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Year 3 - Surgery > 2.07 Trauma and Orthopaedics - The Hip > Flashcards

2.07 Trauma and Orthopaedics - The Hip Flashcards

1
Q

What are the anatomical features of:

a) anterior column

b) posterior column

A

a) extends from anterior iliac spines to the pubic rami

b) extends from the sciatic notch to the ischium

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2
Q

What is the typical mechanism of action of an acetabular fracture?

A

Usually following high-energy injury, such as road traffic collision or a significant fall from heigh.

In the elderly or those with poor bone health (e.g. osteoporosis), acetabular fracture may occur following low energy mechanisms.

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3
Q

What are the clinical features of acetabular fractures?

A
  • pain
  • inability to weight bare
  • associated injuries

Associated injuries include hip dislocation and femoral neck fractures.

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4
Q

What investigations are used to diagnose acetabular fractures?

A

CT scan considered gold-standard.

Can be diagnosed using AP plain film radiograph.

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5
Q

How are acetabular fractures managed?

A

Following ATLS guidelines,

Reduce any associated hip dislocation.

Surgical fixation of acetabular fracture.

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6
Q

What are the complications of acetabular fractures?

A
  • secondary osteoarthritis
  • venous thromboembolism

NB nerve injury (e.g. sciatic or obturator nerve) is less common.

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7
Q

What is the typical cause of pelvic fractures?

A

High energy blunt trauma, for example road traffic accidents or falls from height.

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8
Q

What are the clinical features of pelvic fractures?

A
  • obvious deformity
  • pain and swelling
  • abdominal injury
  • urethral injury
  • open fractures (including internal, into the rectum or vaginal vault)
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9
Q

What assessment/s must be performed when suspecting a pelvic fracture?

A
  • full neurovascular assessment of lower limbs
  • anal tone (as sacral nerve roots and iliac vessels can be injured)
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10
Q

What are the investigations used to diagnose pelvic fractures?

A

3x plain film radiographs:
- AP
- inlet view
- outlet view

In trauma setting, CT scan is performed as part of patient assessment, which negates the need for plain films.

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11
Q

What is the management of pelvic fractures?

A

Follow ATLS guidelines

Apply pelvic binder to give skeletal stabilisation (required for attempted clot formation).

Surgical fixation.

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12
Q

What are the complications of pelvic fractures?

A
  • massive haemorrhage
  • urological injury
  • venous thromboembolism
  • long-standing pelvic pain
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13
Q

What is the one year mortality of neck of femur (NOF) fractures?

A

Approx. 30%

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14
Q

What is the MOI in NOF #s?

A

Low energy injury, for example a fall in a frail older patient (most common).

Can be associated with high-energy injuries, such as road traffic collisions or fall from height.

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15
Q

Anatomically define NOF #s.

A

A fracture that occurs between the femoral head to 5cm distal to the lesser trochanter.

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16
Q

Define:

a) intracapsular NOF #

b) extracapsular NOF #

A

a) a fracture that occurs within the joint capsule region of the hip joint, from the femoral head to the lesser trochanter.

b) a fracture that occurs beneath the joint capsule region of the hip joint, from the lesser trochanter to 5cm distal to this point.

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17
Q

Describe the blood supply to the head of the femur.

A

A retrograde blood supply from the medial circumflex femoral artery (major).

NB intravascular NOF #s risk compromising the MCFA and thus resulting in AVN.

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18
Q

Through what classification are intracapsular NOF #s classified?

A

Garden classification

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19
Q

What are the clinical features of NOF #s?

A
  • pain
  • inability to weight bear
  • shortened and externally rotated leg
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20
Q

What are the investigations of NOF #s?

A
  • AP plain film radiograph
  • routine blood tests (including FBC, U&Es, coagulation screen, Group & Save, CK if significant lye time)
  • urine dip
  • CXR
  • ECG
21
Q

What is the management of NOF #s?

A

Follow ATLS guidelines.

Adequate analgesia (ie. opioid analgesia).

Definitive management is surgical:
- hip hemiarthroplasty
- dynamic hip screw
- cannulated hip screws
- anterograde intramedullary femoral nail

22
Q

What are the complications of NOF #s?

A
  • joint dislocation
  • aseptic loosening
  • prosthetic joint infection
  • mortality
23
Q

What is the main blood supply to the femoral shaft?

A

Penetrating branches of the profunda femoris artery

24
Q

Approximately how much blood can be lost per femoral shaft fracture?

A

1500ml

25
Q

What are the typical MOI of femoral shaft #s?

A
  • high energy trauma
  • fragility fracture in the elderly
  • pathological fractures (e.g. metastases, osteomalacia)
  • bisphosphonate-related fractures
26
Q

What are the clinical features of femoral shaft fractures?

A
  • pain or swelling
  • inability to weight bear
  • deformity (incl. tenting of the skin)
27
Q

What are the investigations of a femoral shaft fracture?

