Lecture 5 Femur

Question 1

Articulation of femur

Answer 1

Proximally - Head of femur with the acetabulum of hip

Distally - condyles with the tibia and patella

Question 2

Fovea capitis

Answer 2

Small depression in the centre of the femoral head where the ligamentum teres attaches to.

The ligamentum teres artery passes through to supply the femoral head in children.

Question 3

Femoral neck

Answer 3

Connects head with shaft

Passes inferiorly, posteriorly and laterally at 125 degrees to the shaft (angle smaller in females)

Question 4

Intertrochanteric line

Answer 4

Connects the greater and lesser trochanters anteriorly

Question 5

Intertrochanteric crest

Answer 5

Connects the greater and lesser trochanters posteriorly

Question 6

Linea aspera

Answer 6

Ridge in the posterior femoral shaft

Question 7

Gluteal tuberosity

Answer 7

Thickened line on the posterior femoral shaft in between the intertrochanteric crest and the upper linear aspera

Where the gluteus maximus inserts

Question 8

Medial supracondylar ridge

Answer 8

Medial branch of when the lower linear aspera splits.

Ends at the adductor tubercle near the medial condyle.

Question 9

What separates the medial and lateral condyles?

Answer 9

The intercondylar notch posteriorly

Trochlear (patellofemoral groove) anteriorly

Question 10

Attachments of the hip capsule

Answer 10

Proximally - outside acetabular labrum
Distally - intertrochanteric line anteriorly
- Femoral neck posteriorly

Question 11

Longitudinal retinacula

Answer 11

Capsule fibres of the capsule that ascend along the femoral neck anteriorly

Contains blood vessels for the femoral head and neck

Question 12

Intracapsular ligament

Answer 12

Ligamentum teres

Question 13

Extracapsular ligaments

Answer 13

Iliofemoral
Pubofemoral
Ischiofemoral

Question 14

Iliofemoral ligament

Answer 14

Strongest
inverted Y shape
Blends with capsule
Most superior

Screws femoral head into the acetabulum when standing

Prevents backward slippage and hyperextension of the hip

Question 15

Attachment sites of iliofemoral ligament

Answer 15

Anterior inferior iliac spine

Intertrochanteric line

Question 16

Pubofemoral ligament and attachment sites

Answer 16

Inferior to iliofemoral ligament
Triangular

origin - superior pubic ramus
Insertion - inferior aspect of the intertrochanteric line

Question 17

Role of pubofemoral ligament

Answer 17

Prevents excessive abduction and extension of the hip joint

Question 18

Ischiofemoral ligament

Answer 18

Spiral shaped
Posterior
Weakest

Prevents excessive (internal) medial rotation

origin- ischial body
insretion- Greater trochanter

Question 19

Transverse acetabular ligament

Answer 19

Formed by the acetabular labrum as it bridges the acetabular notch, making a tunnel.

In which nerves and blood vessels enter the hip joint

Question 20

6 factors that stabilise the hip joint

Answer 20

1. Acetabular labrum (deepens acetabulum)
2. Capsule
3. Acetabulum
4. Extracapsular ligaments
5. Ligamentum teres
6. Muscles surrounding the hip joint

Question 21

Relationship between hip muscles and ligaments

Answer 21

Reciprocal:

Anteriorly, ligaments are the strongest so the anterior muscles (medial flexors) are fewer and weaker

Posteriorly, the ligament is weaker therefore the muscles (lateral rotators) are stronger and greater in number.

Question 22

Muscles that flex the hip

Answer 22

Iliopsoas 
Assisted by:
- Rectus femoris
- Sartorius
- Pectineus

Question 23

Muscles that extend the hip

Answer 23

Gluteus maximus
Hamstrings:
- Semimembranosus
- Semitendinosus 
- Biceps femoris (long head)

Question 24

Muscles that abduct the hip

Answer 24

Gluteus medius 
Gluteus minimus 
Assisted by:
- Sartorius 
- Tensor fascia lata

Question 25

Muscles that adduct the hip

Answer 25

Adductor longus
Adductor brevis
Adductor magnus

Assisted by:

• Pectineus
• Gracilis
• Obturator externus

Question 26

Muscles that laterally rotate the hip

Answer 26

Obturator externus
Piriformis
Obturator internus 
Superior and inferior gemelli 
Quadratus femoris 

Assisted by:
Gluteus maximus
Sartorius

Question 27

Muscles that medially rotate the hip

Answer 27

Anterior fibres of Gluteus medius and minimus
Tensor fascia lata

Assisted by:

• adductor brevis
• adductor longus
• superior portion of adductor magnus
• pectineus

Question 28

What controls the degree of flexion of the hip?

Answer 28

When the knee is flexed, the hamstrings are relaxed which increases the range of flexion at the hip

Question 29

What limits extension of the hip?

Answer 29

Joint capsule

Iliofemoral ligament

Question 30

Describe the extracapsular arterial ring

Answer 30

At the base of the femoral neck

Anteriorly - branch of the lateral femoral circumflex artery
Posteriorly - large branch of the medial femoral circumflex artery (branch of profunda femoris artery)

The MFCA and LFCA give rise to the retinacular arteries ( ascending cervical branches)
- travel deep to the hip capsule and synovial membrane of the femoral neck to the femoral head

• Supply metaphysis

Question 31

Where is the ligamentum teres derived from?

Answer 31

Obturator artery

Question 32

Consequences of an intracapsular fracture

Answer 32

Disruption of the medial femoral circumflex artery, which disrupts the ascending cervical arteries supplying the femoral head in adults.

Risk of avascular necrosis of the bone