSER TROCHANTER
20. IT HAS TWO SETS OF FIBRES, CIRCULAR
AND LONGITUDINAL
THE CIRCULAR FIBRES (ZONA ORBICULARIS)
ARE INTERNAL AND FORM A COLLAR ROUND
THE FEMORAL NECK.
PARTLY BLENDED WITH THE PUBOFEMORAL
AND ISCHIOFEMORAL LIGAMENTS BUT ARE
NOT DIRECTLY ATTACHED TO BONE
21. EXTERNALLY, LONGITUDINAL FIBRES ARE
MOST NUMEROUS IN THE ANTEROSUPERIOR
REGION, REINFORCED BY THE ILIOFEMORAL
LIGAMENT.
22. THE CAPSULE IS ALSO STRENGTHENED
BY THE PUBOFEMORAL AND
ISCHIOFEMORAL LIGAMENTS
EXTERNALLY IT IS ROUGH, COVERED BY
MUSCLES AND SEPARATED FROM PSOAS
MAJOR AND ILIACUS BY A BURSA
23. THE CAPSULAR ATTACHMENT TO THE
FEMUR LIES DISTAL TO THE GROWTH
PLATE OF THE FEMORAL HEAD BOTH
ANTERIOR AND POSTERIORLY
THE UPPER FEMORAL EPIPHYSIS
ENTIRELY INTRACAPSULAR
26. ILIOFEMORAL LIGAMENT
VERY STRONG AND SHAPED LIKE AN
INVERTED Y, LYING ANTERIORLY AND
INTIMATELY BLENDED WITH THE
CAPSULE.
APEX IS ATTACHED BETWEEN THE
ANTERIOR INFERIOR ILIAC SPINE AND
ACETABULAR RIM, ITS BASE TO THE
INTERTROCHANTERIC LINE
27. ERECT POSTURE, A VERTICAL LINE
THROUGH THE CENTER OF GRAVITY OF
THE BODY FALLS SLIGHTLY BEHIND A LINE
JOINING THE CENTERS OF THE TWO HIP
JOINTS.
THE TENDANCY OF THE BODY TO FALL
BACKWARDS ON THE HIP JOINTS IS
RESISTED BY THE ILIOFEMORAL
LIGAMENTS WHICH MAINTAIN THE ERECT
POSTURE WITHOUT MUSCULAR ACTIVITY
AT THESE JOINTS
29. PUBOFEMORAL LIGAMENT
TRIANGULAR, ITS BASE ATTACHING TO
THE ILIOPUBIC EMINENCE, SUPERIOR
PUBIC RAMUS, OBTURATOR CREST AND
OBTURATOR MEMBRANE.
IT BLENDS DISTALLY WITH THE CAPSULE
AND DEEP SURFACE OF THE MEDIAL
ILIOFEMORAL LIGAMENT..
31. ISCHIOFEMORAL LIGAMENT
THICKENS THE BACK OF THE CAPSULE
AND CONSISTS OF THREE DISTINCT PARTS
CENTRAL
MEDIAL
LATERAL
32. CENTRAL PART, THE SUPERIOR
ISCHIOFEMORAL LIGAMENT
LATERAL AND MEDIAL INFERIOR
ISCHIOFEMORAL LIGAMENTS
EMBRACE THE POSTERIOR
CIRCUMFERENCE OF THE FEMORAL
NECK
34. TRANSVERSE ACETABULAR LIGAMENT
PART OF THE LABRUM BUT HAS NO
CARTILAGE CELLS.
ITS STRONG, FLAT FIBRES CROSS THE
ACETABULAR NOTCH FORMING A
FORAMEN THROUGH WHICH VESSELS
AND NERVES ENTER THE JOINT.
36. LIGAMENTUM TERES (LIGAMENT OF THE
HEAD OF THE FEMUR)
TRIANGULAR, FLATTENED BAND
APEX ATTACHED ANTEROSUPERIORLY IN
THE FOVEA ON THE FEMORAL HEAD
BASE IS ATTACHED ON BOTH SIDES OF
THE ACETABULAR NOTCH, BETWEEN
WHICH IT BLENDS WITH THE
TRANSVERSE LIGAMENT.
