Hip Trauma

Question 1

Proximal femoral fractures are very common.
___% die within a year of fracture.
___% of survivors are unable to live independently due to lack of movement.

Answer 1

12-20% die within a year
50% of survivors are unable to live independently

Question 2

How might a young patient obtain a proximal femoral fracture vs a geriatric patient?

Answer 2

Young: severe acute fracture or stress/fatigue fracture
Geriatric: most commonly minimal trauma in patient with osteoporosis

pathologic fracture also possible with Paget, tumors, etc.

Question 3

What is the biggest concern when preventing proximal femoral fractures in geriatric patients?

Answer 3

Fall risk

Question 3

prevalence

What is the sex distribution for all proximal femoral fractures?
For intracapsular fractures?

Answer 3

All proximal femoral fractures: 2:1 female
Intracapsular fractures: 5:1 female

Question 4

What are the three intracapsular proximal hip fracture diagnoses?

Answer 4

• Subcapital
• Midcervical
• Basicervical

Question 5

What are the three extracapsular proximal hip fracture diagnoses?

Answer 5

• Trochanteric
• Intertrochanteric
• Subtrochanteric

Question 6

Intracapsular types of proximal femoral fracture have higher incidence of ___ and ___ complications.

Answer 6

avascular necrosis and nonunion

Question 7

What is the most common site of proximal femoral fracture?

Answer 7

Subcapital

head-neck junction

intracapsular

Question 8

Subcapital fracture of the proximal femur can be difficult to see.
What radiographic findings help locate this fracture?

Answer 8

• Disruption of cortex
• Zone of impaction

Question 9

Subcaptial fracture of the proximal femur leads to avascular necrosis from disruption of the ___ arteries.

Answer 9

lateral and/or medial femoral circumflex arteries

Question 10

Radiographic changes due to proximal femoral avascular necrosis can take up to 1 year after injury to appear.
What are these changes?

Answer 10

• Sclerosis
• Flattening
• Fragmentation

Question 11

When looking for proximal femoral AVN after fracture, which imaging modality is preferred?

Answer 11

MRI is most sensitive

x-ray can take up to 1 year after injury to show
bone scan misses 20% of acute fractures after 24 hrs, and 5-10% after 72 hrs

Question 12

How does surgical management differ between intracapsular and extracapsular proximal femoral fractures?

Answer 12

Intracapsular: total hip arthroplasty (replacement)
Extracapsular: dynamic hip resection with hip compression screws and intramedullary rods

extracapsular fracture is too low for replacement

Question 13

If the extracapsular proximal femoral fracture occurs at the ___ trochanter, it is often pathologic.

Answer 13

lesser

trochanteric fracture

Question 14

What is the prevalence of AVN and nonunion for extracapsular proximal femoral fractures?

Answer 14

Uncommon

Question 15

Slipped capital femoral epiphysis (SCFE) often refers pain to the ___.

Answer 15

thigh and knee

always check joints above and below the pain

Question 16

What is the most common hip disorder of adolescence?

Answer 16

SCFE

Question 17

What age range is most affected by SCFE?

Answer 17

Age 10-15

adolescent growth spurt

Question 18

Which pathological gait may present in an adolescent with SCFE?

Answer 18

Positive Trendelenberg

due to gluteus medius weakness

Question 19

Which muscle presents as weak with SCFE?

Answer 19

Gluteus medius

positive Trendelenberg

Question 20

Which ranges of motion are most limited with SCFE?

Answer 20

Abduction and internal rotation of the hip

Question 21

SCFE is a specific name for a ___ fracture at the proximal femur.

Answer 21

Type 1 Salter-Harris

Question 22

How is the femur displaced with SCFE?

Answer 22

• Head remains in acetabulum
• Posteromedial slippage of the head on the femoral neck

Question 23

x-ray

What is the minimal diagnostic series for a hip?

Answer 23

• AP with 15 degrees internal rotation of hip
• Frogleg with leg up on step/stool

Question 24

Which radiographic view is most sensitive for SCFE?

Answer 24

Frogleg

Question 25

Best seen on frogleg view, SCFE will present an abnormal ___ line.

Answer 25

Klein

Question 26

# imaging findings SCFE may display a ___ appearance to the femoral head and/or a ___ appearance to the femoral neck.

Answer 26

**parrot beak** appearance to the head **pistol grip** appearance to the neck

Question 27

# imaging findings If SCFE is present, radiographs may display ___ epiphyseal height, ___ growth plate, and a metaphysis ___ to acetabulum.

Answer 27

**decreased** epiphyseal height **wide irregular** growth plate metaphysis **lateral** to acetabulum

Question 28

What are the possible unfavorable outcomes of SCFE?

Answer 28

* Degenerative joint disease (most common) * Coxa vera deformity (<120 degrees) * Short, broad femoral neck * AVN

Question 29

What is the most common cause of hip dislocation?

Answer 29

Severe trauma, most commonly due to MVA | hips are hard to dislocate

Question 30

___% of hip dislocation is in the posterior direction while ___% is anterior.

Answer 30

85% posterior 15% anterior

Question 31

If there is posterior hip dislocation with posterior acetabular fracture, there was likely a blow to the ___ while the hip was ___.

Answer 31

blow to the **knee** while the hip was **flexed and abducted**

Question 32

If there is posterior hip dislocation without acetabular fracture, there was likely a blow to the ___ while the hip was ___.

Answer 32

blow to the **knee** while the hip was **flexed and adducted**

Question 33

If a patient has sustained a blow to the knee with their hip flexed and abducted, what hip injury is of concern?

Answer 33

Posterior hip dislocation with posterior acetabular fracture

Question 34

If a patient has sustained a blow to the knee with their hip flexed and adducted, what hip injury is of concern?

Answer 34

Posterior hip dislocation | without acetabular fracture

Question 35

Posterior hip dislocation includes a femoral head fracture in ___% of cases.

Answer 35

13%

Question 36

If the hip has dislocated posteriorly, the femoral head will lie ___.

Answer 36

above the acetabulum | shifts superiorly

Question 37

If the hip has dislocated anteriorly, the femoral head will lie ___.

Answer 37

near the obturator | shifts inferiorly

Question 38

What position was the hip in at the time of trauma if it has dislocated anteriorly?

Answer 38

Abduction and external rotation of femur

Question 39

Which nerve is of most concern with posterior hip dislocation?

Answer 39

Sciatic nerve

Question 40

Which nerve is of most concern with anterior hip dislocation?

Answer 40

Femoral nerve