Transcript Pelvic Ring Fractures

The Hip
http://www.youtube.com/watch?v=wdxIz3
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Bones of the Hip
• Coxal Bone – hip bone
composed of 3 fused bones:
1. Ilium
iliac crest – serves as attachment
point for abdominal muscles
2. Ischium
ischial tuberosity – hamstring
attachment
3. Pubis
pubic symphysis
The 3 bones fuse at the acetabulum – receives the
head of the femur
• Coxal Bones – hip bones
consists of 3 fused bones
- ilium
- ischium
- pubis
• Pelvis – 2 hip bones and the
sacrum
• Pelvic girdle – the paired coxal
bones
• The Femur
Greater Trochanter and Lesser Trochanter
are sites for muscle attachments
• The hip joint is a ball and socket joint
that is designed for STABILITY
and not for MOBILITY
Motions of the Hip Joint
Hip Flexion
Hip Extension
Hip Abduction
Hip Adduction
Rotation
Muscles of the Hip Joint
• Hip Flexors:
1. Iliopsoas
- Iliacus
- Psoas Major
2. Rectus Femoris (one of the Quad m.)
a hip flexor as well as a knee
extensor
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• Exercises that
work the hip
flexors:
- situps
- leg raises
- hanging leg
raises
Hip Extensor Muscles
• Gluteus Maximus – main hip
extensor
• Hamstring muscles – can not
flex the knee and extend the hip
fully at the same time
Hip Adductors
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Adductor Longus
Adductor Brevis
Adductor Magnus
Gracilis
Pectineus
Hip Abductors
• Gluteus Medius
• Gluteus Minimus
2 parts of the same muscle
Tensor Fascia Lata
Muscle – inserts into
the Iliotibial Band.
Helps to stabilize the
hip joint
The Femoral
Triangle
• Borders:
1.Inguinal
Lig
2.Sartorius
3.Adductor
longus
• Contents:
1.Femoral
Vein
2.Femoral
Artery
3.Femoral
Nerve
Injuries to the Hip
Sacral Fractures
- MOI: fall in a sitting position or direct contact
- Displacement can injure nerves and the
urinary bladder
- Bed rest, only surgery for severe
displacement
Coccyx Fractures
• MOI – fall in a sitting position
• Sitting is almost impossible
• Treatment aimed at pain relief, sitting
“forward” on the ischial tuberosities
• Return to athletics as soon as comfortable
Acetabular Fractures
• Rare, results from severe trauma
• MOI – direct, violent force that passes
through femoral neck into the acetabulum
• Immediate pain, inability to walk on leg
• Shortening of extremity
• Bed rest, possible surgery, followed by
ROM exercises
• Best treatment may still result in
osteoarthritis of the hip
Acetabular Fractures
Dislocations of the Hip
• Posterior dislocations most common
- 95% of all hip dislocations
- Why? Anterior hip capsule is strong, and MOI
occurs more commonly in athletics
- MOI: hip and knee flexed at 900 , force exerted
through shaft of femur, driving it posteriorly
“dashboard injury”
- S & S: severe pain, inability to move, hip flexed
and internally rotated, shortened extremity
- Complications: fractures, sciatic nerve problems,
avascular necrosis, arthritis
Dislocations of the Hip
• Anterior Hip Dislocation
- less than 5% of hip dislocations
- MOI: forceful ABDuction and external
roation
- S & S: immediate pain, limb is ABDucted
and externally rotated, palpable mass in
groin
- Complications: avascular necrosis,
compression of femoral vein which can
lead to a thrombus
Fractures of the Femur
• Strength of femur is very good in young
athletes
• Severe trauma causes the injury
Femoral Fractures
Femoral Neck Fractures
Slipped Capital Femoral
Epiphysis
• Occurs in growing athlete
• More common in boys, usually between
ages of 11 – 15, short, heavy boys more
common
• MOI: not always identifiable
• S & S: pain, may be referred to knee,
common to have coach “run it out”
Common to see glutues medius limp
Treament depends on degree of slippage
Hip Pointer
Avulsion of Lesser
Trochanter of Femur
• Forceful Strain of Ilioposas
muscle
Avulsion of Ischial
Tuberosity
• Forceful stretch of Hamstring
muscles
Avulsion of Anterior
Superior Iliac Spine
(ASIS)
• Origin of the Sartorius muscle
Avulsion of Crest of
Ilium
• Forceful contraction of
the abdominal muscle
Osteitis Pubis
Snapping Hip Syndrome
Legg-Calve-Perthes
Disease
Slipped Capital Femoral
Epiphysis
Quadriceps Contusion
Myositis Ossificans
Iliotibial Band Syndrome
Piriformis Syndrome
The Abdominal
Muscles
1. Rectus Abdominus
trunk flexion
2. Internal Oblique
rotates trunk to same side
3. External oblique
rotates trunk to opposite side
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