Pelvis And Hip Anatomy

Front 1

What is the origin of the iliofemoral ligament (Y ligament of bigelow)?

Back 1

Anterior Inferior Iliac Spine (AIIS)

Front 2

What structure of the pelvis is an anteriorly raised region that represents the union of the ilium and pubis?

Back 2

The iliopectineal eminence

Front 3

The acetabulum is anteverted by what degree and obliquely oriented by what degree?

Back 3

Anteverted by 15 degrees
Obliquely oriented by 45 degrees caudally

Front 4

Is the femoral neck anteverted or retroverted and by what degree in relation to the femoral condyles?

Back 4

Anteverted approximately 14 degrees in relation to the femoral condyles

Front 5

What is the average femoral neck shaft angle?

Back 5

127 degrees

Front 6

What do the trabecular patterns of the hip help determine?

Back 6

Trabecular patterns help determine the presence of osteopenia and displacement of femoral neck fractures

Front 7

The hip joint capsule extends anteriorly across the femoral neck to the trochanteric crest. However, it extends posteriorly only partially across the femoral neck, so what regions of the hip are actually left extracapsular because of this?

Back 7

The basocervical and intertrochanteric crest regions are extracapsular

Front 8

What 3 ligaments form the hip capsule?

Back 8

The iliofemoral ligament (Y ligament of Bigelow)
The ischiofemoral ligament
The pubofemoral ligament

Front 9

What is the strongest ligament in the body?

Back 9

The iliofemoral ligament (Y ligament of Bigelow) is the strongest ligament in the body and attaches the anterior-inferior iliac spine to the intertrochanteric line in an inverted Y manner.

Front 10

What is the purpose of the ligamentum teres?

Back 10

Transmits an arterial branch of the posterior division of the obturator artery to the femoral head which is more important in pediatrics than adults

Front 11

Why is the piriformis not used as a starting point for a nail on a pediatric patient?

Back 11

It would damage the posterosuperior retinacular vessels, causing avascular necrosis of the femoral head

Front 12

From birth to 4 years old, what is the primary blood supply to the femoral head?

Back 12

Primary medial and lateral circumflex arteries (from deep femoral artery)
Ligamentum teres with posterior division of obturator artery

Front 13

From 4 years old to adulthood, what is the primary blood supply to the femoral head?

Back 13

Negligible amount from lateral circumflex artery

Minimal amount from ligamentum teres

Posterosuperior and posteroinferior retinacular from medial femoral circumflex artery

Front 14

In adulthood, what is the primary blood supply to the femoral head?

Back 14

Medial femoral circumflex to lateral epiphyseal artery

Front 15

When performing a posterior acetabular approach in an adult, why should you not completely transect the quadratus femoris muscle?

Back 15

In order to avert damage to the main blood supply to the femoral head– the medial femoral circumflex artery

Front 16

What structures outline the boundaries for the greater and lesser sciatic foramina?

Back 16

The greater and lesser sciatic foramina

Front 17

What structure constitutes the inferior border of the greater sciatic foramen and the superior border of the lesser sciatic foramen, effectively separating the greater and lesser sciatic foramina

Back 17

The sacrospinous ligament (anterior sacrum to the ischial spine)

Front 18

What forms the inferior border of the lesser sciatic foramen?

Back 18

The sacrotuberous ligament (posterolateral sacrum to the ischial tuerosity)

Front 19

What exits the greater and lesser sciatic foramina?

Back 19

The piriformis, sciatic nerve, and other important structures exit the greater sciatic foramen.

The short external rotators of the hip exit the lesser sciatic foramen.

Front 20

What 3 muscles are hip flexors?

Back 20

Hip flexor muscles are the iliopsoas, rectus femoris, and sartorius.

Front 21

What are the 4 hip extensor muscles?

Back 21

Hip extensor muscles are the gluteus maximus and hamstrings (semitendinosus, semimembranosus, and long head of biceps femoris)

Front 22

What are the 2 main hip abductors? What muscle provides abduct in a flexed hip?

