Hip pathology Flashcards
(12 cards)
What is this?
Clinical indications?
This is a cannulated hip screw.
The commonest way of fixing an undisplaced fracture in patients with adequate bone integrity
What are the three common types of hip fracture?
- Intertrochanteric
- Subtrochanteric
- Intracapsular
What makes up the blood supply of the femoral head?
The medial circumflex artery
The lateral circumflex artery
These two arteries join together to run through the capsular retinaculum to supply the femoral head
The ligamentum teres is another vessel that supplies the femoral head.
Most common complication of displaced fractures that are untreated?
Avascular necrosis of the femoral head.
What is the classification of NOF fractures?
The Garden system/classification
1: This is an incomplete fracture of the femoral neck where the head has tilted into a valgus position
2: There is a complete fracture across the femoral neck but it is completely undisplaced
3: Complete fracture which is displaced though there remains come continuity between the fracture ends. This can be seen as the head remains tilted
4: ere is again a complete fracture but there is no continuity between the fracture ends and the femoral head comes back to rest in its neutral position
Management of fractured neck of femur?
“One and two; use a screw. ree and four; Austin Moore”. What this means is that undisplaced fractures should be fixed and displaced fractures should be replaced, usually with a hemiarthroplasty (the Austin Moore is an early design of hemiarthroplasty).
Management of a young patient with a fractured neck of femur vs an older patient?
Patients in their 2nd-5th decade of life should have an intracapsular fracture fixed within 6 hours rather than replaced.
Fit patients between the ages of 40 and 60 would do poorly with a hemiarthroplasty as they still have a high functional demand. These patients should be treated with a total hip replacement which has much better functional outcomes.
What is this?
Clinical indications?
This is a dynamic hip screw.
Indicated in intertrochanteric fractures.
Management of subtrochanteric fractures?
A gamma nail.
Classic clinical presentation of a fractured neck of femur?
A hip fracture will present with a shortened and externally rotated leg.
What is a Hill-Sach’s lesion? Superior aspect of the humeral head (osseous defect) as a result of anterior shoulder instability.
What is a Bankarts lesion? Anterior labral disruption with tearing of the attached periosteum.
Risk factors for psoas abscess – IVDU, IBD, Diverticulitis, vertebral osteomyelitis.
Investigations for psoas abscess – CT abdomen
Management of psoas abscess? Abx, percutaneous drainage
How do you classify growth plate fractures? Salter Harris.
1 (fracture through the physis only) 2 (fracture through the physis and metaphysis) 3(fracture through the physis and epiphysis to include the joint 4 (fracture through the physis, metaphysis and epiphysis) 5 (crush injury involving the physis)
What is a Galleazi fracture? radial shaft fracture associated with dislocation of the distal radioulnar joint. On x-ray, we would expect to see a displaced fracture of the radius and a prominent ulnar head
What is the classic triad of Leriche syndrome?
- Claudication of buttocks and thighs. 2) Atrophy of musculature of the legs. 3) Impotence (paralysis of L1)
What is leriche syndrome? Atherosclerotic occlusive disease involving the abdominal aorta and/or both of the iliac arteries.
What classification is used to assess open fractures? Gustillo Anderson classification.
What are the different categories of Gustillo-Anderson classification? Low energy wound <1cm (1), >1cm wound with moderate soft tissue damage (2), high energy wound >1cm with extensive soft tissue damage (3) adequate tissue coverage (a), inadequate soft tissue coverage (b) associated arterial injury (c)
What scoring system can help to decide the requirement for primary amputation? Mangled extremity scoring system (MESS)
What is the first line analgesia for lower back pain? NSAID’s.
How do you manage suspected scaphoid fractures in the emergency department? Immobilise using futuro splint or standard below elbow backslab before specialist review.
Clinical presentation of a scaphoid fracture?
Pain along the radial aspect of the wrist, at the base of the thumb. Loss of grip/pinch strength. Pain on ulnar deviation of the wrist and tenderness over the anatomical snuffbox.
What investigations should be carried out for a scaphoid fracture?
Plain film radiographs should be requested in the wrist (AP and lateral)
MRI used second line when plain films are inconclusive.
What test is used to confirm a meniscal tear? McMurray’s test. This is where you flex the knee and rotate the joint. If there is a click or grinding and pain is elicited this is a positive test.
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