Hip Fracture Classification
   HOME

TheInfoList



OR:

In
vertebrate Vertebrates () comprise all animal taxa within the subphylum Vertebrata () ( chordates with backbones), including all mammals, birds, reptiles, amphibians, and fish. Vertebrates represent the overwhelming majority of the phylum Chordata, ...
anatomy Anatomy () is the branch of biology concerned with the study of the structure of organisms and their parts. Anatomy is a branch of natural science that deals with the structural organization of living things. It is an old science, having its ...
, hip (or "coxa"Latin ''coxa'' was used by
Celsus Celsus (; grc-x-hellen, Κέλσος, ''Kélsos''; ) was a 2nd-century Greek philosopher and opponent of early Christianity. His literary work, ''The True Word'' (also ''Account'', ''Doctrine'' or ''Discourse''; Greek: grc-x-hellen, Λόγ ...
in the sense "hip", but by
Pliny the Elder Gaius Plinius Secundus (AD 23/2479), called Pliny the Elder (), was a Roman author, naturalist and natural philosopher, and naval and army commander of the early Roman Empire, and a friend of the emperor Vespasian. He wrote the encyclopedic '' ...
in the sense "hip bone" (Diab, p 77)
in medical terminology) refers to either an anatomical region or a joint. The hip region is located
lateral Lateral is a geometric term of location which may refer to: Healthcare *Lateral (anatomy), an anatomical direction *Lateral cricoarytenoid muscle *Lateral release (surgery), a surgical procedure on the side of a kneecap Phonetics *Lateral cons ...
and
anterior Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position prov ...
to the
gluteal region The gluteal muscles, often called glutes are a group of three muscles which make up the gluteal region commonly known as the buttocks: the gluteus maximus, gluteus medius and gluteus minimus. The three muscles originate from the ilium and s ...
, inferior to the
iliac crest The crest of the ilium (or iliac crest) is the superior border of the wing of ilium and the superiolateral margin of the greater pelvis. Structure The iliac crest stretches posteriorly from the anterior superior iliac spine (ASIS) to the posterior ...
, and overlying the
greater trochanter The greater trochanter of the femur is a large, irregular, quadrilateral eminence and a part of the skeletal system. It is directed lateral and medially and slightly posterior. In the adult it is about 2–4 cm lower than the femoral head.Stan ...
of the
femur The femur (; ), or thigh bone, is the proximal bone of the hindlimb in tetrapod vertebrates. The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates with ...
, or "thigh bone". In adults, three of the bones of the pelvis have fused into the
hip bone The hip bone (os coxae, innominate bone, pelvic bone or coxal bone) is a large flat bone, constricted in the center and expanded above and below. In some vertebrates (including humans before puberty) it is composed of three parts: the Ilium (bone), ...
or
acetabulum The acetabulum (), also called the cotyloid cavity, is a concave surface of the pelvis. The head of the femur meets with the pelvis at the acetabulum, forming the hip joint. Structure There are three bones of the ''os coxae'' (hip bone) that c ...
which forms part of the hip region. The hip joint, scientifically referred to as the acetabulofemoral joint (''art. coxae''), is the
joint A joint or articulation (or articular surface) is the connection made between bones, ossicles, or other hard structures in the body which link an animal's skeletal system into a functional whole.Saladin, Ken. Anatomy & Physiology. 7th ed. McGraw ...
between the head of the femur and
acetabulum The acetabulum (), also called the cotyloid cavity, is a concave surface of the pelvis. The head of the femur meets with the pelvis at the acetabulum, forming the hip joint. Structure There are three bones of the ''os coxae'' (hip bone) that c ...
of the
pelvis The pelvis (plural pelves or pelvises) is the lower part of the trunk, between the abdomen and the thighs (sometimes also called pelvic region), together with its embedded skeleton (sometimes also called bony pelvis, or pelvic skeleton). The ...
and its primary function is to support the weight of the body in both static (e.g., standing) and dynamic (e.g., walking or running) postures. The hip joints have very important roles in retaining balance, and for maintaining the pelvic inclination angle. Pain of the hip may be the result of numerous causes, including nervous, osteoarthritic, infectious, traumatic, and genetic.


Structure


Region

The hip joint, also known as a ball and socket joint, is formed by the acetabulum of the pelvis and the femoral head, which is the top portion of the thigh bone (femur). It allows for a wide range of movement and stability in the lower body. The proximal femur is largely covered by muscles and, as a consequence, the
greater trochanter The greater trochanter of the femur is a large, irregular, quadrilateral eminence and a part of the skeletal system. It is directed lateral and medially and slightly posterior. In the adult it is about 2–4 cm lower than the femoral head.Stan ...
is often the only palpable bony structure in the hip region.''Thieme Atlas of Anatomy'' (2006), p 381


