The Hip Flashcards

1
Q

MOA of hip dislocation?

A

Trauma directed at axis of femur

  • Axial load with flexed knee
  • MVA

> 90% posterior
< 10% anterior

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2
Q

MOA of posterior hip dislocation?

A

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

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3
Q

Presentation of posterior hip dislocation?

A

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

Shortened extremity

Prominence of greater trochanter and femoral head under gluteal muscles

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4
Q

MOA of anterior hip dislocation?

A

Abduction and external rotation of the femur

Anterior displacement of femoral head from acetabulum

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5
Q

Presentation of hip dislocation?

A

LE in “helpless eversion”
Hip externally rotated and abducted

Flattened lateral hip

Prominence of femoral head in groin

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6
Q

Complications of hip dislocations?

A

Acetabular fractures

Sciatic nerve injury

Rupture of ligamentum teres artery → avascular necrosis of femoral head

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7
Q

MOA of hip fx?

A

Fall → elderly w/ osteoporosis

Stress → long distance runners

Pathologic → metastatic and primary bone lesions

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8
Q

Clinical presentation for hip fx?

A

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

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9
Q

Imaging for hip fx?

A

X-rays first line

CT for detailed evaluation

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10
Q

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

A

sub-capital (intra capsular)

disrupts blood supply to femoral head

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11
Q

surg tx options for hip fx?

A

ORIF v. arthoplasty

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12
Q

What is avascular necrosis of the hip?

A

Loss of blood supply leads to destruction of the femoral head

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13
Q

Describe avascular necrosis of the hip in adults

A

30 – 50 y/o range

Unilateral or bilateral

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

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14
Q

Describe avascular necrosis of the hip in kids

A

“Legg Calve Perthes disease”

2 – 11 y/o range (peak 4-10)

M:F of 4:1

Unilateral

Idiopathic

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15
Q

Presentation of avascular necrosis in adults?

A

MC insidious onset

Groin pain is initial complaint

Pain with weight bearing / limp

ROM loss: internal rotation and abduction

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16
Q

Presentation of avascular necrosis in peds?

A

Painless limp is initial presentation

Groin, thigh or knee pain may follow

ROM loss (both adult and peds)
Internal rotation and abduction
17
Q

Staging for avascular necrosis

A

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
Q

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

A

crescent sign

stage III

MRI- detects early changes

19
Q

Tx for avascular necrosis in adults?

A

Core decompression w/ bone graft

Total hip replacement if advanced disease or failure with graft

20
Q

Tx for avascular necrosis in children?

A

Period of bed rest followed by progressive weight bearing

21
Q

What is a Femoroacetabular Impingement?

A

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
Q

Femoroacetabular Impingement may lead to…

A

hip labral tears

chondral injury

early onset osteoarthritis

23
Q

Etiology of femoroacetabular impingement?

A

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

Incidence of 10-15%

24
Q

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

A

Athletes / active individuals

due to high demand on hips

25
Q

presentation of femoroacetabular impingement?

A

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
Q

What test can you use to eval for femoroacetabular impingement?

A

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

Very sensitive but not absolutely specific

27
Q

Work up for Femoroacetabular Impingement?

A

xray

MRI

Sensitivity increased with arthrogram (labral tears)

Marcaine (+/- Kenalog) injection test

28
Q

Tx for Femoroacetabular Impingement?

A

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
Q

What is hip osteoarthritis?

A

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

30
Q

Causes of hip osteoarthritis?

A

varies:
- Primary (idiopathic)

  • Trauma
  • Infection
  • Slipped capital femoral epiphysis (SCFE)
  • Legg-Calvé-Perthes disease
  • Developmental dysplasia of the hip
  • Avascular necrosis
31
Q

Clinical features of hip osteoarthritis?

A

Groin and/or anterior thigh pain with weight bearing activities or at rest

Decreased, and often painful, ROM of hip
Flexion, internal rotation

May c/o difficulty crossing legs or putting on shoes/socks

Can produce referred pain to the knee

32
Q

Treatment of hip osteoarthritis?

A

Analgesics: APAP, NSAID and narcotics

Weight reduction

Lifestyle modification

Intra-articular corticosteroid injections

Intra-articular viscosupplementation

Joint arthroplasty

33
Q

What is trochanteric bursitis?

A

Inflammation and hypertrophy of greater trochanteric bursa

34
Q

Presentation of trochanteric bursitis?

A

Pain + tenderness over greater trochanter

Pain may radiate distally

Pain worse when first rising from seated or recumbent position, feels somewhat better after a few steps and recurs after walking for 1 hr +

Night pain and inability to lie on affected side

35
Q

Management of trochanteric bursitis?

A

+/- xray to r/o bony abnormalities and intra-articular hip pathology

NSAIDs, activity modification

Stretching targeted at IT band and gluteal musculature

US guided injection of local anesthetic and corticosteroid into greater trochanteric bursa