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Foundations III-Musculoskeletal/Rheum > The Hip > Flashcards

Flashcards in The Hip Deck (35)
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1

MOA of hip dislocation?

Trauma directed at axis of femur

-Axial load with flexed knee
-MVA

> 90% posterior
< 10% anterior

2

MOA of posterior hip dislocation?

Forced exerted at the knee, through the femoral shaft (hip and knee flexed to 90˚)

Head of femur driven posteriorly (“dashboard injury”)

Posterior displacement of femoral head from acetabulum

3

Presentation of posterior hip dislocation?

LE in “scissors” position:
Hip internally rotated, adducted and flexed
Knee flexed

Shortened extremity

Prominence of greater trochanter and femoral head under gluteal muscles

4

MOA of anterior hip dislocation?

Abduction and external rotation of the femur

Anterior displacement of femoral head from acetabulum

5

Presentation of hip dislocation?

LE in “helpless eversion”
Hip externally rotated and abducted

Flattened lateral hip

Prominence of femoral head in groin

6

Complications of hip dislocations?

Acetabular fractures

Sciatic nerve injury

Rupture of ligamentum teres artery → avascular necrosis of femoral head

7

MOA of hip fx?

Fall → elderly w/ osteoporosis

Stress → long distance runners

Pathologic → metastatic and primary bone lesions

8

Clinical presentation for hip fx?

Pain radiates to groin and inner thigh

Difficulty with flexion and internal rotation

Will hold leg in external rotation and abduction

Leg may appear shorter

9

Imaging for hip fx?

X-rays first line

CT for detailed evaluation

10

Which type of hip fracture has higher incidence of non union and necrosis of the femoral head? why?

sub-capital (intra capsular)

disrupts blood supply to femoral head

11

surg tx options for hip fx?

ORIF v. arthoplasty

12

What is avascular necrosis of the hip?

Loss of blood supply leads to destruction of the femoral head

13

Describe avascular necrosis of the hip in adults

30 – 50 y/o range

Unilateral or bilateral

RF: h/o trauma, long term corticosteroid use, EtOH abuse, radiation therapy, RA & SLE

14

Describe avascular necrosis of the hip in kids

“Legg Calve Perthes disease”

2 – 11 y/o range (peak 4-10)

M:F of 4:1

Unilateral

Idiopathic

15

Presentation of avascular necrosis in adults?

MC insidious onset

Groin pain is initial complaint

Pain with weight bearing / limp

ROM loss: internal rotation and abduction

16

Presentation of avascular necrosis in peds?

Painless limp is initial presentation

Groin, thigh or knee pain may follow

ROM loss (both adult and peds)
Internal rotation and abduction

17

Staging for avascular necrosis

Ficat stages -based upon x-rays:

I – Normal

II – Sclerotic or cystic lesions, without subchondral collapse

III – Subchondral collapse demonstrated by Crescent sign

IV – Osteoarthrosis with decreased articular cartilage and osteophyte formation

18

What is usually the earliest xray finding of avascular necrosis? Wjay is the diagnostic study of choice?

crescent sign

stage III

MRI- detects early changes

19

Tx for avascular necrosis in adults?

Core decompression w/ bone graft

Total hip replacement if advanced disease or failure with graft

20

Tx for avascular necrosis in children?

Period of bed rest followed by progressive weight bearing

21

What is a Femoroacetabular Impingement?

Hip impingement between a femoral head/neck bump (CAM lesion) and acetabular over coverage/retro-version (Pincer lesion)

can be Cam, Pincer or both

22

Femoroacetabular Impingement may lead to...

hip labral tears

chondral injury

early onset osteoarthritis

23

Etiology of femoroacetabular impingement?

Generally caused by the development of the hip and acetabulum during childhood

Incidence of 10-15%

24

Which pts with Femoroacetabular Impingement are at risk for developing pathological changes and sxs earlier?

Athletes / active individuals

due to high demand on hips

25

presentation of femoroacetabular impingement?

Pain is typically localized to the groin

Dull ache at rest / post activity

Sharp stabbing pain may occur with turning, twisting, and squatting

+/- clicking, catching and rarely locking

26

What test can you use to eval for femoroacetabular impingement?

Impingement test:
Flexion, adduction and internal rotation of the hip which causes severe anterior hip pain

Very sensitive but not absolutely specific

27

Work up for Femoroacetabular Impingement?

xray

MRI

Sensitivity increased with arthrogram (labral tears)

Marcaine (+/- Kenalog) injection test

28

Tx for Femoroacetabular Impingement?

Non surg:
Activity modification
NSAIDs
PT for hip capsular stretching, ROM and strengthening exercises


Surg:
-open or arthroscopic
-Address the isolated pincer, cam or combined pincer and cam lesion

29

What is hip osteoarthritis?

Degeneration of cartilage from the femoral head and/or the acetabulum

30

Causes of hip osteoarthritis?

varies:
-Primary (idiopathic)

-Trauma

-Infection

-Slipped capital femoral epiphysis (SCFE)

-Legg-Calvé-Perthes disease

-Developmental dysplasia of the hip

-Avascular necrosis