Articulation

The hip joint is a ball and socket
synovial joint A synovial joint, also known as diarthrosis, joins bones or cartilage with a fibrous joint capsule that is continuous with the periosteum of the joined bones, constitutes the outer boundary of a synovial cavity, and surrounds the bones' articulat ...
formed by the articulation of the rounded head of the femur and the cup-like
acetabulum The acetabulum (), also called the cotyloid cavity, is a concave surface of the pelvis. The head of the femur meets with the pelvis at the acetabulum, forming the hip joint. Structure There are three bones of the ''os coxae'' (hip bone) that c ...
of the pelvis. The socket of the acetabulum is pointing downwards and anterolaterally. The socket is also turned such that the outer edge of its roof is more lateral than outer edge of the floor. It forms the primary connection between the bones of the lower limb and the
axial skeleton The axial skeleton is the part of the skeleton that consists of the bones of the head and trunk (anatomy), trunk of a vertebrate. In the human skeleton, it consists of 80 bones and is composed of six parts; the human skull, skull (22 bones), als ...
of the trunk and pelvis. Both joint surfaces are covered with a strong but lubricated layer called articular hyaline
cartilage Cartilage is a resilient and smooth type of connective tissue. In tetrapods, it covers and protects the ends of long bones at the joints as articular cartilage, and is a structural component of many body parts including the rib cage, the neck an ...
. The cuplike acetabulum forms at the union of three pelvic bones — the ilium, pubis, and
ischium The ischium () form ...
.Faller (2004), pp 174-175 The Y-shaped growth plate that separates them, the
triradiate cartilage The triradiate cartilage (in Latin cartilago ypsiloformis) is the 'Y'-shaped epiphyseal plate between the ilium, ischium and pubis to form the acetabulum of the os coxae. Human development In children, the triradiate cartilage closes at an app ...
, is fused definitively at ages 14–16.''Thieme Atlas of Anatomy'' (2006), p 365 It is a special type of spheroidal or
ball and socket joint The ball-and-socket joint (or spheroid joint) is a type of synovial joint in which the ball-shaped surface of one rounded bone fits into the cup-like depression of another bone. The distal bone is capable of motion around an indefinite number o ...
where the roughly spherical femoral head is largely contained within the acetabulum and has an average radius of curvature of 2.5 cm.''Thieme Atlas of Anatomy'' (2006), p 378 The acetabulum grasps almost half the femoral ball, a grip deepened by a ring-shaped fibrocartilaginous lip, the
acetabular labrum The acetabular labrum (glenoidal labrum of the hip joint or cotyloid ligament in older texts) is a ring of cartilage that surrounds the acetabulum of the hip. The anterior portion is most vulnerable when the labrum tears. It provides an articulat ...
, which extends the joint beyond the equator. The centre of the acetabulum (fovea) does not articulate to anything. Instead, it is lined with fat pad and attached to ligamentum teres. The acetabular labrum is horse-shoe shaped. Its inferior notch is bridged by transverse acetabular ligament. The joint space between the femoral head and the superior acetabulum is normally between 2 and 7 mm. The head of the femur is attached to the shaft by a thin neck region that is often prone to fracture in the elderly, which is mainly due to the degenerative effects of
osteoporosis Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to bone fragility, and consequent increase in fracture risk. It is the most common reason for a broken bone ...
. The acetabulum is oriented inferiorly, laterally and anteriorly, while the femoral neck is directed superiorly, medially, and slightly anteriorly.


Articular angles

Acetabular angle (or Sharp's angle) is the angle between the horizontal line passing through the inferior aspects of
triradiate cartilages The triradiate cartilage (in Latin cartilago ypsiloformis) is the 'Y'-shaped epiphyseal plate between the ilium, ischium and pubis to form the acetabulum of the os coxae. Human development In children, the triradiate cartilage closes at an app ...
(
Hilgenreiner's line Hilgenreiner's line is a horizontal line drawn on an AP radiograph of the pelvis running between the inferior aspects of both triradiate cartilages of the acetabulums. It is named for Heinrich Hilgenreiner. Clinical Use Used in conjunction wi ...
) and another line passing through the inferior angle of triradiate cartilage to superior acetabular rim. The angle measures 35 degrees at birth, 25 degrees at one year of age, and less than 10 degrees by 15 years of age. In adults the angle can vary from 33 to 38 degrees. The sagittal angle of the acetabular inlet is an angle between a line passing from the anterior to the posterior acetabular rim and the sagittal plane. It measures 7° at birth and increases to 17° in adults. Wiberg's centre-edge angle (CE angle) is an angle between a vertical line and a line from the centre of the femoral head to the most lateral part of the acetabulum,Page 131
in:
as seen on an
anteroposterior Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position prov ...
radiograph Radiography is an imaging technique using X-rays, gamma rays, or similar ionizing radiation and non-ionizing radiation to view the internal form of an object. Applications of radiography include medical radiography ("diagnostic" and "therapeut ...
.
The vertical-centre-anterior margin angle (VCA) is an angle formed from a vertical line (V) and a line from the centre of the femoral head (C) and the anterior (A) edge of the dense shadow of the subchondral bone slightly posterior to the anterior edge of the acetabulum, with the radiograph being taken from the ''false angle'', that is, a lateral view rotated 25 degrees towards becoming frontal. The articular cartilage angle (AC angle, also called ''acetabular index'' or Hilgenreiner angle) is an angle formed parallel to the weight bearing dome, that is, the acetabular '' wikt:sourcil, sourcil'' or "roof", and the horizontal plane, or a line connecting the corner of the triangular cartilage and the lateral acetabular rim. In normal hips in children aged between 11 and 24 months, it has been estimated to be on average 20°, ranging between 18° to 25°. It becomes progressively lower with age. Suggested cutoff values to classify the angle as abnormally increased include: :*30° up to 4 months of age.Page 942
in:
:*25° up to 2 years of age.