38. IT ALSO RECEIVES WEAKER
CONTRIBUTIONS FROM THE MARGINS OF
THE ACETABULAR FOSSA.
ENSHEATHED BY SYNOVIAL MEMBRANE,
39. SYNOVIAL MEMBRANE
LINES INNER PORTION OF CAPSULE AND
NON ARTICULAR STRUCTURES
THE SYNOVIAL MEMBRANE COVERS THE
INTRACAPSULAR PART OF THE FEMORAL
NECK.
THEN PASSES TO THE INTERNAL SURFACE
OF THE CAPSULE TO COVER THE
ACETABULAR LABRUM, LIGAMENTUM
TERES AND FAT IN THE ACETABULAR
FOSSA.
40. IT IS THIN ON THE DEEP SURFACE OF THE
ILIOFEMORAL LIGAMENT WHERE IT IS
COMPRESSED AGAINST THE FEMORAL
HEAD AND SOMETIMES IS EVEN ABSENT
HERE.
43. OBTURATOR ARTERY
BRANCH OF THE INTERNAL ILIAC
ARTERY
GIVES RISE TO AN ACETABULAR BRANCH
AND SUPPLIES THE FAT IN THE
ACETABULAR FOSSA.
44. MEDIAL CIRCUMFLEX FEMORAL ARTERY
ARISES FROM THE PROFUNDA FEMORIS
THREE BRANCHES
ACENDING
TRANSVERSE
TERMINAL
45. LATERAL CIRCUMFLEX ARTERY
ARISES FROM THE PROFUNDA FEMORIS
HAS THREE BRANCHES
ACENDING
TRANSVERSE
DECENDING
46. SUPERIOR GLUTEAL ARTERY
ARISES FROM THE POSTERIOR BRANCH
OF THE INTERNAL ILIAC ARTERY
TWO DIVISIONS
SUPERFICIAL
DEEP—TAKES PART IN TROCHANTERIC
ANASTOMOSIS
47. INFERIOR GLUTEAL ARTERY
ANTERIOR BRANCH OF THE INTERNAL
ILIAC ARTERY
6 DIVISIONS:
ARTICULAR BRANCHES OF THE HIP JOINT
CRUCIATE ANASTOMOTIC BRANCHES
48. SUPERIOR GLUTEAL ARTERY SUPPLIES
THE UPPER PART OF THE ACETABULUM
INFERIOR GLUTEAL ARTERY SUPPLIES
THE INFERIOR AND POSTERIOR PART OF
THE ACETABULUM AND THE CAPSULE
51. BLOOD SUPPLY OF THE HEAD OF FEMUR
EXTRACAPSULAR ARTERIAL RING AT THE
BASE OF THE FEMORAL NECK;
FORMED POSTERIORLY BY BRANCH OF MFCA
FORMED ANTERIORLY BY BRANCHES OF LFCA;
SUPERIOR & INFERIOR GLUTEAL
ARTERY HAVE MINOR CONTRIBUTIONS;
52. ASCENDING CERVICAL BRANCHES
- THESE GIVE RISE TO RETINACULAR
ARTERIES
- GIVES RISE TO SUBSYNOVIAL INTRA
ARTICULAR RING
53. ARTERY OF LIGAMENTUM TERES
DERIVED FROM OBTURATOR OR MFCA
INADEQUATE TO SUPPLY FEMORAL HEAD
WITH DISPLACED FRACTURES
FORMS THE MEDIAL EPIPHYSEAL VESSELS
ONLY SMALL & VARIABLE AMOUNT OF THE
FEMORAL HEAD IS NOURISHED BY ARTERY OF
LIGAMENTUM TERES
54. EPIPHYSEAL BLOOD SUPPLY:
EPIPHYSEAL ARTERIAL BRANCHES ARISE AS
ARTERIES OF SUBSYNOVIAL INTRAARTICULAR
RING
TWO GROUPS OF EPIPHYSEAL ARTERIES:
LATERAL & INFERIOR
55. METAPHYSEAL BLOOD SUPPLY:
ARISES FROM EXTRACAPSULAR ARTERIAL
RING
