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MBBS Orthopedics > Hip > Flashcards

Hip Flashcards

1
Q

Types of NOF #

A

intracapsular - subcapital, transcervical

extracapsular- basal

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2
Q

RF of fragility #

A

Non modifiable:

  • old age
  • female
  • early menopause
  • nulliparity
  • family/ personal hx of #

Modifiable:

  1. increased risk of falls
    - poor vision, vestibular dysfx
    - LL weakness
    - co-morbid (CCF, CVA)
    - home hazards
  2. reduction of bone strength
    - osteoporosis
    - steroids, alcohol, smoking
    - immobility
    - pathological bone conditions
    - chronic liver/ renal failure
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3
Q

What is FRAX

A

WHO Fracture risk assessment tool: Gives 10-year probability of hip # and 10yr probability of a major osteoporotic #

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4
Q

Indications for THR

A

OA hips
pathological #
Acetabular involvement
revision of hip implant

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5
Q

Describe the garden classification

A

1 and 2 non displaced

1: incomplete #, incl valgus impacted #
2: complete

3 and 4 displaced and complete

3: incompletely displaced
4: completely displaced

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6
Q

Mgx of NOF#

A

children/ young
- undisplaced: hip spica
- displaced: preserve head! (60yo cut off)
> M&R
> secure int fixation: 3 cancellous screws/ dynamic compression screw

Old

  • undisplaced:
    65yo: cancellous screw
    90yo: hemiarthroplasty (uni/bipolar)
  • displaced: no need preserve head
  • hemiarthroplasty
  • THR (for active adults)
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7
Q

Cx of NOF #

A
  • Bedbound cx: thromboembolism, pneumonia, sores, UTI
  • AVN femoral head
  • non union (cause: poor blood supply, imperfect reduction, poor fixation, poor healing)
  • secondary OA
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8
Q

Mgx of non union

A

<50yo: bone graft across # + reinsert fixation device

>50yo: hemiarthroplasty/ THR

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9
Q

Blood supply of femoral neck

A

a) Nutrient artery of femur (from profunda femoris)
b) Retinacular arteries in capsule (from medial and lateral circumflex arteries from profunda femoris)
c) 10% by ligamentum teres vessels (from obturator)

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10
Q

Classification of intertrochanteric #

A

Evans-jensen classification

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11
Q

Mgx of

  • intertrochanteric #
  • subtrochanteric #
A

similar

M&R under x ray
internal fixation with DHS (for IT#), or cephalomedullary nail (PFNA) for IT and subT#

post op weight bearing with crutches

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12
Q

Types of hemiarthroplasty

A

Unipolar

  • Thompson: no holes, need cement. Has neck
  • Moore: has 2 holes, no need cement. No neck.

Bipolar

  • more sizes than unipolar
  • less friction
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13
Q

Trendelenburg test

  • when is it positive
  • causes of positive test
A 
- SSS: Sound side sags
Etiology
abductor weakness
- fulcrum problems: hip OA, AVN
- lever arm problems: NOF #, coxa vara
- effort: weak abductors
- nerve problems: superior gluteal n or L5
- myositis, poliomyelitis
- others: perthes disease, DDH, SCFE
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14
Q

what is the landmark of the hip joint

A

2cm below and lateral to midpoint of inguinal ligament

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15
Q

Measuring

  • relative limb length
  • true length
A

most comfortable positive with legs parallel. from xiphisternum to medial malleolus on each side

Square the pelvis (both LL are right angles to line joining 2 ASIS)
- ASIS to medial malleolus

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16
Q

Explain the galeazzi test

A

done when there is a true length discrepancy
(ensure both malleoli touching)

when knee of affected limb is proximal = femoral shortening
knee is distal = tibial shortening

17
Q

6 lines to look for in pelvic x ray looking for acetabular #

A
  • iliopectineal line
  • ilioischial line
  • acetabular tear drop
  • dome
  • anterior wall of acetabulum
  • posterior wall of acetabulum
18
Q

causes of positive galleazi test

A

previous femur #
AVN head of femur
perches, DDH, SCFE
previous polio

19
Q

What is the mgx of perthes

A

Abduction splint,

Realignment osteotomy

20
Q

What is the mgx of SCFE

A

surgical fixation

21
Q

Approach to hip pain

A

Referred pain: disc dz, hip pain to knee

Joint: infection, OA, RA, perthes, SCFE, AVN

Periarticular: Hernia, tendinitis, bursitis, synovitis

mimics: SI pathology, spine, gluteal muscle, iliotibial pathology, non ortho (hernia, LN, PID)