Femoral neck angle

The angle between the longitudinal axes of the femoral neck and shaft, called the caput-collum-diaphyseal angle or CCD angle, normally measures approximately 150° in newborn and 126° in adults (''coxa norma'').''Thieme Atlas of Anatomy'' (2006), p 367 An abnormally small angle is known as ''
coxa vara Coxa vara is a deformity of the hip, whereby the angle between the head and the shaft of the femur is reduced to less than 120 degrees. This results in the leg being shortened and the development of a limp. It may be congenital and is commonly cau ...
'' and an abnormally large angle as ''
coxa valga Coxa valga is a deformity of the hip where the angle formed between the head and neck of the femur and its shaft is increased, usually above 135 degrees. The differential diagnosis includes neuromuscular disorders (i.e. cerebral palsy, spinal dys ...
''. Because changes in shape of the femur naturally affects the knee, ''coxa valga'' is often combined with ''
genu varum Genu varum (also called bow-leggedness, bandiness, bandy-leg, and tibia vara) is a varus deformity marked by (outward) bowing at the knee, which means that the lower leg is angled inward ( medially) in relation to the thigh's axis, giving the ...
'' (bow-leggedness), while ''coxa vara'' leads to ''
genu valgum Genu, a Latin word for "knee," may refer to: * Genu of internal capsule * Genu of the corpus callosum * Genu recurvatum * Genu valgum * Genu varum Genu varum (also called bow-leggedness, bandiness, bandy-leg, and tibia vara) is a varus def ...
'' (knock-knees). Changes in the CCD angle is the result of changes in the stress patterns applied to the hip joint. Such changes, caused for example by a dislocation, change the
trabecula A trabecula (plural trabeculae, from Latin for "small beam") is a small, often microscopic, tissue element in the form of a small beam, strut or rod that supports or anchors a framework of parts within a body or organ. A trabecula generally has ...
r patterns inside the bones. Two continuous trabecular systems emerging on the auricular surface of the
sacroiliac joint The sacroiliac joint or SI joint (SIJ) is the joint between the sacrum and the ilium bones of the pelvis, which are connected by strong ligaments. In humans, the sacrum supports the spine and is supported in turn by an ilium on each side. The ...
meander and criss-cross each other down through the hip bone, the femoral head, neck, and shaft. * In the hip bone, one system arises on the upper part of the auricular surface to converge onto the posterior surface of the
greater sciatic notch The greater sciatic notch is a notch in the ilium (bone), ilium, one of the bones that make up the human pelvis. It lies between the posterior inferior iliac spine (above), and the ischial spine (below). The sacrospinous ligament changes this notch ...
, from where its trabeculae are reflected to the inferior part of the acetabulum. The other system emerges on the lower part of the auricular surface, converges at the level of the superior gluteal line, and is reflected laterally onto the upper part of the acetabulum. * In the femur, the first system lines up with a system arising from the lateral part of the femoral shaft to stretch to the inferior portion of the femoral neck and head. The other system lines up with a system in the femur stretching from the medial part of the femoral shaft to the superior part of the femoral head.Palastanga (2006), p 353 On the lateral side of the hip joint the
fascia lata The fascia lata is the deep fascia of the thigh. It encloses the thigh muscles and forms the outer limit of the fascial compartments of thigh, which are internally separated by the medial intermuscular septum and the lateral intermuscular septu ...
is strengthened to form the
iliotibial tract The iliotibial tract or iliotibial band (ITB; also known as Maissiat's band or the IT band) is a longitudinal fibrous reinforcement of the fascia lata. The action of the muscles associated with the ITB (tensor fasciae latae and some fibers of glu ...
which functions as a tension band and reduces the bending loads on the proximal part of the femur.


Capsule

Proximally, capsule of the hip joint is attached to the edge of the acetabulum, acetabular labrum, and transverse acetabular ligament. Distally, it is attached to the trochanters of the femur and intertrochanteric line anteriorly. Posteriorly, it is attached to a junction between medial two-thirds and lateral one-third of the femoral neck, one finger breath away from the intertrochanteric crest. From its attachment at the femoral neck, the fibres of the capsule reflected backwards towards the acetabulum, carrying retinacula vessels supplying the femoral head. The part of femoral neck outside the capsule is shorter in front than posteriorly. The strong but loose fibrous capsule of the hip joint permits the hip joint to have the second largest range of movement (second only to the
shoulder The human shoulder is made up of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone) as well as associated muscles, ligaments and tendons. The articulations between the bones of the shoulder mak ...
) and yet support the weight of the body, arms and head. The capsule has two sets of fibers: longitudinal and circular. * The circular fibers form a collar around the femoral neck called the
zona orbicularis The zona orbicularis or annular ligament is a ligament on the Femur neck, neck of the femur formed by the circular fibers of the Capsule of hip joint, articular capsule of the Hip, hip joint. It is also known as the orbicular zone, ring ligament, ...
. * The longitudinal retinacular fibers travel along the neck and carry blood vessels.