Back 22

Hip abduction results primarily from the actions of the gluteus medius and minimus. The tensor fasciae latae also helps with abduction in a flexed hip.

Front 23

Hip adduction is primarily performed by what 5 muscles?

Back 23

Hip adduction results primarily from the actions of the adductor brevis, adductor longus, adductor magnus, pectineus, and gracilis

Front 24

What 6 muscles provide hip external rotation?

Back 24

Hip external rotation results from the action of the
P-GO-GO-Q: piriformis, gemellus superior, obturator externus, gemellus inferior, obturator internus, quadratus femoris

Front 25

Hip internal rotation is provided by what 7 muscles?

Back 25

Hip internal rotation is provided by secondary actions of the anterior fibers of the gluteus medius and gluteus minimus and by the tensor fasciae latae, semimembranosus, semitendinosus, pectineus, and posterior part of the adductor magnus.

Front 26

What is the origin, insertion, nerve, and spinal segment of the following hip FLEXOR?
Iliacus

Back 26

Origin: Iliac fossa
Insertion: Lesser trochanter
Innervation: Femoral
Spinal Segment L2-L4 (P) - Common to all flexors

Front 27

What is the origin, insertion, nerve, and spinal segment of the following hip FLEXOR?
Psoas Major

Back 27

Origin: Transverse processes of L1-L5
Insertion: Lesser trochanter
Innervation: Ventral Ramus L1-L3
Spinal Segment L2-L4 (P) - Common to all flexors

Front 28

What is the origin, insertion, nerve, and spinal segment of the following hip FLEXOR?
Psoas Minor

Back 28

Origin: Transverse processes T12-L1
Insertion: Pectineal line of femur
Innervation: Ventral Ramus of L1

Runs superficial to psoas major, sometimes indistinguishable

Front 29

What is the origin, insertion, nerve, and spinal segment of the following?
Tensor Fascia Latae

Back 29

Origin: ASIS

Insertion: Iliotibial band

Action: Helps stabilize and steady the hip and knee joints by putting tension on the iliotibial band of fascia (in extension)

Innervation: Superior gluteal - Common to abductors

Spinal Segment: L4-S1 (P) - Common to all abductors

Front 30

What is the origin, insertion, nerve, and spinal segment of the following hip FLEXOR?
Rectus Femoris

Back 30

Origin: Anterior inferior iliac spine, acetabular rim
Insertion: Patella and tibial tubercle
Innervation: Femoral
Action: Flexes hip and extends knee
Spinal Segment L2-L4 (P) - Common to all flexors

Front 31

What is the origin, insertion, nerve, and spinal segment of the following hip FLEXOR?
Sartorius

Back 31

Origin: Anterior superior iliac spine
Insertion: Proximal medial tibia @ pes anserinus
Innervation: Femoral
Action: Flex, abduct, externally rotate hip
Spinal Segment L2-L4 (P) - Common to all flexors

Front 32

What is the origin, insertion, nerve, and spinal segment of the following hip EXTERNAL ROTATOR?
Obturator Externus

Back 32

Origin: External surface of obturator membrane and anterior bony margins of obturator foramen

Insertion: Posteromedial surface of greater trochanter of femur

Innervation: Obturator

Spinal Segment: L2-L4 (A)

Front 33

What is the origin, insertion, nerve, and spinal segment of the following hip FLEXOR?
Pectineus

Back 33

Origin: Pectineal line of pubis
Insertion: Pectineal line of femur
Innervation: Femoral nerve usually, although it may sometimes receive additional innervation from the obturator nerve as well (L2, L3, L4)

Spinal Segment L2-L4 (P) - Common to all flexors

Front 34

What is the origin, insertion, nerve, and spinal segment of the following hip ADDUCTOR?
Adductor brevis

Back 34

Origin: Inferior pubic ramus
Insertion: Linea aspera/pectineal line
Innervation: Obturator (P)
Spinal Segment: L2-L4 (A) - Common to all adductors

Front 35

What is the origin, insertion, nerve, and spinal segment of the following hip ADDUCTOR?
Adductor Longus

