lower extremity injuries Flashcards
(89 cards)
who do hip fx usually occur in?
- elderly female with osteoporosis
- generally fx happens first then they fall
clinical presentation for femoral head fx
- hip/groin pain s/p fall
- non-ambulatory or need assistance
- internal or external rotation of leg on affected side
- TTP over fx area
- pain with AROM and PROM
- pain with IR very sensitive for fx*
imaging to order for hip fx
- AP pelvis, frog lateral
- if suspect fx but it is not visible on x-ray then order MRI
treatment for femoral head fx
- almost always surgical
- cannulated screws
- hemiarthroplasty
garden classification
- for femoral neck fx
- predicts dev of AVN
- stages I- IV
garden stage I
- nondisplaced incomplete fx
- possible greenstick fx
- valgus impaction fx
- stable fx
- can be treated with internal fixation
garden stage II
- nondisplaced complete fx
- stable fx
- can be treated with internal fixation
garden stage III
- complete fx, incompletely displaced
- femoral head tilts into varus position
- unstable
- requires arthroplasty
garden stage IV
- complete fx completely displaced
- unstable
- requires arthroplasty
intertrochanteric fx
- hip fx that happens between greater and lesser troch
- extracapsular
- fx through cancellous bone with good blood supply so heals well
treatment for intertrochanteric fx
- IM nailing
- DHS compression screw
subtrochanteric hip fx
- fx below greater and lesser troch
- requires IM nailing
which hip fx get a hemiarthroplasty
- displaced femoral neck
- supcapital hip fx
which hip fx get cannulated screws
- nondisplaced femoral neck fx
which hip fx get nailing/ compression screws
- intertrochanteric fx
- subtrochanteric fx
prognosis of hip fx
- 25% of pts do not survive past 1 year
- of those who do survive, often return one level below baseline ambulatory/ ADL status
greater trochanteric bursitis
- usually women, more common in 40s and 50s
- triggered by minor direct trauma over greater troch
- pain in lateral hip
clinical presentation of greater troch bursitis
- aching, intense lateral hip pain
- worsened with direct pressure
- pain radiates down lateral thigh
- painful ambulation
- TTP over greater troch
- pain with resisted hip abduction and passive hip rotation
treatment for greater troch bursitis
- ice
- NSAIDs
- PT
- steroid injection
- surgery rare
femoral acetabular impingement
- femoral neck abnorm shaped during childhood growth
- active people may experience pain sooner
- cam bone spur vs. pincer bone spur
cam bone spur
- abnormal femoral head/ neck junction
- increased radius at waist
- impingement occurs during flexion, adduction, IR
pincer bone spur
- excessive acetabular coverage
- linear contact between labrum and femoral head/ neck junction
clinical presentation of femoral acetabular impingement
- pain in groin, may radiate to lateral hip
- dull ache which waxes/ wanes with activity and rest
- improves withPT but sx will return
- sharp stabbing pain with turning, twisting, squatting
diagnosis of femoral acetabular impingement
- impingement test- hip flexion to 90, adduct to 20 degrees the IR, will prod pain
- x-ray for bone morphology
- MRI for labrum and articular cartilage assessment