Ligaments

The hip joint is reinforced by four ligaments, of which three are extracapsular and one intracapsular. The extracapsular ligaments are the iliofemoral, ischiofemoral, and
pubofemoral ligament The pubofemoral ligament (pubocapsular ligament) is a ligament on the inferior side of the hip joint. This ligament is attached, above, to the obturator crest and the superior ramus of the pubis; below, it blends with the capsule and with the d ...
s attached to the bones of the pelvis (the ilium,
ischium The ischium () form ...
, and pubis respectively). All three strengthen the capsule and prevent an excessive range of movement in the joint. Of these, the Y-shaped and twisted iliofemoral ligament is the strongest ligament in the human body. It has a tensile strength of 350 kg. Iliofemoral ligament is a thickening of the anterior capsule extending from
anterior inferior iliac spine Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position prov ...
to
intertrochanteric line The intertrochanteric line (or ''spiral line of the femur''White (2005), p 256 ) is a line located on the anterior side of the proximal end of the femur. Structure The rough, variable ridge stretches between the lesser trochanter and the greater t ...
. Ischiofemoral ligament is the thickening of posterior capsule of the hip and pubofemoral ligament is the thickening of the inferior capsule. In the upright position, iliofemoral ligament prevents the trunk from falling backward without the need for muscular activity, thus preventing excessive hyperextension. In the sitting position, it becomes relaxed, thus permitting the pelvis to tilt backward into its sitting position. Ischiofemoral prevents excessive extension and the pubofemoral ligament prevents excess abduction and extension. The
zona orbicularis The zona orbicularis or annular ligament is a ligament on the Femur neck, neck of the femur formed by the circular fibers of the Capsule of hip joint, articular capsule of the Hip, hip joint. It is also known as the orbicular zone, ring ligament, ...
, which lies like a collar around the most narrow part of the
femoral neck The femoral neck (femur neck or neck of the femur) is a flattened pyramidal process of bone, connecting the femoral head with the femoral shaft, and forming with the latter a wide angle opening medialward. Structure The neck is flattened from ...
, is covered by the other ligaments which partly radiate into it. The zona orbicularis acts like a buttonhole on the femoral head and assists in maintaining the contact in the joint. All three ligaments become taut when the joint is extended - this stabilises the joint, and reduces the energy demand of muscles when standing. The intracapsular ligament, the ligamentum teres, is attached to a depression in the acetabulum (the acetabular notch) and a depression on the femoral head (the fovea of the head). It is only stretched when the hip is dislocated, and may then prevent further displacement. It is not that important as a ligament but can often be vitally important as a conduit of a small artery to the head of the femur, that is, the . This artery is not present in everyone but can become the only blood supply to the bone in the head of the femur when the neck of the femur is fractured or disrupted by injury in childhood.''Thieme Atlas of Anatomy'' (2006), pp 383, 440


Blood supply

The hip joint is supplied with blood from the medial circumflex femoral and lateral circumflex femoral arteries, which are both usually branches of the deep artery of the thigh (profunda femoris), but there are numerous variations and one or both may also arise directly from the
femoral artery The femoral artery is a large artery in the thigh and the main arterial supply to the thigh and leg. The femoral artery gives off the deep femoral artery or profunda femoris artery and descends along the anteromedial part of the thigh in the fem ...
. There is also a small contribution from the foveal artery, a small vessel in the ligament of the head of the femur which is a branch of the
posterior division of the obturator artery The obturator artery is a branch of the internal iliac artery that passes antero-inferiorly (forwards and downwards) on the lateral wall of the pelvis, to the upper part of the obturator foramen, and, escaping from the pelvic cavity through the ...
, which becomes important to avoid
avascular necrosis Avascular necrosis (AVN), also called osteonecrosis or bone infarction, is death of bone tissue due to interruption of the blood supply. Early on, there may be no symptoms. Gradually joint pain may develop which may limit the ability to move. Co ...
of the head of the femur when the blood supply from the medial and lateral circumflex arteries are disrupted (e.g. through fracture of the neck of the femur along their course). The hip has two anatomically important
anastomoses An anastomosis (, plural anastomoses) is a connection or opening between two things (especially cavities or passages) that are normally diverging or branching, such as between blood vessels, leaf veins, or streams. Such a connection may be normal ...
, the
cruciate Cruciate, and similar words, can mean: *The cruciate ligament Cruciate ligaments (also cruciform ligaments) are pairs of ligaments arranged like a letter X. They occur in several joints of the body, such as the knee joint and the atlanto-axial ...
and the trochanteric anastomoses, the latter of which provides most of the blood to the head of the femur. These anastomoses exist between the femoral artery or profunda femoris and the gluteal vessels.Clemente (2006), p 227