Back 35

Origin: Anterior pubic ramus

Insertion: Middle 1/3 Linea aspera between adductor magnus and brevis medially and vastus medialis laterally

Action: Adducts & flexes thigh

Innervation: Obturator (Anterior division
)
Spinal Segment: L2-L4 (A) - Common to all adductors

Front 36

What is the origin, insertion, nerve, and spinal segment of the following hip ADDUCTOR?
Posterior Adductor Magnus

Back 36

Origin: Inferior pubic ramus, ischial ramus, and inferolateral area of ischial tuberosity

Insertion: Linea aspera/adductor tubercle

Action: Powerful thigh adductor; superior horizontal fibers also help flex the thigh, while vertical fibers help extend the thigh

Innervation: Posterior division of obturator nerve innervates most of the adductor magnus; vertical or hamstring portion innervated by tibial nerve (L2, L3, L4)

Spinal Segment: L2-L4 (A) - Common to all adductors

Front 37

What is the origin, insertion, nerve, and spinal segment of the following hip ADDUCTOR?
Gracilis

Back 37

Origin: Inferior symphysis/pubic arch

Insertion: Proximal medial tibia, just posterior to sartorius

Innervation: Obturator (A)

Spinal Segment: L2-L4 (A) - Common to all adductors

Front 38

What is the origin, insertion, nerve, and spinal segment of the following hip EXTERNAL ROTATOR?
Gluteus Maximus

Back 38

Origin:Ilium & sacrum

Insertion: Primarily in fascia lata at the iliotibial band; also into the gluteal tuberosity on posterior femoral surface

Innervation: Inferior gluteal

Action: Major extensor of hip joint, assists in laterally rotating the thigh; upper and middle third section of the muscle are abductors

Spinal Segment: L5-S2 (P)

Front 39

What is the origin, insertion, nerve, and spinal segment of the following hip ABDUCTOR?
Gluteus Medius

Back 39

Origin: Ilium between posterior and anterior gluteal lines

Insertion: Greater trochanter lateral & superior

Action: Major abductor of thigh; anterior fibers help to rotate hip medially; posterior fibers help to rotate hip laterally

Innervation: Superior gluteal - Common to abductors

Spinal Segment: L4-S1 (P) - Common to all abductors

Front 40

What is the origin, insertion, nerve, and spinal segment of the following hip ABDUCTOR?
Gluteus Minimus

Back 40

Origin: Ilium between anterior and inferior gluteal lines

Insertion: Anterior border of greater trochanter

Innervation: Superior gluteal - Common to abductors

Spinal Segment: L4-S1 (P) - Common to all abductors

Front 41

What is the origin, insertion, nerve, and spinal segment of the following hip EXTERNAL ROTATOR?
Piriformis

Back 41

Origin: Anterior sacrum

Insertion: Superior border greater trochanter

Action: Lateral rotator of the hip joint; also helps abduct the hip if it is flexed

Innervation: Nerve to Piriformis (L5-S2)

Front 42

What is the origin, insertion, nerve, and spinal segment of the following hip EXTERNAL ROTATOR?
Obturator Internus

Back 42

Origin: Ischiopubic rami/obturator membrane

Insertion: Medial greater trochanter, in common with superior and inferior gemelli

Innervation: Nerve to the obturator internus and superior gemellus -- a branch of the sacral plexus (L5, S1) (L5, S1)

Spinal Segment: L5-S2 (A)

Front 43

What is the origin, insertion, nerve, and spinal segment of the following hip EXTERNAL ROTATOR?
Superior Gemellus

Back 43

Origin: Outer ischial spine

Insertion: Medial greater trochanter, in common with obturator internus

Rotates the thigh laterally; also helps abduct the flexed thigh

Innervation: Nerve to the obturator internus and superior gemellus -- a branch of the sacral plexus (L5, S1) (L5, S1)

Spinal Segment: L5-S2 (A)

Front 44

What is the origin, insertion, nerve, and spinal segment of the following hip EXTERNAL ROTATOR?
Inferior Gemellus