22
Q

Most sensitive hip test for quick screening

A

Internal rotation

23
Q

What is Bryant’s triangle

A

when pt is supine

  • detect disturbance of normal anatomy of the femoral head and neck
  • right angled triangle with lines between asis and greater trochanter
  • to determine if shortening if above or below the greater trochanter
24
Q

what is the normal neck/shaft angle of the hip

  • coxa varus
  • coxa valgum
A

normal: 120-135deg
<120 coxa varus
>135 coxa valgum

25
Q

causes of foot drop

- bilateral causes

A
  1. cortical foot drop: stroke, SOL
  2. L5: PID, lumbar spondylosis
  3. sciatic nerve: pelvic/hip#, hip posterior dislocation
  4. common perineal nerve
    - ext pressure (casts)
    - trauma (tibia/fibular #)
    - masses (ganglion, popliteal cysts, tumor
    - DM, leprosy

bilateral:

  • peripheral neuropathy
  • b/l L5
  • cauda equina syndrome
  • spastic paraplegia
26
Q

Causes of hip pain

A 
Vascular: perthes, AVN
Infection: OM, septic arthritis, TB, transient synovitis
Trauma: OA, dislocation, fracture
Autoimmune: RA
Congenital: SCFE, DDH
27
Q

RF for AVN

A

Vascular: hemoglobinopathies (sickle cell anemia)
Infective: septic arthritis
Trauma: post fracture, dislocation (e.g. NOF#)
Autoimmune: RA, SLE
Metabolic: alcohol intake, obesity, smoking, caisson (deep sea diving), gaucher (AR dz of glucocerebroside metabolism), cushing, anti phospholipid syndrome)
Iatrogenic: steroid
Neoplastic infiltration
Congenital: Perthes, SCFE, clotting disorder
Idiopathic
Others: acetabular dysplasia, pagets, coxa vera

28
Q

What are the stages of AVN

A

Ficat Arlet Staging

0: preclinical: no signs no pain, hip at risk
1: pre-radiographic: bone death with no structural change (pain)
2: pre-collapse: repair and early structural failure (pain + stiffness)
3: collapse: femoral head distorted (pain + stiff + limping)
4: osteoarthritis (v pain + stiff + limp)

29
Q

What is the management of AVN by stage

A

1-2: Conservative vs surgical

  • conservative (for early or surgically unfit): bed rest, weight relief (crutches), splintage, NSAIDs analgesia, bisphosphonates to slow resorption, physio, control RF
  • sx: core decompression KIV bone grafting (from fibular)

3: Surgery
- femoral head resurfacing
- hemiarthroplasty
- sugioka transtrochanteric rotational osteotomy
- realignment osteotomy (redistribution of weight bearing)

  1. Tx as per OA
    - resurfacing arthroplasty
    - THR (relieves pain due to removal of capsule fibrosis)
30
Q

Imaging Expected for AVN by Stage

A

Stage 1: preradiographic

  • X ray: normal
  • MRI: T1 shows decreased signal within femoral head (edema) - single low density line
  • bone scan: increased uptake

Stage 2: pre-collapse

  • X ray: subarticular segment increased bone density due to increased sclerosis/ cyst formation. normal contour, some ostoepaenia
  • MRI: T2 shows double rim sign (hypointense line - granulation, hyperintense line - sclerosis)
  • bone scan: increased uptake

Stage 3: collapse

  • X ray: contour step off, crescent sign (subchondral lucency - collapse), acetabulum intact
  • MRI: cescent sign, cortical collapse

Stage 4: OA

  • X ray: LOSS, shortening of limb, collapse and flattening of head, loss of sphericity, superior subluxation of femoral head
  • MRI: degen changes

MBBS Orthopedics (13 decks)

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