Muscles and movements

The hip muscles act on three mutually perpendicular main axes, all of which pass through the center of the
femoral head The femoral head (femur head or head of the femur) is the highest part of the thigh bone (femur). It is supported by the femoral neck. Structure The head is globular and forms rather more than a hemisphere, is directed upward, medialward, and a l ...
, resulting in three
degrees of freedom Degrees of freedom (often abbreviated df or DOF) refers to the number of independent variables or parameters of a thermodynamic system. In various scientific fields, the word "freedom" is used to describe the limits to which physical movement or ...
and three pair of principal directions:
Flexion Motion, the process of movement, is described using specific anatomical terms. Motion includes movement of organs, joints, limbs, and specific sections of the body. The terminology used describes this motion according to its direction relative ...
and
extension Extension, extend or extended may refer to: Mathematics Logic or set theory * Axiom of extensionality * Extensible cardinal * Extension (model theory) * Extension (predicate logic), the set of tuples of values that satisfy the predicate * E ...
around a transverse axis (left-right);
lateral rotation Motion, the process of movement, is described using specific anatomical terms. Motion includes movement of organs, joints, limbs, and specific sections of the body. The terminology used describes this motion according to its direction relativ ...
and
medial rotation Motion, the process of movement, is described using specific anatomical terms. Motion includes movement of organs, joints, limbs, and specific sections of the body. The terminology used describes this motion according to its direction relativ ...
around a longitudinal axis (along the thigh); and abduction and
adduction Motion, the process of movement, is described using specific anatomical terms. Motion includes movement of organs, joints, limbs, and specific sections of the body. The terminology used describes this motion according to its direction relative ...
around a sagittal axis (forward-backward);''Thieme Atlas of Anatomy'' (2006), p 386 and a combination of these movements (i.e. circumduction, a compound movement in which the leg describes the surface of an irregular cone). Some of the hip muscles also act on either the vertebral joints or the knee joint, that with their extensive areas of origin and/or insertion, different part of individual muscles participate in very different movements, and that the range of movement varies with the position of the hip joint. Additionally, the inferior and Superior gemelli muscles assist the
obturator internus The internal obturator muscle or obturator internus muscle originates on the medial surface of the obturator membrane, the ischium near the membrane, and the rim of the pubis. It exits the pelvic cavity through the lesser sciatic foramen. The i ...
and the three muscles together form the three-headed muscle known as the
triceps coxae The human leg, in the general word sense, is the entire lower limb of the human body, including the foot, thigh or sometimes even the hip or gluteal region. However, the definition in human anatomy refers only to the section of the lower limb ...
. The movements of the hip joint is thus performed by a series of muscles which are here presented in order of importance with the range of motion from the neutral zero-degree position indicated: * Lateral or external rotation (30° with the hip extended, 50° with the hip flexed):
gluteus maximus The gluteus maximus is the main extensor muscle of the hip. It is the largest and outermost of the three gluteal muscles and makes up a large part of the shape and appearance of each side of the hips. It is the single largest muscle in the human ...
;
quadratus femoris The quadratus femoris is a flat, quadrilateral skeletal muscle. Located on the posterior side of the hip joint, it is a strong external rotator and adductor of the thigh, but also acts to stabilize the femoral head in the acetabulum. Quadratus ...
;
obturator internus The internal obturator muscle or obturator internus muscle originates on the medial surface of the obturator membrane, the ischium near the membrane, and the rim of the pubis. It exits the pelvic cavity through the lesser sciatic foramen. The i ...
; dorsal fibers of
gluteus medius The gluteus medius, one of the three gluteal muscles, is a broad, thick, radiating muscle. It is situated on the outer surface of the pelvis. Its posterior third is covered by the gluteus maximus, its anterior two-thirds by the gluteal aponeu ...
and
minimus The Minimus books are a series of school textbooks, written by Barbara Bell, illustrated by Dr. Helen Forte, and published by the Cambridge University Press, designed to help children of primary school age to learn Latin. The books espouse some of ...
;
iliopsoas The iliopsoas muscle (; from lat, ile, lit=groin and grc, ψόᾱ, psóā, muscles of the loins) refers to the joined psoas major and the iliacus muscles. The two muscles are separate in the abdomen, but usually merge in the thigh. They are usua ...
(including
psoas major The psoas major ( or ; from grc, ψόᾱ, psóā, muscles of the loins) is a long fusiform muscle located in the lateral lumbar region between the vertebral column and the brim of the lesser pelvis. It joins the iliacus muscle to form the iliop ...
from the vertebral column);
obturator externus The external obturator muscle, obturator externus muscle (; OE) is a flat, triangular muscle, which covers the outer surface of the anterior wall of the pelvis. It is sometimes considered part of the medial compartment of thigh, and sometimes ...
;
adductor magnus Adductor may refer to: * One of the anatomical terms of motion * Adductor muscle (disambiguation) * Adductor canal The adductor canal, also known as the subsartorial canal or Hunter’s canal, is an aponeurotic tunnel in the middle third of the th ...
,
longus Longus, sometimes Longos ( el, Λόγγος), was the author of an ancient Greek novel or romance, ''Daphnis and Chloe''. Nothing is known of his life; it is assumed that he lived on the isle of Lesbos (setting for ''Daphnis and Chloe'') during ...
, brevis, and
minimus The Minimus books are a series of school textbooks, written by Barbara Bell, illustrated by Dr. Helen Forte, and published by the Cambridge University Press, designed to help children of primary school age to learn Latin. The books espouse some of ...
;
piriformis The piriformis muscle () is a flat, pyramidally-shaped muscle in the buttock, gluteal region of the lower limbs. It is one of the six muscles in the lateral rotator group. The piriformis muscle has its origin upon the front surface of the sacrum, ...
; and sartorius. The
iliofemoral ligament The iliofemoral ligament is a ligament of the hip joint which extends from the ilium to the femur in front of the joint. It is also referred to as the Y-ligament (see below). the ligament of Bigelow, the ligament of Bertin and any combinations ...
inhibits lateral rotation and extension, this is why the hip can rotate laterally to a greater degree when it is flexed. * Medial or internal rotation (40°): anterior fibers of
gluteus medius The gluteus medius, one of the three gluteal muscles, is a broad, thick, radiating muscle. It is situated on the outer surface of the pelvis. Its posterior third is covered by the gluteus maximus, its anterior two-thirds by the gluteal aponeu ...
and
minimus The Minimus books are a series of school textbooks, written by Barbara Bell, illustrated by Dr. Helen Forte, and published by the Cambridge University Press, designed to help children of primary school age to learn Latin. The books espouse some of ...
;
tensor fasciae latae The tensor fasciae latae (or tensor fasciæ latæ or, formerly, tensor vaginae femoris) is a muscle of the thigh. Together with the gluteus maximus, it acts on the iliotibial band and is continuous with the iliotibial tract, which attaches to the ...
; the part of
adductor magnus Adductor may refer to: * One of the anatomical terms of motion * Adductor muscle (disambiguation) * Adductor canal The adductor canal, also known as the subsartorial canal or Hunter’s canal, is an aponeurotic tunnel in the middle third of the th ...
inserted into the
adductor tubercle The adductor tubercle is a tubercle on the lower extremity of the femur. It is formed where the medial lips of the linea aspera end below at the summit of the medial condyle. It is the insertion point of the tendon of the vertical fibers of the ...
; and, with the leg abducted also the pectineus. * Extension or retroversion (20°):
gluteus maximus The gluteus maximus is the main extensor muscle of the hip. It is the largest and outermost of the three gluteal muscles and makes up a large part of the shape and appearance of each side of the hips. It is the single largest muscle in the human ...