Back 44

Origin: Posterior Ischial tuberosity
Insertion: Medial greater trochanter, in common with obturator internus
Innervation: Nerve to Quadratus femoris
Spinal Segment: L5-S1 (A)

Front 45

What is the origin, insertion, nerve, and spinal segment of the following hip EXTERNAL ROTATOR?
Quadratus Femoris

Back 45

Origin: Ischial tuberosity - Lateral margin of obturator ring above ischial tuberosity

Insertion: Quadrate line of femur

Innervation: Nerve to quadratus femoris

Spinal Segment: L5-S1 (A)

Front 46

Back 46

Front 47

What nerves make up the lumbosacral plexus?

Back 47

T12-S3.

Front 48

The sciatic nerve is made up of L4-S3 and has a preaxial and postaxial division, what are these divisions?

Back 48

The tibial nerve is preaxial
The peroneal nerve is postaxial. The peroneal division is more lateral

Front 49

What is the most common nerve injury with primary total hip arthroplasty?

Back 49

The peroneal division of the sciatic nerve

Front 50

What is the only muscle innervated by the peroneal nerve above the fibular neck?

Back 50

The short head of the biceps femoris

Front 51

On what muscle does the peroneal nerve run?

Back 51

The deep surface of the long head of the biceps femoris

Front 52

The lumbar plexus is found on the anterior surface of the ___________ muscle under (and within) the substance of the ____________ muscle

Back 52

The lumbar plexus is found on the anterior surface of the QUADRATUS LUMBORUM under (and within) the substance of the PSOAS MAJOR muscle

Front 53

Which nerve pierces the psoas and then lies on the anteromedial surface of the psoas

Back 53

The genitofemoral nerve

Front 54

What 2 muscles does the femoral nerve lie between at its origin?

Back 54

The iliacus and psoas

Front 55

Describe the path of the lateral femoral cutaneous nerve as it exits the pelvis

Back 55

Lies on the surface of the iliacus muscle and exits the pelvis under the lateral attachment of the inguinal ligament

Front 56

What muscle is the "key" for naming in the pelvis, ie, why is the superior gluteal nerve and artery named "superior"?

Back 56

The piriformis

Front 57

From lateral to medial, what are the nerves that exit the sciatic foramen?

Back 57

Mnemonic: POP'S IQ.
Pudendal, Obturator internus, Postfemoral cutaneous, Sciatic, Inferior gluteal, Quadratus femoris

Front 58

What nerves leave via the greater sciatic foramen and then reenter the pelvis via the lesser foramen?

Back 58

Pudendal and Nerve to the Obturator Internus

Front 59

What are the borders of the femoral triangle?

Back 59

The sartorius laterally, the pectineus medially, and the inguinal ligament superiorly

Front 60

What are the structures found within the femoral triangle?

Back 60

NAVEL (from lateral to medial...venous near the penis)
Nerve (femoral), Artery, Vein, Empty Space, Lymphatics

Front 61

What are the muscles that make up the floor to the femoral triangle, lateral to medial?

Back 61

Iliacus, Psoas, Pectineus, Adductor Longus

Front 62

Why might Pott's disease of the spine manifest as hip pain?

Back 62

Because of the attachment of the iliopsoas to the lumbar spine

Front 63

At the apex of the femoral triangle, a cutaneous nerve branches off and travels to the foot medially. What is the nerve and what is the muscle it runs under proximally?

Back 63

The saphenous nerve, runs under the sartorious

Front 64

The obturator nerve exits the pelvis via the obturator canal then splits into anterior and posterior divisions within the canal. What does the anterior division and posterior division innervate?

Back 64

Anterior: Proceeds anteriorly to the obturator externus and posteriorly to the pectineus, supplying the adductor longus, adductor brevis, and gracilis; it then delivers cutaneous branches to the medial thigh

Posterior: The posterior division supplies the obturator externus, adductor brevis upper part of the adductor magnus, and then delivers other branches to the knee joint

Front 65

Retractors placed behind what structure could injure the obturator nerve and artery?

