Hip + pelvis

Question 1

How do you treat hip osteoarthritis?

Answer 1

Conservative treatment: acetaminophen, NSAIDs, activity modification, cane/walker, ice/heat, gentle ROM, non-weight bearing exercise, correct obesity

Intra-articular steroid injections

If conservative treatment fails, → refer
Require total hip arthroplasty, metal on metal hip resurfacing

Question 2

How do you treat a hip dislocation?

Answer 2

Closed reduction attempted ASAP: Allis maneuver
Rule out fracture/loose bodies before reduction is performed
Post reduction and CT are necessary
Document neurovascular function before + after reduction

Closed reduction fails → open reduction (or if there are bony fragments)

Abduction pillow + dislocation precautions
Weight bearing status depends on acetabular fracture

Crutch assistance w/ WBAT 2-4 weeks, progression to exercises → cane

Question 3

the —- —– is used for a closed reduction in hip dislocation

Answer 3

allis maneuver

Question 4

How do you treat avascular necrosis?

Answer 4

Refer!

Non weight bearing w/ use of crutches may allow regeneration of involved segment
Pulse magnetic electrical fields
Surgical treatment - core decompression

Collapse → surgery

Question 5

tx for hip fracture

Answer 5

Refer to ortho + internist → needs surgery within 48 hours:
Displaced: hemiarthroplasty or total hip arthroplasty
Nondisplaced/impacted: pinning
Intertrochanteric: ORIF or IM nail

Question 6

tx of femoral shaft fracture

Answer 6

Splint + immediate referral
Surgery to perform external fixation, traction, IM nailing

Question 7

greater trochanter bursitis tx

Answer 7

NSAIDs, activity modification, IT band stretching, ice, short term cane, hip abduction strengthening, steroid

Referral to orthopedist when treatment fails

Rarely surgery

Question 8

How do you treat snapping hip?

Answer 8

Avoid provocative maneuvers, stretching, strengthening NSAIDs, steroid

Question 9

How do you treat a hip strain?

Answer 9

RICE + protected weight bearing

Rehab - PROM, heat, e-stim, US, activity modification, home exercise, strength, flexibility

Question 10

tx of thigh strain

Answer 10

RICE - rehab, NSAIDs, prevent long-term complications

Question 11

treatment of pelvic fractures

Answer 11

Based on degree of instability + associated injuries

Low impact → analgesics, rest, gait training w walker ~6 weeks for fracture healing + improved pain, evaluation for osteoporosis

High impact → hemodynamic resuscitation + injury treatment
Pelvic binding w/ sheet, skeletal traction, surgery once stable