Flashcards in Hip Deck (30)
What type of hip dislocation is most common?
Posterior Dislocation, Anterior is from a forced abduction when flexed
T/F: A posterior hip dislocation is a medical emergency.
True. A posterior hip dislocation is a medical emergency needing early reduction to prevent AVN.
Mechanism of Injury for a Posterior Hip Dislocation
Impact forcing the femoral head posteriorly tearing the ligamentum teres and posterior capsule. The posterior acetabulum may be fractured, vascular supply to the femoral head may be disrupted. This may also lead to a sciatic nerve injury.
Patient Presentation with a Posterior Hip Dislocation
Posterior Hip Dislocation will give neurological findings, which might be subtle. A limb in internal rotation with hip flexed and adducted. Evaluate sciatic nerve injury by having patient dorsiflex foot and plantar flex/invert foot.
Treatment for Posterior Hip Dislocation
If no fracture present, immediate reduction. If reduction cannot be obtained, open reduction. Evaluated sciatic nerve function after reduction.
Mechanism of Injury for a Anterior Hip Dislocation
Forceful abduction and external rotation
Patient Presentation with a Anterior Hip Dislocation
Abducted and externally rotated limb with a palpable groin mass. Displaced femoral head can compress femoral vein and produce thrombus. Evaluate femoral nerve function with quadriceps contraction, thigh sensation and knee extension.
Treatment for a Anterior Hip Dislocation
Similar to posterior, if no fracture present- immediate reduction. If reduction cannot be obtained, open reduction. Evaluate femoral nerve function after reduction.
With a Posterior Hip Dislocation we need to be cautious of the ________ nerve where as with a Anterior Hip Dislocation we are concerned about the ________ nerve.
Mechanism of Injury of Trochanteric Bursitis
Can be due to: leg length discrepancy, broad pelvis in females, poor runnng mechanics, or tight tensor fascia.
Cause of Bursitis
Caused by friction from overuse or trauma from a direct blow.
Patient Presentation with Bursitis
Pain with motion, lying on side (affected or non-affected). Localized tenderness and fullness. "Snapping" may develop of condition is chronic. Erythema and Rubor may be present.
Special Test for Trochanteric Bursitis
Can have a positive Ober Test.
Treatment for Bursitis (Trochanteric Bursitis)
Rest/Ice, NSAIDs, Steroid injections. Physical Therapy to restore flexibility, ROM and strength. IT Band strectching.
"Benchwarmers" - pain when seated probably secondary to sciatic nerve irritation.
Due to microtrauma. Symptoms include anterior hip pain and antalgic gait. Symptoms lessen with flexion and external rotation.
Patient Presentation with Trochanteric Bursitis
Adduction and external rotation aggravates the symptoms. Pain with rising, night pain or lying on affected side.
Osteonecrosis of the Femoral Head
Avascular necrosis, necrosis of the femoral head- microfractures.
Cause of Osteonecrosis of the Femoral Head
Several: EtOH, Steroid Use, Sickle Cell and Hx of Chemotherapy
Patient Presentation with Osteonecrosis of the Femoral Head
Dull ache or throbbing pain in groin, laterally in buttocks
Treatment for Osteonecrosis of the Femoral Head
Before the collapse:
No TX- PWB, core decompression, Strut grafting, vascularized strut grafting.
After the collapse:
Pain management, Hemi-arthroplasty, Total Hip Arthroplasty.
Who is more likely to develop Osteonecrosis of the Femoral Head
Males, Usually 30-50 years old.
Progression of Osteonecrosis of the Femoral Head
50-90% bilateral with in 2 years
Radiographic Classifications for Osteonecrosis of the Femoral Head
Stage 0- no x-ray change, + MRI.
Stage 1- Motted densities/osteopenia.
Stage 2- Increased densities in femoral head (CRESENT SIGN), no collapse.
Stage 3- Flattening of femoral head; normal joint space.
Stage 4- Joint space narrowing, acetabular changes or both.
Stage 5- Advanced degenerative changes.
Osteoarthritis of the Hip
Loss of cartilage in the Hip
Presentation of Osteoarthritis of the Hip
Pain in the GROIN (must differentiate from SI joint and greater trochanteric bursitis). Possible loss of motion. Possible limp.
Radiographic signs for Osteoarthritis of the Hip
Loss of joint space (cartilage ht), sclerosis of femoral head, osteophytes, bone cysts (filled with gelatinous material), loss of spherical shape of the femoral head.
Treatment for Osteoarthritis of the Hip
Non-operative: NSAIDs, Maintain ROM, Activity modification, steroid injection, cane.
Operative: Arthroplasty, Osteotomy, Resection of femoral head, hip fusion.
Only femoral side of hip is replaced. Not good if there is acetabular degeneration.