Back 65

The transverse acetabular ligament

Front 66

Is the following nerve from the anterior or posterior division of the lumbosacral plexus? What spinal levels make up the nerve? What muscles/sensation is provided by the nerve?
Tibial

Back 66

Division: Anterior
Spinal Levels: L4-S3
Innervations: Semimembranosus, semitendinosus, biceps brachii (long head), adductor magnus, superior gemellus, soleus, plantaris, popliteus, tibialis posterior, flexor digitorum longus, flexor hallucis longus

Front 67

Is the following nerve from the anterior or posterior division of the lumbosacral plexus? What spinal levels make up the nerve? What muscles/sensation is provided by the nerve?
Quadratus femoris

Back 67

Division: Anterior
Spinal Levels: L4-S1
Innervations: Quadratus femoris, inferior gemellus

Front 68

Is the following nerve from the anterior or posterior division of the lumbosacral plexus? What spinal levels make up the nerve? What muscles/sensation is provided by the nerve?
Obturator internus

Back 68

Division: Anterior
Spinal Levels: L5-S2
Innervations: Obturator internus, superior gemellus

Front 69

Is the following nerve from the anterior or posterior division of the lumbosacral plexus? What spinal levels make up the nerve? What muscles/sensation is provided by the nerve?
Pudendal

Back 69

Division: Anterior
Spinal Levels: S2-S4
Innervation - Sensory: perineal
Motor: Bulbocavernosus, urethra, urogenital diaphragm

Front 70

Is the following nerve from the anterior or posterior division of the lumbosacral plexus? What spinal levels make up the nerve? What muscles/sensation is provided by the nerve?
Coccygeus

Back 70

Division: Anterior
Spinal Levels: S4
Innervation: Coccygeus

Front 71

Is the following nerve from the anterior or posterior division of the lumbosacral plexus? What spinal levels make up the nerve? What muscles/sensation is provided by the nerve?
Levator ani

Back 71

Division: Anterior
Spinal Levels: S3-S4
Innervation: Levator ani

Front 72

Is the following nerve from the anterior or posterior division of the lumbosacral plexus? What spinal levels make up the nerve? What muscles/sensation is provided by the nerve?
Peroneal

Back 72

Division: Posterior (Peroneal Posterior)
Spinal Levels: L4-S2
Innervations: Biceps (short head), tibialis anterior, extensor digitorum longus, peroneus tertius, extensor hallucis longus, Peroneus longus and brevis, extensor hallucis brevis, extensor digitorum brevis

Front 73

Is the following nerve from the anterior or posterior division of the lumbosacral plexus? What spinal levels make up the nerve? What muscles/sensation is provided by the nerve?
Superior Gluteal

Back 73

Division: Posterior
Spinal Levels: L4-S1
Innervation: Gluteus medius and minimus, tensor fascia lata

Front 74

Is the following nerve from the anterior or posterior division of the lumbosacral plexus? What spinal levels make up the nerve? What muscles/sensation is provided by the nerve?
Inferior Gluteal

Back 74

Division: Posterior
Spinal Levels: L5-S2
Innervation: Gluteus Maximus

Front 75

Is the following nerve from the anterior or posterior division of the lumbosacral plexus? What spinal levels make up the nerve? What muscles/sensation is provided by the nerve?
Piriformis

Back 75

Division: Posterior
Spinal Level: S2
Innervation: Piriformis

Front 76

Is the following nerve from the anterior or posterior division of the lumbosacral plexus? What spinal levels make up the nerve? What muscles/sensation is provided by the nerve?
Posterior femoral cutaneous nerve

Back 76

Division: Posterior
Spinal Level: S1-S3
Innervation: Sensor - Posterior Thigh

Front 77

What is the interval for the anterior (Smith-Peterson) approach to the hip?

Back 77

Sartorius (femoral nerve) and Tensor Fasciae Latae (superior gluteal nerve)

Front 78

During a Smith-Peterson approach to the hip, where can the lateral femoral cutaneous nerve be injured?