ARISE FROM BRANCHES OF ASCENDING
CERVICAL ARTERIES- SUBSYNOVIAL INTRA
ARTICULAR RING
56. NERVE SUPPLY OF THE HIP JOINT
FEMORAL NERVE
ANTERIOR DIVISION OF THE OBTURATOR
NERVE
NERVE TO QUADRATUS FEMORIS
SUPERIOR GLUTEAL NERVE
58. FEMORAL NERVE
FORMED BY THE DORSAL DIVISIONS OF THE
ANTERIOR PRIMARY RAMI OF SPINAL NERVES
L2,L3,L4
GIVES RISE TO MUSCULAR/CUTANEOUS/
ARTICULAR BRANCHES
ARTICULAR BRANCH-NERVE TO RECTUS
FEMORIS SUPPLIES THE HIP JOINT
59. OBTURATOR NERVE
VENTRAL DIVISIONS OF THE ANTERIOR
PRIMARY RAMI OF SPINAL NERVES L2,L3,L4
WITHIN THE OBTURATOR CANAL THE NERVE
DIVIDES INTO ANTERIOR AND POSTERIOR
DIVISONS
BRANCH TO THE HIP JOINT ARISES FROM THE
ANTERIOR DIVISON
60. NERVE TO QUADRATUS FEMORIS
ARISES FROM THE SACRAL PLEXUS (L4,L5,S1)
SUPPLIES THE QUADRATUS FEMORIS,
GEMELLUS INFERIOR AND THE HIP JOINT
61. SUPERIOR GLUTEAL NERVE
ARISES FROM THE SACRAL PLEXUS( L4,L5,S1)
SUPPLIES THE GLUTEUS MEDIUS, GLUTEUS
MINIMUS AND TENSOR FASCIA LATAE AND
THE HIP JOINT
63. MOVEMENTS MUSCLES NERVE SUPPLY
FLEXION ILIACUS AND
PSOAS MAJOR
LUMBAR
VENTRAL RAMI
RECTUS
FEMORIS
FEMORAL
SARTORIUS FEMORAL
TENSOR FACIA
LATA
SUPERIOR
GLUTEAL
PECTINEUS FEMORAL
ADDUCTORS
LONGUS AND
BREVIS
OBTURATOR
64. MOVEMENTS MUSCLES NERVE SUPPLY
EXTENSION GLUTEUS
MAXIMUS
INFERIOR
GLUTEAL
SEMIMEMBRANO
SUS
SCIATIC(TIBIAL
PART)
SEMITENDINOSU
S
SCIATIC(TIBIAL
PART)
BICEPS FEMORIS
LONG HEAD
SCIATIC(TIBIAL
PART)
ADDUCTOR
MAGNUS
ISCHIAL PART
SCIATIC(TIBIAL
PART)
65. MOVEMENTS MUSCLES NERVE SUPPLY
ADDUCTION ADDUCTORS
LONGUS,
BREVIS AND
MAGNUS
OBTURATOR
GRACILIS OBTURATOR
PECTINEUS FEMORAL
QUADRATUS
FEMORIS
L4/5 AND S1
VENTRAL RAMI
66. MOVEMENTS MUSCLES NERVE SUPPLY
ABDUCTION GLUTEUS
MEDIUS AND
MINIMUS
SUPERIOR
GLUTEAL
TENSOR FASCIA
LATA
SUPERIOR
GLUTEAL
PIRIFORMIS L5S1/2
VENTRAL RAMI
OBTURATOR
INTERNUS IN
FLEXION
L5S1/2
VENTRAL RAMI
67. MOVEMENTS MUSCLES NERVE SUPPLY
MEDIAL
ROTATION
TENSOR FASCIA
LATA
SUPERIOR
GLUTEAL
GLUTEUS
MINIMUS
SUPERIOR
GLUTEAL
GLUTEUS
MEDIUS ANT
FIBERS
SUPERIOR
GLUTEAL
FRACTURES THROUGH THIS REGION THEREFORE OFTEN LEAD TO POOR OUTCOMES
The pubis forms the anterosuperior fifth of the articular surface
the ischium forms the floor of the fossa and rather more than the posteroinferior two-fifths of the articular surface
ilium forms the remainder.
