5 - Hip (2)

Question 1

What is FAI?

Answer 1

Femoral acetabular impingement

Question 2

Describe femoral acetabular impingement (FAI)

Answer 2

Repetitive microtrauma from impingement of the femoral head against the acetabulum

Question 3

What is Pincer type FAI?

Answer 3

Excess acetabular coverage

Subtle joint subluxation

Question 4

What is Cam type FAI?

Answer 4

Aspherical part of the femoral head-neck junction interferes with movement

Question 5

Are most cases of FAI Pincer or Cam?

Answer 5

Trick question - most cases of FAI are BOTH Pincer and Cam

Question 6

Clinical presentation of FAI?

Answer 6

Trauma

Childhood hip disease (including dysplasia)

Slipped capital femoral epiphysis

Insidious onset

Groin pain

Question 7

What is Legg-Calve-Perthes disease?

Answer 7

Avascular necrosis of the femoral head (insufficiency of obturator artery branch)

Question 8

PE findings on FAI?

Answer 8

Persistent hip or groin pain

Decreased internal rotation in flexion

Trendelenburg sign

Question 9

Radiographs of FAI?

Answer 9

Pincer-type - Figure 8 sign (anteriorly)

Cam-type - pistol grip deformity

Question 10

Management of FAI?

Answer 10

Conservative - exercises, PT, NSAIDs - non-impact stuff (elliptical, cycle)

Surgical - femoral reshaping, debridement of labral tears, periacetabular osteotomy

THA for advanced cases

Question 11

Tenderness of the groin and increased pain with passive abduction suggests injury to:

Answer 11

The hip adductors

Question 12

Increased pain when the patient tries to do a sit-up suggests injury to the:

Answer 12

Abdominals

Question 13

Increase pain with flexion of the hip against resistance or with passive extension of the hip suggests injury to the:

Answer 13

Hip flexor

Question 14

Contusion in the quadriceps muscle may progress to:

Answer 14

Myositis ossificans

Can appear like a malignant tumor on radiograph

Question 15

Pelvic avulsion fractures with ANY displacement requires:

Answer 15

Surgical consult

Question 16

Describe the txt regimen for nondisplaced pelvic avulsion fx’s: (athletes)

Answer 16

Week 1 - RICE and NSAIDs
Week 2 - PROM and PWB
Week 3 - Resistance
Week 4-6 - Dynamic Drills
Month(s) 2 - Return to play

Question 17

Mortality for pelvic fx’s:

Answer 17

Open - 50%

Closed - 25%

Question 18

How much blood can accumulate in the setting of a pelvic fx without clinical evidence?

Answer 18

2L

Question 19

How is slipped capital femoral epiphysis described?

Answer 19

Ice cream scoop falls off the cone (based on radiograph appearance)

Chubby kids

Question 20

Pelvic fx’s include fx’s of the:

Answer 20

Pelvic ring
Sacrum
Acetabulum

Question 21

What are the two columns of the pelvis?

Answer 21

Anterior (iliopubic)

Posterior (ilioischial)

Question 22

What are the two walls of the pelvis? (Rim, lip)

Answer 22

Anterior

Posterior

Question 23

Increased alpha angle is associated with:

Answer 23

FAI

Question 24

What muscle for ischial tuberosity?

Answer 24

Hamstrings

Question 25

What muscle for pubic symphysis?

Answer 25

Adductors

Question 26

What muscle for lesser trochanter?

Answer 26

Iliopsoas

Question 27

What muscle for greater trochanter?

Answer 27

Gluteus med-min

Question 28

What muscle for anterior inferior iliac spine?

Answer 28

Rectus femoris

Question 29

What muscle for anterior superior iliac spine?

Answer 29

Sartorius

Question 30

What muscle for iliac crest?

Answer 30

Abdominal muscles

Question 31

Stable pelvis fx’s:

Answer 31

Single pubic ramus Unilateral pubic rami Iliac Transverse sacrum fx

Question 32

MC associated injuries with pelvic fx?

Answer 32

Chest injury Long bone Head

Question 33

Pelvic fx txt?

Answer 33

External stabilization with Stryker Hoffman External Fixator

Question 34

Pelvic fx’s - increased risk for:

Answer 34

Genitourinary injuries Post-traumatic arthritis VTE risk

Question 35

Clinical presentation of femur fx:

Answer 35

Pain in the groin, inability to bear weight Externally rotated, abducted, and shorted Common to younger and older, with a drop in the middle

Question 36

Three common ways to describe femoral shaft fx’s:

Answer 36

Simple Wedge Complex

Question 37

Femur fx’s have a high association with what condition that can cause ARDS?

Answer 37

Fat embolism

Question 38

Tx for femoral fx?

Answer 38

Traction splint emergently

Question 39

Stress fx’s pt population:

Answer 39

MC to young females Recent increase in athletic activity Distance runners

Question 40

Greater than 50% compression fx of the femoral neck:

Answer 40

Surgery

Question 41

Stress fx txt:

Answer 41

No set way to do it - pain is the guide

Question 42

What happened when I forgot which side the sun rises from?

Answer 42

It dawned on me!