Back 78

Either anterior or medial to the sartorious, about 6-8 cm below the ASIS

Front 79

What artery penetrates the TFL just anterior to the lateral femoral cutaneous nerve is at risk for injury with the Smith-Peterson approach?

Back 79

The superficial circumflex artery

Front 80

What is the interval for the anterolateral (Watson-Jones) approach to the hip?

Back 80

No true interneural plane. The intermuscular plane is the TFL and Gluteus Medius (bother superior gluteal nerve)

Front 81

In the Watson-Jones (anterolateral) approach to the hip, TFL denervation can occur if dissected too far superiorly because the superior gluteal nerve lies where in relation to what structure?

Back 81

About 5 cm above the acetabular rim

Front 82

What is the interval for the lateral (Hardinge's) approach to the hip?

Back 82

Interval: Splitting of the gluteus medius and vastus lateralis in tandem

Dissection:
□ Incise the skin and the fascia lata to expose the gluteus medius and the vastus lateralis.
□ Incise the gluteus medius from the greater trochanter, leaving a cuff of tissue and the posterior half to two thirds attached.
□ Extend this incision to split the gluteus medius proximally.
□ Split the vastus lateralis distally along its anterior fourth down to the femoral shaft.
□ Detach the gluteus minimus from its insertion.
□ The hip capsule is now exposed for further dissection

Front 83

What is at risk in the lateral (Hardinge's) approach to the hip if the split is taken too proximal?

Back 83

Injury to the femoral nerve and possible denervation of the gluteus medius (superior gluteal nerve) if the split is too proximal (more than 5 cm proximal to the greater trochanter)

Front 84

What is the interval for the posterior (Moore's or Southern's) approach to the hip?

Back 84

Splitting the fibers of the gluteus maximus

Dissection:
□ Incise the skin and the fascia lata along the posterior border of the femur, and then split the fibers of the gluteus maximus bluntly.
□ Expose the short external rotators close to their insertions into the greater trochanter, and reflect them laterally to protect the sciatic nerve and expose the posterior hip capsule.
□ A portion of the quadratus femoris may be taken down with the short external rotators, but be aware of the significant bleeding that can come from the inferior portion of this muscle (ascending branches of the medial femoral circumflex artery).

Front 85

How could sciatic neurapraxia occur with the posterior approach to the hip? What artery is at risk with this approach?

Back 85

Sciatic neurapraxia if the nerve is not properly protected by the short external rotators.

Damage to the inferior gluteal artery during the splitting of the gluteus maximus can occur

Front 86

What are the superficial and deep intervals for the medial approach (Ludloff's) to the hip?

Back 86

Superficial: Between adductor longus and gracilis
Deep: Adductor brevis and adductor magnus

Front 87

What structures are at risk with the medial approach to the hip?

Back 87

Anterior division of the obturator nerve and medial femoral circumflex artery (between the adductor brevis and the adductor magnus/pectineus)

Front 88

What approach to the pelvis provides access to the posterior column?

Back 88

Kocher-Langenbach (posterolateral approach)

Front 89

What approach to the pelvis exposes the anterior column?

Back 89

Ilioinguinal approach, it relies on mobilization of the rectus abdominis and iliacus

Front 90

There are 3 windows available with the ilioinguinal approach to the pelvis. What is provided with each window?

Back 90

▪ The first window gives access to the internal iliac fossa, the anterior sacroiliac joint, and the upper portion of the anterior column.
▪ The second window (between the iliopectineal fascia and the external iliac vessels) provides access to the pelvic brim from the anterior sacroiliac joint to the lateral portion of the superior pubic ramus.
▪ The third window (below the vessels and the spermatic cord) gives access to the symphysis pubis

Front 91

What approach to the pelvis provides access to both the anterior and posterior columns with one approach?

Back 91

The extended iliofemoral incision allows access to both columns by reflecting the gluteal muscles and tensor posteriorly and dividing the obturator internus and piriformis

Front 92

Back 92

Front 93

Back 93

Front 94

Back 94