THE ARTICULAR SURFACES ARE RECIPROCALLY CURVED BUT NEITHER COEXTENSIVE NOR COMPLETELY CONGRUENT
THE ACETABULAR ARTICULAR SURFACE IS AN INCOMPLETE RING, THE LUNATE SURFACE, BROADEST ABOVE WHERE THE PRESSURE OF BODY WEIGHT FALLS IN THE ERECT POSTURE, AND NARROWEST IN ITS PUBIC REGION
A FIBROCARTILAGINOUS RIM
The labrum is triangular in section, attaching by the base of the triangle to the acetabular rim while the apex is its free margin
IT SURROUNDS THE FEMORAL NECK AND IS ATTACHED
The capsular attachment also intersects the growth plate of the greater trochanter on the upper surface of the base of the neck
AS THE HIP MOVES THE CAPSULAR LIGAMENTS, WIND AND UNWIND, TIGHTENING AROUND THE HIP, AFFECTING STABILITY AND JOINT CAPACITY.
As a result of the last point, a hip containing fluid is most comfortable held a little flexed as this provides the largest volume for joint distension
The iliofemoral ligament is more than 0.5 cm thick and one of the strongest ligaments of the body. The only rival being the interosseous sacroiliac ligament.
It can be used as astay for levering the head of femur back into the ACETABULUM
Role: It prevents overextension during standing.
Fuss and Bacher consider this ligament to consist of four crura
Role: It limits extension and abduction.
Role: It limits extension
SPIRALS SUPEROLATERALLY FROM THE ISCHIUM, WHERE IT IS ATTACHED POSTEROINFERIOR TO THE ACETABULUM, BEHIND THE FEMORAL NECK TO ATTACH TO THE GREATER TROCHANTER DEEP TO THE ILIOFEMORAL LIGAMENT. SOME FIBRES BLEND WITH THE ZONA ORBICULARIS.
IT VARIES IN STRENGTH. OCCASIONALLY ITS SYNOVIAL SHEATH EXISTS ALONE, WITHOUT A CORE; RARELY BOTH LIGAMENT AND SHEATH ARE ABSENT.
The ligament appears to tense when the thigh is semi-flexed and adducted, and to relax in abduction
ole: It limits adduction and provides a pathway for blood vessels to enter the head of femur.
ANTR OR MEDIAL BRANCH
PASTR OR LATERAL BRANCH---THE ACETABULAR BRANCH
BOTH FORMS AN ANASTOMOSIS WITH THE MFCA
ACENDING OF BOTH PLUS SUP GLUTEAL ARTERY FORMS TROCHANTERIC ANASTOMOSIS AND GIVES RISE TO RETINACULAR BRANCHES– HEAD OF FEMUR
TRANVERSE OF BOTH AND INF GLUTEAL AND 1 PERFORATOR FROM THE PROFUNDA FEMORIS: CRUCIATE ANASOTOMIS
TERMINAL GIVES RISE TO AN ACETABULAR BRANCH AND IT SUPPLIES FAT IN THE ACETABULAR FOSSA
SUPERFICIAL SUPPLIES THE G MAXIMUS
DEEP HAS SUPERIOR AND INFERIOR DIVISIONS AND DEEP TAKES PART IN TROCHANTERIC ANASTOMOSIS
MUSCULAR BRANCHES TO THE G MAX AND PIRIFORMIS
CUTANEOUS BRANCHES TO THE BUTTOCKS AND BACK
ARTERY TO SCIATIC NERVE
COCCYGEAL BRANCH
LATERAL EPIPHYSEAL VESSELS THAT ENTER HEAD POSTEROSUPERIORLY;
VESSELS FROM MEDIAL EPIPHYSEAL ARTERY ENTERING THRU LIGAMENTUM TERES