- See: Anterior Capsulotomy:
- Discussion:
- fibrous capsule encloses
hip joint & greater part of neck of femur;
- it encloses the femoral head and most of its neck;
- capsule is attached anteriorly at the intertrochanteric line;
- posteriorly the lateral half of the femoral neck is extracapsular;
- reinforcing the capsular ligament are three ligaments:
- triangular iliofemoral ligament:
- anterior ligament which is attached above to ASIS & adjacent acetabular rim, and below to intertrochanteric line;
- pubofemoral ligament:
- attached to pubic portion of acetabular rim & superior ramus of pubis, & to inferior surface of neck
of the femur;
- this ligament lies in the front of the hip joint;
- ischiofemoral ligament:
- attached to ischial wall of acetabulum & to neck of femur medial to base of greater trochanter;
- this ligament lies above and behind the joint.
- orientation of fibers of capsule & of three ligaments is such that they "wind up tightly" when femur is fully extended;
- Hip Capsule in Femoral Neck Frx:
- displaced femoral neck frx may disrupt posterior part of hip capsule, however, capsule may remain intact w/ minimally displaced fractures;
- intracapsular hematoma may elevate pressure enough to occlude venous drainage system within capsule;
- this increased intracapsular pressure may have an adverse effect on the final clinical outcome, thru occlussion of local arterioles;
- extension & internal rotation of hip elevate intracapsular pressure because of effect on volume of capsule, and therefore,
this position should be avoided in pts w/
femoral neck frx;
-
anterior capsulotomy:
- may reduce danger of ischemia of femoral head;
- performed under direct vision, in line w/ femoral neck on anterior surface;
which also allows an anatomical
reduction under direct vision;
Intracapsular pressure and caput circulation in nondisplaced femoral neck fractures.
Intracapsular pressure and hemarthrosis following femoral neck fracture.
Drake, J. K., and Meyers, M. H.: Clin. Orthop., 182: 172-176, 1984.
Intracapsular pressures in undisplaced fractures of the femoral neck.
Stromqvist, B.; Nilsson, L. T.; Egund, N.; Thorngren, K.-G.; and Wingstrand, H.:
J. Bone and Joint Surg., 70-B(2): 192-194, 1988.
Capsular distension and intracapsular
pressure in subcapital fractures of the femur.
Crawfurd, E. J. P.; Emery, R. J. H.; Hansell, D. M.; Phelan,
M.; and Andrews, B. G.:
J. Bone and Joint Surg., 70-B(2): 195-198, 1988.
Magnetic resonance imaging of the femoral head after acute intracapsular fracture of the femoral neck.
Speer-K-P. Spritzer-C-E. Harrelson-J-M. Nunley-J-A.
Tetracycline labeling of the femoral head following acute intracapsular fracture of the femoral neck.
Speer-K-P. Quarles-L-D. Harrelson-J-M. Nunley-J-A.
The mechanical properties of the human hip capsule ligaments.
