Pradeep Chockalingam
Pradeep Chockalingam
Pradeep Chockalingam
Pradeep Chockalingam
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Anatomy
Acetabulum
(Proximal)
Femoral head
(Distal)
http://www.fpnotebook.com/ORT78.htm
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Joint Type
Ball and socket joint
Synovial joint
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Blood supply to head & NOF
Medial and lateral femoral
circumflex arteries
Obturator artery
Superior and inferior gluteal
arteries
Ascending branch of first
perforating branch of
profunda femoris
http://www.orthogastonia.com/patient_ed/images/hip/hip_avn/hip_avn_anatomy02.jpg
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Capsule
Proximal
Attached around the brim of the bony
acetabulum
Distal
Anteriorly along the inter trochanteric line
Posteriorly ½" above the inter trochanteric crest
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Ligaments
Iliofemoral ligament
reinforcing the anterior surface of the articular
capsule of the hip joint
Ischiofemoral ligament
reinforcing the posterior surface of the articular
capsule of the hip joint
Ligament of the head of the femur
attaches to the fovea of the head and to the
acetabular fossa
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Ligaments Cont.
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Muscles
Adduction Abduction
Adductor longus Gluteus medius
Adductor brevis Gluteus minimus
Adductor magnus Tensor fascia latae
Gracilis
Pectineus (to a small
degree)
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Muscles
Lateral Rotation Medial Rotation
Obturator externus Gluteus minimus
Obturator internus Anterior part of gluteus
Superior and inferior gemelli medius
Piriformis Pectineus
Quadratus femoris
Gluteus maximus
Sartorius
Posterior part of gluteus
medius
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Range of Motion
Flexion: 110 to 120 degrees
Extension: 10 to 15 degrees
Abduction: 30 to 50 degrees
Adduction: 30 degrees
Lateral rotation: 40 to 60 degrees
Medial rotation: 30 to 40 degrees
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Examination of Hip
Subjective
Objective
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Subjective
History taking
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Objective
Observation
Palpation
Examination
Special tests
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Common problems in adults
#NOF
Osteoarthritis
Rheumatoid Arthritis
Ankylosing spondylitis
Paget's Disease
Dislocation
Infectious joint diseases
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Paediatrics
Developmental dysplasia of the hip
Girls > Boys
Perthes disease
Boys > Girls
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#NOF
Falls (1% of all falls cause #NOF)
90% of hip fractures occur after age 70
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http://herkules.oulu.fi/isbn9514270959/html/x286.html
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Trabicullar system of Hip
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Classification of #NOF
http://herkules.oulu.fi/isbn9514270959/html/c247.html
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Pauwels Classification
http://www.e-radiography.net/articles/Fractures%20of%20the%20lower%20limb/Fractures%20of%20the%20lower%20limb.htm
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Intracapsular (Gardens)
http://www.emedicine.com/radio/topic342.htm
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Extracapsular (Jensen)
http://herkules.oulu.fi/isbn9514270959/html/x261.html
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Intracapsular Vs Extracapsular
Less common More
Minimal rotation Lateral violence
violence
Minimal Fully externally rotated
Nil Marked local swelling
Difficult Easy
Common Does not occur
Rare Common
http://www.bonetumour.org/book/Truma/chapter18/ch18_sub2.html
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Management of #NOF
Conservative
Surgical
THR
HHR
DHS
CHS
Girdlestone
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Surgical approach to hip
Anterior
Lateral
Posterior
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http://www.totaljoints.info/Approaches_TH.jpg
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Anterior
Internal rotators, Abductors
Low risk of hip dislocation, but risk of
limp due to division of the abductor
muscles attachments. Risk for damage
of skin nerves with persisting skin
numbness
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Lateral
TFL, G. Medius, G. Minimus, V. Lateralis
Risk to Superior Glutial Nerve
Excellent access but healing problems
with detached abductor muscles
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Posterior
External rotator, G. Maximus, Fascia
lata
Risk to Sciatic Nerve
Easy access, but greater risk of total hip
dislocation
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PT Management
Early Mobilisation
Early Weight Bearing
Quadriceps, Abductor Exercises
Patient Education
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