1. Trauma: Hip/Femur/Sacrum Flashcards
the classic stress fracture location of the femoral shaft
Medial
bisphosphonate related fx location.
On the outside (lateral)
More common Hip fracture/ Dislocation
posterior dilocation
Anterior Column vi’Posterior Column
the acetabulum is supported by two columns of bone that merge together to fonn an “inverted Y”
Iliopectineal Line =
Anterior
Ilioischial Line =
Posterior
Corona Mortis
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
femoral head gets vascular flow from
circumflex femorals
displaced intracapsular femoral fracture could disrupt this blood supply
circumflex femorals = leading to AVN
Testable Point: Degree of fracture displacement corresponds with risk ofAVN.
if you see an isolated “avulsion” of the lesser trochanter in a seemingly mild trauma / injury in an adult
query a pathologic fracture
Muscle attachment
Iliac creast =
Abdominal Muscles
Muscle attachment
ASIS =
Sartorius
Tensor Fascia Lata
Muscle attachment
AIIS =
Muscle attachment
Greater Trochanter =
Gluteal Muscles
Muscle attachment
Lesser trochanter =
llliopsoas
Muscle attachment
Ischial Tuberosity =
Hamstrings
Muscle attachment
Symphysis =
ADDuctor Group
what are the unstable pelvic fractures?
Pelvic and Sacral Fractures can result in
Arterial injury
The following isolated fractures are considered “Stable”
3 Types of Snapping Hip:
IT Band Syndrome
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.
Hip Labrum
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.
Iliopsoas Bursa
Largest bursa of the entire body.
Communicates with the joint in 15% of the
population
Seen Anterior to the hip
A fluid signal “mass” anterior to the femur (adjacent to the psoas tendon) at the level o f the ischial tuberosity is likely
Iliopsoas Bursitis
Iliopsoas Bursitis is seen in
OA and RA + snapping hip, trauma, arhtroplasty
Femoroacetabular Impingement (FAI)
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).
Femoacetabular Impingement type (FAI)
This is an osseous “bump” along the femoral head-neck junction.
CAM Type
The femoral one (cam-type) is more common in men because
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.
Pincer Type
defomiity of the acetabulum.
CAM Type
deformity of the femur
The most classic way to show or ask PINCER type is the so-called
The most classic way to show or ask this is the so-called
The other associated finding(s) o f the pincer subtype worth knowing are the acetabular over coverage buzzwords
(Coxa Profunda and Protrusio), and the Ischial Spine Sign:
Classic FAI Association:
- Os Acetabuli (40%) * Labral Tears
- Early Arthritis
Os Acetabuli
Potentially Asymptomatic Complications of Hip Arthroplasty:
- Stress Shielding
- Aggressive Granulomatosis
Heterotopic Ossifications:
“hip stiffness” is the most common complaint.
Aseptic Loosening
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).
Subsidence:
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.
Wear Patterns
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
Particle Disease (Aggressive Granulomatosis)
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.
The most common cause is postmenopausal osteoporosis.
Sacral Insufficiency Fracture
Sacral Insufficiency Fracture associations
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.
Sacral Insufficiency Fracture