(if put out of action, active standing from a sitting position is not possible, but standing and walking on a flat surface is); dorsal fibers of
gluteus medius The gluteus medius, one of the three gluteal muscles, is a broad, thick, radiating muscle. It is situated on the outer surface of the pelvis. Its posterior third is covered by the gluteus maximus, its anterior two-thirds by the gluteal aponeu ...
and
minimus The Minimus books are a series of school textbooks, written by Barbara Bell, illustrated by Dr. Helen Forte, and published by the Cambridge University Press, designed to help children of primary school age to learn Latin. The books espouse some of ...
;
adductor magnus Adductor may refer to: * One of the anatomical terms of motion * Adductor muscle (disambiguation) * Adductor canal The adductor canal, also known as the subsartorial canal or Hunter’s canal, is an aponeurotic tunnel in the middle third of the th ...
; and
piriformis The piriformis muscle () is a flat, pyramidally-shaped muscle in the buttock, gluteal region of the lower limbs. It is one of the six muscles in the lateral rotator group. The piriformis muscle has its origin upon the front surface of the sacrum, ...
. Additionally, the following thigh muscles extend the hip:
semimembranosus The semimembranosus muscle () is the most medial of the three hamstring muscles in the thigh. It is so named because it has a flat tendon of origin. It lies posteromedially in the thigh, deep to the semitendinosus muscle. It extends the hip joint ...
,
semitendinosus The semitendinosus () is a long superficial muscle in the back of the thigh. It is so named because it has a very long tendon of insertion. It lies posteromedially in the thigh, superficial to the semimembranosus. Structure The semitendinosus, r ...
, and long head of
biceps femoris The biceps femoris () is a muscle of the thigh located to the posterior, or back. As its name implies, it has two parts, one of which (the long head) forms part of the hamstrings muscle group. Structure It has two heads of origin: *the ''long h ...
. Maximal extension is inhibited by the
iliofemoral ligament The iliofemoral ligament is a ligament of the hip joint which extends from the ilium to the femur in front of the joint. It is also referred to as the Y-ligament (see below). the ligament of Bigelow, the ligament of Bertin and any combinations ...
. * Flexion or anteversion (140°): the
hip flexor A flexor is a muscle that flexes a joint. In anatomy, flexion (from the Latin verb ''flectere'', to bend) is a joint movement that decreases the angle between the bones that converge at the joint. For example, one’s elbow joint flexes when one ...
s:
iliopsoas The iliopsoas muscle (; from lat, ile, lit=groin and grc, ψόᾱ, psóā, muscles of the loins) refers to the joined psoas major and the iliacus muscles. The two muscles are separate in the abdomen, but usually merge in the thigh. They are usua ...
(with psoas major from vertebral column);
tensor fasciae latae The tensor fasciae latae (or tensor fasciæ latæ or, formerly, tensor vaginae femoris) is a muscle of the thigh. Together with the gluteus maximus, it acts on the iliotibial band and is continuous with the iliotibial tract, which attaches to the ...
, pectineus,
adductor longus In the human body, the adductor longus is a skeletal muscle located in the thigh. One of the adductor muscles of the hip, its main function is to adduct the thigh and it is innervated by the obturator nerve. It forms the medial wall of the fem ...
,
adductor brevis The adductor brevis is a muscle in the thigh situated immediately deep to the pectineus and adductor longus. It belongs to the adductor muscle group. The main function of the adductor brevis is to pull the thigh medially. The adductor brevis ...
, and gracilis. Thigh muscles acting as hip flexors:
rectus femoris The rectus femoris muscle is one of the four quadriceps muscles of the human body. The others are the vastus medialis, the vastus intermedius (deep to the rectus femoris), and the vastus lateralis. All four parts of the quadriceps muscle attach to ...
and sartorius. Maximal flexion is inhibited by the thigh coming in contact with the chest. * Abduction (50° with hip extended, 80° with hip flexed):
gluteus medius The gluteus medius, one of the three gluteal muscles, is a broad, thick, radiating muscle. It is situated on the outer surface of the pelvis. Its posterior third is covered by the gluteus maximus, its anterior two-thirds by the gluteal aponeu ...
;
tensor fasciae latae The tensor fasciae latae (or tensor fasciæ latæ or, formerly, tensor vaginae femoris) is a muscle of the thigh. Together with the gluteus maximus, it acts on the iliotibial band and is continuous with the iliotibial tract, which attaches to the ...
;
gluteus maximus The gluteus maximus is the main extensor muscle of the hip. It is the largest and outermost of the three gluteal muscles and makes up a large part of the shape and appearance of each side of the hips. It is the single largest muscle in the human ...
with its attachment at the
fascia lata The fascia lata is the deep fascia of the thigh. It encloses the thigh muscles and forms the outer limit of the fascial compartments of thigh, which are internally separated by the medial intermuscular septum and the lateral intermuscular septu ...
;
gluteus minimus The gluteus minimus, or glutæus minimus, the smallest of the three gluteal muscles, is situated immediately beneath the gluteus medius. Structure It is fan-shaped, arising from the outer surface of the ilium, between the anterior and infer ...
;
piriformis The piriformis muscle () is a flat, pyramidally-shaped muscle in the buttock, gluteal region of the lower limbs. It is one of the six muscles in the lateral rotator group. The piriformis muscle has its origin upon the front surface of the sacrum, ...
; and
obturator internus The internal obturator muscle or obturator internus muscle originates on the medial surface of the obturator membrane, the ischium near the membrane, and the rim of the pubis. It exits the pelvic cavity through the lesser sciatic foramen. The i ...
. Maximal abduction is inhibited by the neck of the femur coming into contact with the lateral pelvis. When the hips are flexed, this delays the impingement until a greater angle. * Adduction (30° with hip extended, 20° with hip flexed):
adductor magnus Adductor may refer to: * One of the anatomical terms of motion * Adductor muscle (disambiguation) * Adductor canal The adductor canal, also known as the subsartorial canal or Hunter’s canal, is an aponeurotic tunnel in the middle third of the th ...
with adductor minimus;
adductor longus In the human body, the adductor longus is a skeletal muscle located in the thigh. One of the adductor muscles of the hip, its main function is to adduct the thigh and it is innervated by the obturator nerve. It forms the medial wall of the fem ...
,
adductor brevis The adductor brevis is a muscle in the thigh situated immediately deep to the pectineus and adductor longus. It belongs to the adductor muscle group. The main function of the adductor brevis is to pull the thigh medially. The adductor brevis ...
,
gluteus maximus The gluteus maximus is the main extensor muscle of the hip. It is the largest and outermost of the three gluteal muscles and makes up a large part of the shape and appearance of each side of the hips. It is the single largest muscle in the human ...
with its attachment at the
gluteal tuberosity The gluteal tuberosity is the lateral one of the three upward prolongations of the linea aspera of the femur, extending to the base of the greater trochanter. It serves as the principal insertion site for the gluteus maximus muscle. Structure T ...
; gracilis (extends to the tibia); pectineus,
quadratus femoris The quadratus femoris is a flat, quadrilateral skeletal muscle. Located on the posterior side of the hip joint, it is a strong external rotator and adductor of the thigh, but also acts to stabilize the femoral head in the acetabulum. Quadratus ...
; and
obturator externus The external obturator muscle, obturator externus muscle (; OE) is a flat, triangular muscle, which covers the outer surface of the anterior wall of the pelvis. It is sometimes considered part of the medial compartment of thigh, and sometimes ...
. Of the thigh muscles,
semitendinosus The semitendinosus () is a long superficial muscle in the back of the thigh. It is so named because it has a very long tendon of insertion. It lies posteromedially in the thigh, superficial to the semimembranosus. Structure The semitendinosus, r ...
is especially involved in hip adduction. Maximal adduction is impeded by the thighs coming into contact with one another. This can be avoided by abducting the opposite leg, or having the legs alternately flexed/extended at the hip so they travel in different planes and do not intersect.


