The Hip

Question 1

What is the MC dislocation of the hip?

Answer 1

Posterior Hip dislocation

Question 2

What are some MOI for a posterior hip dislocation?

Answer 2

Head of femur driven posteriorly (“dashboard injury”)

Posterior displacement of femoral head from acetabulum

Question 3

How does a Posterior hip dislocation present?

Answer 3

Lower extremity in “scissors” position

Hip internally rotated, adducted and flexed
Knee flexed
Shortened extremity

Question 4

What is the MOI or cause of a Anterior hip dislocation?

Answer 4

Abduction and external rotation of the femur

Anterior displacement of femoral head from acetabulum

Question 5

How does an Anterior hip dislocation present?

Answer 5

Lower extremity in “helpless eversion”

Hip externally rotated and abducted
Flattened lateral hip
Prominence of femoral head in groin

Question 6

What are complications that can occur with a Hip Dislocation?

Answer 6

Acetabular fractures
Sciatic nerve injury
Rupture of ligamentum teres artery → avascular necrosis of femoral head

Question 7

What is a pathological cause of a Hip fracture?

Answer 7

Pathologic → metastatic and primary bone lesions

Question 8

What is the presentation of someone with a Hip Fracture?

Answer 8

Pain radiates to groin and inner thigh

Difficulty with flexion and internal rotation

Will hold leg in external rotation and abduction

Leg may appear shorter

Question 9

What imagine must be done for a hip fracture?

What can give a more detailed reading?

Answer 9

X-ray –> 1st line

CT for detailed evaluation

Question 10

How are hip fractures repaired?

Answer 10

Open Reduction Internal Fixation (ORIF)

Arthroplasty

Question 11

What is Avascular Necrosis of the HIP?

Answer 11

Loss of blood supply leads to destruction of the femoral head

Question 12

What are risk factors for this?

Answer 12

H/o trauma
long term corticosteroid use
EtOH abuse
radiation therapy
RA & SLE

Question 13

How does an Adults with avascular necrosis present?

Answer 13

Groin pain is initial complaint

Pain with weight bearing / limp

Question 14

How do children with avascular necrosis present?

Answer 14

Painless limp is initial presentation
Groin, thigh or knee pain may follow

BOTH loose ROM

• internal rotation
• abduction

Question 15

Based on x-ray differentiate the different Ficat stages for Avascular Necrosis

Answer 15

I – Normal

II – Sclerotic or cystic lesions, without subchondral
collapse

III – Subchondral collapse demonstrated by Crescent sign

IV – Osteoarthrosis with decreased articular cartilage and osteophyte formation

Question 16

What is the MC finding on x-ray with avascular necrosis?

Answer 16

Crescent sign is often the earliest finding

Question 17

What is the diagnostic image study used in avascular necrosis of the hip?

Answer 17

MRI

Question 18

Treatment of avascular necrosis of the hip in Adults

Answer 18

Core decompression w/ bone graft

Total hip replacement if advanced disease or failure with graft

Question 19

Treatment of avascular necrosis of the hip in children

Answer 19

Period of bed rest followed by progressive weight bearing

Question 20

What is Femoroacetabular impingement?

Answer 20

Hip impingement between a femoral head/neck bump (CAM lesion) and acetabular over coverage/retro-version (Pincer lesion)

Question 21

Presentation of Femoroacetabular impingement?

Answer 21

Pain at the groin

May experience clicking, catching and locking

Question 22

How is characterized in someone with femoroacetabular impingement?

Answer 22

Pain is dull ache at rest/post activity

Sharp stabbing pain with turning, twisting and squatting

Question 23

What test can be used to assess for femoroacetabular impingement? How is it performed?

Answer 23

Impingement test

Leg is flexed, adducted and internally rotated
Pain is a positive for impingement

Question 24

Non surgical treatment for femoroacetabular impingement?

Answer 24

Activity modification
NSAIDS
PT

Question 25

What is the presentation of someone with Trochanteric bursitis?

Answer 25

Pain and tenderness over greater trochanter

Pain worse when first rising from seated position, better after a couple steps and recurs after walking for half and hour

Inability to lay on affected side at night

Question 26

Treatment options for trochanteric bursitis?

Answer 26

NSAIDS
Activity restrictions
Stretching IT band and gluteal muscles