A 73-year-old woman is brought to the emergency department due to right hip pain. The patient was getting out of the shower when she slipped and fell directly on her right hip. She now has pain and swelling over the lateral aspect of her hip and cannot walk without assistance. Vital signs are within normal limits. Bilateral pedal pulses are normal, and sensation is intact. X-ray of the right hip is shown below. Examination of this patient will most likely show impaired function of which of the following muscles?

Question

A 73-year-old woman is brought to the emergency department due to right hip pain.  The patient was getting out of the shower when she slipped and fell directly on her right hip.  She now has pain and swelling over the lateral aspect of her hip and cannot walk without assistance.  Vital signs are within normal limits.  Bilateral pedal pulses are normal, and sensation is intact.  X-ray of the right hip is shown below.  Examination of this patient will most likely show impaired function of which of the following muscles?

Quizplus · Accepted Answer

11ec160b_35e5_172e_9249_21f860d0d06f_MD0001_00 The pelvic bones and femoral trochanters provide sites of attachment for the large postural and ambulatory muscles of the hip girdle. Fractures involving these attachment sites are commonly caused by high-velocity trauma (eg, motor vehicle collisions, falls from height), but may occur even with ground-level falls (eg, getting out of the shower) in patients with skeletal fragility (eg, postmenopausal osteoporosis). This patient's x-ray shows avulsion of the tip of the greater trochanter of the femur. The greater trochanter serves as the site of insertion for the gluteus medius muscle, which originates from the ilium. The main actions of the gluteus medius are hip abduction and stabilization of the pelvis during ambulation. Damage to the point of insertion on the greater trochanter can result in lateral hip pain with gait instability (ie, positive Trendelenburg sign) and weakness of abduction. (Choice A) The ischiocondylar portion of the adductor magnus originates from the ischial tuberosity and inserts onto the medial condyle of the distal femur. Major functions include hip adduction and extension. (Choice C) The iliopsoas is the union of iliacus and psoas major and inserts onto the lesser trochanter of the femur. It is the primary flexor of the hip. (Choice D) The rectus femoris originates from the anterior inferior iliac spine, joins the other portions of the quadriceps femoris (ie, vastus lateralis, vastus medialis, and vastus intermedius) in a common quadriceps tendon, and attaches to the lower leg via the patella and patellar tendon. Because of its origin on the ilium, the rectus femoris contributes to hip flexion in addition to knee extension. (Choice E) The sartorius originates from the anterior superior iliac spine and crosses the anterior thigh to insert with the pes anserinus (common tendon for the sartorius, gracilis, and semitendinosous muscles) onto the superomedial surface of the tibia. It aids in hip flexion, abduction, and external rotation. Educational objective: The greater trochanter of the femur serves as the site of insertion for the gluteus medius muscle, which is responsible for hip abduction and stabilization of the pelvis during ambulation. Fractures of the greater trochanter (eg, fragility fracture from a fall) can disrupt the integrity of the gluteus medius tendon and result in lateral hip pain with gait instability and weakness of hip abduction. __________ References: Does isolated greater trochanter implication affect hip abducent strength and functions in intertrochanteric fracture? (http://www.ncbi.nlm.nih.gov/pubmed/30764807)

A 73-Year-Old Woman Is Brought to the Emergency Department Due