Clinical significance

A
hip fracture A hip fracture is a break that occurs in the upper part of the femur (thigh bone). Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. Usually the person cannot walk. They most often occur as a res ...
is a
break Break or Breaks or The Break may refer to: Time off from duties * Recess (break), time in which a group of people is temporarily dismissed from its duties * Break (work), time off during a shift/recess ** Coffee break, a short mid-morning res ...
that occurs in the upper part of the femur. Symptoms may include pain around the hip particularly with movement and shortening of the leg. The hip joint can be replaced by a
prosthesis In medicine, a prosthesis (plural: prostheses; from grc, πρόσθεσις, prósthesis, addition, application, attachment), or a prosthetic implant, is an artificial device that replaces a missing body part, which may be lost through trau ...
in a
hip replacement Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis. Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. Such joint replacement o ...
operation due to fractures or illnesses such as
osteoarthritis Osteoarthritis (OA) is a type of degenerative joint disease that results from breakdown of joint cartilage and underlying bone which affects 1 in 7 adults in the United States. It is believed to be the fourth leading cause of disability in the w ...
.
Hip pain Pain in the hip is the experience of pain in the muscles or joints in the hip/ pelvic region, a condition commonly arising from any of a number of factors. Sometimes it is closely associated with lower back pain. Causes Causes of pain around ...
can have multiple sources and can also be associated with
lower back pain Low back pain (LBP) or lumbago is a common disorder involving the muscles, nerves, and bones of the back, in between the lower edge of the ribs and the lower fold of the buttocks. Pain can vary from a dull constant ache to a sudden sharp feeli ...
. At the 2022 Consumer Electronics Show, a company named Safeware announced an airbag belt that is designed to prevent hip fractures among such uses as the elderly and hospital patients. Abnormal orientation of the acetabular socket as seen in
hip dysplasia Hip dysplasia is an abnormality of the hip joint where the socket portion does not fully cover the ball portion, resulting in an increased risk for joint dislocation. Hip dysplasia may occur at birth or develop in early life. Regardless, it doe ...
can lead to hip subluxation (partial dislocation), degeneration of the
acetabular labrum The acetabular labrum (glenoidal labrum of the hip joint or cotyloid ligament in older texts) is a ring of cartilage that surrounds the acetabulum of the hip. The anterior portion is most vulnerable when the labrum tears. It provides an articulat ...
. Excessive coverage of femoral head by the acetabulum can lead to pincer-type femoro-acetabular impingement (FAI).


