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Flashcards in Hip Deck (22):
1

Describe positive trendelenberg sign

Fall on side with leg raised due to contralateral superior gluteal nerve damage/adductor weakness

2

What movements cause femoroacetabular impingement

Flexion
Adduction
Internal rotation

3

4 X-ray features of OA

Loss of joint space
Osteophytes
Subchondral cyst
Sclerosis

4

Describe positive result for Thomas test

Hand under patients lumbar spine
Ask patient to keep one leg flat while bringing other knee to chest (straightens lumbar lordosis)
Positive if can't keep leg flat on table

5

What does positive Thomas test mean

Fixed flexion deformity I.e inability to extend at hip (iliopsoas contracture)

6

Describe events following AVN

Hip works normally for a few days but over time there is no bone turnover so hip deteriorates
Microfractures of hip
Cartilage unaffected as gets nutrition from synovial fluid

7

Causes of AVN

Trauma
Alcohol
Steroids
Immunosuppression
Liver disease
Idiopathic

8

Describe perthes disease

AVN before growth plate fusion
Necrosis of epiphysis makes it softer so femoral head flattens

9

Management of perthes disease

Stop weight bearing to reestablish blood flow

10

Pathophysiology of septic arthritis

Infection of a joint
Pus in the synovial fluid so no nutrition to cartilage
Cartilage becomes necrotic and lose function of joint completely, needs replacement

11

Symptoms of septic arthritis

Severe pain
Can't weight bear
ROM significantly reduced
Patient won't let you examine them
Temperature over joint
Tense effusion

12

Investigations for septic arthritis

Bedside: baseline obs to screen for sepsis
Bloods: emergency cultures, FBC, CRP, U+E, LFT
Imaging: US
Special tests: joint aspiration + MCS

13

Treatment for septic arthritis

Orthopaedic review
Urgent arthrocentesis, washout and debridement
ABx (after blood cultures) for 2 weeks IV and then switch to oral for 2-4 further weeks if improving

14

Risk factors for septic arthritis

Preexisting joint pathology (RA!)
Diabetes
Immunosuppression
IVDU
CKD
Prosthetic joint
Recent joint surgery

15

Common causative organisms of septic arthritis

Staph aureus
Strep
Staph epidermidis
Neisseria gonococcus
Gram negative bacilli

16

Describe congenital hip dislocation

Bilateral posterior hip dislocation
Trendelenberg gait positive due to weak adductors
Needs intervention to make femoral head grow into acetabulum e.g pavlik harness
Early arthritis

17

Describe a SUFE

Slipped upper femoral epiphysis
Femoral head slips off epiphysis, needs pinning in place
Often occurs bilaterally so during surgery can pin other leg prophylactically

18

Describe X-ray appearance of metastatic bone cancer

Irregular lytic area
No sclerotic edge
Fractures likely

19

Management of metastatic bone cancer

Bridge lesion with nail to reduce chance of fracture
Radiotherapy if no risk of fracture

20

Describe X-ray appearance of osteosarcoma

Sclerotic lesion
New bone formation outside of bone
Common in end of femur

21

Describe lipohaemarthrosis

Follows a fracture
Bone marrow fat and blood inside joint
Fat floats on top of blood so in a supine X-ray, there is a hyperdense flat line in joint

22

Describe osteochondritis dissecans

Affects teenage to middle aged
A small segment of bone begins to separate from its surrounding region due to a lack of blood supply
Bone and the surrounding cartilage begin to crack and loosen
Can heal by itself or can detach and float inside joint