A
  • routine urgent bloods (incl. Group & Save)*
  • AP plain film radiograph
  • CT scanning
28
Q

What is the management of femoral shaft fractures?

A

ATLS guidelines followed.

Pain relief (opioid analgesia)

Immediate reduction and immobilisation.

Surgical management (intramedullary nail or external fixation).

29
Q

Generally, how should open fractures be managed?

A
  • antibiotic prophylaxis
  • tetanus vaccination
  • medical photography
30
Q

What are the complications of femoral shaft fractures?

A
  • haemorrhage
  • nerve or vascular injury (pudendal nerve injury)
  • mal-union, or non-union
  • infection
  • fat embolism
  • venous thromboembolism
31
Q

What is the prognosis of femoral shaft fractures?

A

Patients who survive the initial trauma will typically heal well.

Early mobilisation following surgical intervention reduces complications.

32
Q

What are the risk factors for quadriceps tendon rupture?

A
  • increasing age
  • CKD
  • rheumatoid arthritis
  • corticosteroids
33
Q

What are the clinical features of quadriceps tendon rupture?

A
  • hearing a pop or feeling tearing sensation
  • pain in anterior knee or thigh
  • difficulty weight bearing
  • localised swelling
  • tender palpable defect above the patella
  • inability to straight leg raise (unable to extend knee)
34
Q

What is the typical MOI of quadriceps tendon rupture?

A

Sudden and excessive loading of the quadriceps muscles, such as landing from a jump.

35
Q

What investigations are used to diagnose quadriceps tendon rupture?

A

Can be diagnosed on clinical suspicion alone.

Plain film radiographs of the affected knee can show a caudally displaced patella (also excludes underlying fractures).

Ultrasound imaging is gold standard for diagnosis - if uncertain, MRI used.

36
Q

How are

a) partial quadriceps tendon ruptures

b) complete quadriceps tendon ruptures

treated?

A

a) non-operative management, involving immobilisation of knee joint in a brace and intensive rehabilitation.

b) surgical intervention, using sutures to repair the tendon; post-operative immobilisation of knee before intensive rehabilitation.

37
Q

What are the

a) systemic

b) local

risk factors for hip OA?

A

a) increasing age; obesity; female gender; genetic factors; vitamin D deficiency

b) history of local trauma; anatomic abnormalities; muscle weakness; joint laxity; participation in high impact sports

38
Q

What are the clinical features of hip OA?

A
  • pain in the group
  • aggravated by weight bearing
  • improved with rest
  • stiffness that improves with mobility
  • grinding or crushing sensation
  • antalgic gait
  • passive movement is painful
  • ROM reduced

NB in end stage disease, the patient may have a fixed flexion deformity and walk with a Trendelenburg gait.

39
Q

What are the differential diagnoses for hip pain?

A
  • OA
  • trochanteric bursitis
  • sciatica
  • femoral neck fracture
40
Q

What imaging modality is used to diagnose hip OA?

Give the features characteristic of OA that can be seen on this imaging modality.

A

Plain film radiographs.

Features (JOCS):
- joint space narrowing
- osteophyte formation
- cysts of subchondral bone
- subchondral sclerosis

NB further imaging rarely required, unless other diagnoses are being considered, where MRI is gold standard.

41
Q

How can OA progression be classified?

A

Western Ontario and McMaster Universities Arthritis Index (WOMAC) is a well-evaluated measure, which combines scores for pain, stiffness and function to give a score.

The tool can be repeated to allow for a quantitative evaluation of disease progression.

42
Q

What is the management of hip OA?

A
  1. Conservative measures, including simple analgesia and lifestyle modifications (e.g weight loss, regular exercise).
  2. Physiotherapy, aiming to slow disease progression and improve joint mechanics
  3. Corticosteroid injections to hip.
  4. Surgical intervention, including total hip replacement or hemiarthroplasty.
43
Q

What are common post-operative complications of total hip replacement?

A
  • thromboembolic disease
  • bleeding
  • dislocation
  • infection
  • loosening of the prosthesis
  • leg length discrepancy
44
Q

How long can a modern hip prosthesis last for?

A

Designed to last 15-20 years; therefore, depending on the age at the time of replacement, it may never need revising.

45
Q

What is the common mechanism of injury of posterior hip dislocation?

A

Dashboard injury in RTC - striking knee against the dashboard causing the femoral head to be forced posteriorly out of the acetabulum.

46
Q

What are the clinical features of posterior hip dislocation?

A
  • severe pain

OE leg will be shortened, adducted and internally rotated.

47
Q

What are the complications of posterior hip dislocation?

A
  • sciatic nerve injury
  • avascular necrosis (rupture to LCFA)
  • secondary osteoarthritis (post-traumatic)
48
Q

What are the clinical features of anterior hip dislocation?

A
  • severe pain

OE leg will be shortened, abducted and externally rotated.

Year 3 - Surgery (30 decks)

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