Sexual dimorphism and cultural significance

In humans, unlike other animals, the hip bones are substantially different in the two sexes. The hips of human females widen during
puberty Puberty is the process of physical changes through which a child's body matures into an adult body capable of sexual reproduction. It is initiated by hormonal signals from the brain to the gonads: the ovaries in a girl, the testes in a boy. ...
. The
femora The femur (; ), or thigh bone, is the proximal bone of the hindlimb in tetrapod vertebrates. The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates with t ...
are also more widely spaced in females, so as to widen the opening in the hip bone and thus facilitate childbirth. Finally, the ilium and its muscle attachment are shaped so as to situate the buttocks away from the birth canal, where contraction of the buttocks could otherwise damage the baby. The female hips have long been associated with both
fertility Fertility is the capability to produce offspring through reproduction following the onset of sexual maturity. The fertility rate is the average number of children born by a female during her lifetime and is quantified demographically. Fertili ...
and general expression of
sexuality Human sexuality is the way people experience and express themselves sexually. This involves biological, psychological, physical, erotic, emotional, social, or spiritual feelings and behaviors. Because it is a broad term, which has varied ...
. Since broad hips facilitate
childbirth Childbirth, also known as labour and delivery, is the ending of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million births globall ...
and also serve as an anatomical cue of sexual maturity, they have been seen as an attractive trait for women for thousands of years. Many of the classical poses women take when sculpted, painted or photographed, such as the ''
Grande Odalisque ''Grande Odalisque'', also known as ''Une Odalisque'' or ''La Grande Odalisque'', is an oil painting of 1814 by Jean-Auguste-Dominique Ingres depicting an odalisque, or concubine. Ingres' contemporaries considered the work to signify Ingres' brea ...
'', serve to emphasize the prominence of their hips. Similarly, women's fashion through the ages has often drawn attention to the girth of the wearer's hips.


Additional images

File:Slide2DAD.JPG, Hip joint. Lateral view. File:Slide2DADA.JPG, Hip joint. Lateral view. File:Slide1BIBI.JPG, Muscles of Thigh. Anterior views. File:Blausen 0488 HipAnatomy.png, Illustration of Hip (Frontal view). File:Iliopectineal line, ilioischial line, tear drop, acetabular fossa, and anterior and posterior wall of the acetabulumi.jpg,
X-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10  picometers to 10  nanometers, corresponding to frequencies in the range 30&nb ...
of the hip, with measurements used in
X-ray of hip dysplasia X-rays of hip dysplasia are one of the two main methods of medical imaging to diagnose hip dysplasia, the other one being medical ultrasonography. Ultrasound imaging yields better results defining the anatomy until the cartilage is ossified. When th ...
in adults.
Attribution 4.0 International (CC BY 4.0)
/ref>


See also

*
Belly dance Belly dance (Egyptian Arabic: رقص بلدي, translated: Dance of the Country/Folk Dance, romanized: Raks/Raas Baladi) is a dance that originates in Egypt. It features movements of the hips and torso. It has evolved to take many different f ...
r *
Body shape Human body shape is a complex phenomenon with sophisticated detail and function. The general shape or figure of a person is defined mainly by the molding of skeletal structures, as well as the distribution of muscles and fat. Skeletal structure ...
*
Bump (dance) The Bump is a form of popular dance introduced in the 1970s File:1970s decade montage.jpg, Clockwise from top left: U.S. President Richard Nixon doing the V for Victory sign after his resignation from office following the Watergate scandal in 1 ...
*
Femoral acetabular impingement Femoroacetabular impingement (FAI) is a condition involving one or more anatomical abnormalities of the hip joint, which is a ball and socket joint. It is a common cause of hip pain and discomfort in young and middle-aged adults. It occurs when th ...
*
Hip dysplasia (human) Hip dysplasia is an abnormality of the hip joint where the socket portion does not fully cover the ball portion, resulting in an increased risk for joint dislocation. Hip dysplasia may occur at birth or develop in early life. Regardless, it doe ...
*
Hip examination In medicine, physiotherapy, chiropractic, and osteopathy the hip examination, or hip exam, is undertaken when a patient has a complaint of hip pain and/or signs and/or symptoms suggestive of hip joint pathology. It is a physical examination mane ...
*
Obstetrical dilemma The obstetrical dilemma is a hypothesis to explain why humans often require assistance from other humans during childbirth to avoid complications, whereas most non-human primates give birth unassisted with relatively little difficulty. This occurs ...
*
Rump (animal) The rump or croup, in the external morphology of an animal, is the portion of the posterior dorsum – that is, posterior to the loins and anterior to the tail. Anatomically, the rump corresponds to the sacrum. The tailhead or dock is the ...
*
Snapping hip syndrome Snapping hip syndrome, also referred to as dancer's hip, is a medical condition characterized by a snapping sensation felt when the hip is flexed and extended. This may be accompanied by a snapping or popping noise and pain or discomfort. Pain oft ...
*
Waist–hip ratio The waist–hip ratio or waist-to-hip ratio (WHR) is the dimensionless ratio of the circumference of the waist to that of the hips. This is calculated as waist measurement divided by hip measurement (). For example, a person with a 30″ () ...


Notes


References

* * * * * * *


External links


Hip Preservation Awareness, information and support for hip impingement, hip dysplasia, and related issues in young adults (12-adult)



High-performance hips

Hip Pain ICD10
{{Authority control Bones of the lower limb *Hip