1. Trauma: Hip/Femur/Sacrum

Question 1

the classic stress fracture location of the femoral shaft

Answer 1

Medial

Question 2

bisphosphonate related fx location.

Answer 2

On the outside (lateral)

Question 3

More common Hip fracture/ Dislocation

Answer 3

posterior dilocation

Question 4

Anterior Column vi’Posterior Column

Answer 4

the acetabulum is supported by two columns of bone that merge together to fonn an “inverted Y”

Question 5

Iliopectineal Line =

Answer 5

Anterior

Question 6

Ilioischial Line =

Answer 6

Posterior

Question 7

Corona Mortis

Answer 7

The anastomosis of the inferior epigastric and obturator vessels sometimes rides on the superior pubic ramus. During a lateral dissection - sometimes used to repair a hip fracture - this can be injured

Question 8

femoral head gets vascular flow from

Answer 8

circumflex femorals

Question 9

displaced intracapsular femoral fracture could disrupt this blood supply

Answer 9

circumflex femorals = leading to AVN

Testable Point: Degree of fracture displacement corresponds with risk ofAVN.

Question 10

if you see an isolated “avulsion” of the lesser trochanter in a seemingly mild trauma / injury in an adult

Answer 10

query a pathologic fracture

Question 11

Muscle attachment

Iliac creast =

Answer 11

Abdominal Muscles

Question 12

Muscle attachment

ASIS =

Answer 12

Sartorius
Tensor Fascia Lata

Question 13

Muscle attachment

AIIS =

Answer 13

Question 14

Muscle attachment

Greater Trochanter =

Answer 14

Gluteal Muscles

Question 15

Muscle attachment

Lesser trochanter =

Answer 15

llliopsoas

Question 16

Muscle attachment

Ischial Tuberosity =

Answer 16

Hamstrings

Question 17

Muscle attachment

Symphysis =

Answer 17

ADDuctor Group

Question 18

what are the unstable pelvic fractures?

Answer 18

Question 19

Pelvic and Sacral Fractures can result in

Answer 19

Arterial injury

Question 20

The following isolated fractures are considered “Stable”

Answer 20

Question 21

3 Types of Snapping Hip:

Answer 21

Question 22

IT Band Syndrome

Answer 22

This is a repetitive stress syndrome seen most classically in runners. The key finding is fluid on both sides of tlie IT band, extending posterior and lateral.

Question 23

Hip Labrum

Answer 23

1: Anterior-Superior Tears (white arrows) are by far the MOST COMMON

2: Paralabral Cysts (black arrow) are associated with tears and likely a hint that a tear is present.

3: Just like a shoulder intra-articular contrast will increase your sensitivity.

Question 24

Iliopsoas Bursa

Answer 24

Largest bursa of the entire body.

Communicates with the joint in 15% of the
population

Seen Anterior to the hip

Question 25

A fluid signal “mass” anterior to the femur (adjacent to the psoas tendon) at the level o f the ischial tuberosity is likely

Answer 25

Iliopsoas Bursitis

Question 26

Iliopsoas Bursitis is seen in

Answer 26

OA and RA + snapping hip, trauma, arhtroplasty

Question 27

Femoroacetabular Impingement (FAI)

Answer 27

here are two described subtypes: (A) Cam and (B) Pincer (technically there is a mixed type - but I anticipate multiple choice to make it more black and white).

Question 28

Femoacetabular Impingement type (FAI)

This is an osseous “bump” along the femoral head-neck junction.

Answer 28

CAM Type

Question 29

The femoral one (cam-type) is more common in men because

Answer 29

I remember that the femoral one (cam-type) is more common in men because the femoral head kinda looks like a penis.

Be honest, you were thinking that too.

Question 30

Pincer Type

Answer 30

defomiity of the acetabulum.

Question 31

CAM Type

Answer 31

deformity of the femur

Question 32

The most classic way to show or ask PINCER type is the so-called

Answer 32

The most classic way to show or ask this is the so-called

Question 33

The other associated finding(s) o f the pincer subtype worth knowing are the acetabular over coverage buzzwords

Answer 33

(Coxa Profunda and Protrusio), and the Ischial Spine Sign:

Question 34

Classic FAI Association:

Answer 34

• Os Acetabuli (40%) * Labral Tears
• Early Arthritis

Question 35

Os Acetabuli

Answer 35

Question 36

Potentially Asymptomatic Complications of Hip Arthroplasty:

Answer 36

• Stress Shielding
• Aggressive Granulomatosis

Question 37

Heterotopic Ossifications:

Answer 37

“hip stiffness” is the most common complaint.

Question 38

Aseptic Loosening

Answer 38

This is the most common indication for revision. The criteria on x-ray is > 2 mm at the interface (suggestive).

If you see migration of the component, you can call it (migration includes varus tilting of the femoral stem).

Question 39

Subsidence:

Answer 39

Basically an arthroplasty that is sliding downward.

This is a described reason for early failure of THA. You see this most often in arthroplasty implants without a
collar.

Greater than 1 cm along the femoral component, or progression after 2 years are indications of loosening.

Question 40

Wear Patterns

Answer 40

It is normal to have a little bit of thinning in the area of weight bearing - this is called “Creep.” It is not normal to see wear along the superior lateral aspect.

• Wear = Pathologic
• Creep = Normal

Question 41

Particle Disease (Aggressive Granulomatosis)

Answer 41

wear is the primarv underlying factor.

Macrophages will try and eat the particles and spew enzymes all over the place. This process can cause progressive lytic focal regions around the replacement and joint effusions.

Question 42

The most common cause is postmenopausal osteoporosis.

Answer 42

Sacral Insufficiency Fracture

Question 43

Sacral Insufficiency Fracture associations

Answer 43

You can also see this in patients with renal failure, patients with RA, pelvic radiation, mechanical changes after hip arthroplasty, or extended steroid use. They are often (usually) occult on plain films.

Question 44

Answer 44

Sacral Insufficiency Fracture