3 - Hip Flashcards
In general, hip fracture surgery should be performed within ______ hours in medically stable patients
24-48 hours
Following a hip dislocation serial x-rays and hip MRI are needed at ____ weeks to make sure there is no avascular necrosis.
6 weeks
What type of hip fracture has the highest risk of displacement and often have a classic appearance of a shortened extremity?
a. femoral head
b. femoral neck
c. intertrochanteric
d. lesser trochanter
e. greater trochanter
c. intertrochanteric
What is the most common adolescent hip disorder?
Slipped Capital Femoral Epiphysis (SCFE)
Meralgia paresthetica is caused by an entrapment of the __________ nerve as it passes under or through the inguinal ligament.
lateral femoral cutaneous
A patient presents with a shortened limb, adducted and internally rotated hip. What type of dislocation is this?
posterior hip dislocation
A “painless limp” is a buzzword for what pediatric hip problem?
Legg-Calve Perthes Disease
What is the recommended imaging study for avascular necrosis?
MRI
Hip fractures look like an _______ hip dislocation.
anterior hip dislocation
What is the most common type of hip fracture?
a. femoral head
b. femoral neck
c. intertrochanteric
d. lesser trochanter
e. greater trochanter
b. femoral neck
A 70 year old woman presents with unilateral hip pain, stiffness, and limited motion. AROM/PROM is painful and you hear crepitus. She denies any trauma. What is the diagnosis?
osteoarthritis
What muscle is associated with a lesser throchanteric fracture?
Iliopsoas
With any major pelvic fracture what do you also need to assess?
internal injuries and bleeding
especially the bladder -> put in a foley and check for hematuria; if you see blood = get a CT cystoscopy
Following a hip dislocation you can begin jogging/running at _____ weeks, and return to sports at _____ months
jogging/running = 6-8 weeks sports = 3-4 months
What is the difference in anatomic location between a intracapsular vs. extracapsular hip fracture?
- intracapsular = femoral head/neck
- extracapsular = intertrochanteric region
A patient presents with a shortened limb, abducted and externally rotated hip. What is the diagnosis?
anterior hip dislocation
What nerve can be injured with an anterior hip dislocation?
femoral nerve
What classification system is used for a femoral neck fracture?
What classification system is used for a femoral head fracture?
- neck = Garden classification
- head = Pipkin classification
What type of nerve is the lateral femoral cutaneous nerve?
a. Pure motor
b. Pure sensory
c. Equal motor and sensory
d. Motor > Sensory
e. Sensory > Motor
b. Pure sensory
Which of the following is LEAST likely to be a risk factor for a patient with osteoarthritis?
a. Advanced age
b. Female sex
c. Obesity
d. Prior trauma
e. Family history
f. Osteoporosis
f. Osteoporosis
In some patients, especially older adult women, hip OA can be rapidly progressive, with a subacute onset of joint pain which progresses to joint destruction and instability in just a few ______.
months!
What is the best technique for reducing a hip?
“Captain Morgan” technique
Paresthesia or hypesthesia over the anterolateral thigh with no motor or vascular compromise is consistent with this diagnosis.
meralgia paresthetica
If you find a hip dislocation what is the first step in management?
emergent closed reduction
to prevent avascular necrosis of the femoral head
Which of the following is NOT typically a risk factor for a hip fracture?
A. Advanced age B. Female sex C. Low socioeconomic status D. Falls E. Osteoporosis F. Obesity
F. Obesity
What is the biggest risk factor for SCFE?
a. obesity
b. male
c. endocrine abnormalities
d. down syndrome
a. obesity
Anterior hip pain with a locking, clicking, or catching sensation is consistent with this hip pathology.
labrum tear
This is defined as displacement of the capital femoral epiphysis from the rest of the femur through the growth plate.
Slipped Capital Femoral Epiphysis (SCFE)
What muscle is associated with a greater throchanteric fracture?
hip abductors
The ______ is the longest, strongest, heaviest bone in the body
femur
The vast majority of hip dislocation are ______.
posterior (90%)
Which autoimmune condition is associated with sacrioilitis?
A. Gout B. Lupus C. Ankylosing spondylitis D. Scleroderma E. Sjogren’s syndrome
C. Ankylosing spondylitis
Unlike knee osteoarthritis, hip osteoarthritis is frequently ________.
unilateral
A crescent sign on plain films is consistent with this hip pathology.
avascular necrosis of the hip
What is the treatment for greater trochanteric pain syndrome?
self-limiting
- exercise/PT best treatment*
- if refractory get an MRI and consider surgery*
What nerve can be injured with a posterior hip dislocation?
sciatic nerve (OR common peroneal division of sciatic nerve)
A 13 year old obese patient presents with dull aching right hip pain with and isolated knee pain. What is the diagnosis?
Slipped Capital Femoral Epiphysis (SCFE)
What is the etiology of trochanteric bursitis?
- Gluteus maximus tendinopathy
- Gluteus medius/minimus tendinopathy
- Inflamed trochanteric bursa
- Inflamed ischial bursa
- Inflamed pes anserine bursa
- Greater trochanter stress fracture
- Gluteus medius/minimus tendinopathy
What is the mechanism for an anterior hip dislocation?
hip is flexed, abducted, and externally rotated
What is the most common factor for meralgia paresthetica?
a. age
b. obesity
c. diabetes
d. tight belts
e. pregnancy
f. post-operative
g. exercise
c. diabetes
______ trochanteric fractures result in lateral pain, especially with abduction and extension
______ trochanteric fractures result in groin pain, especially with flexion and internal rotation
- greater trochanteric fractures result in lateral pain, especially with abduction and extension
- lesser trochanteric fractures result in groin pain, especially with flexion and internal rotation
Which of the following types of hip fracture is at an increased risk for avascular necrosis?
a. intracapsular
b. extracapsular
a. intracapsular
A male patient presents with pain in the buttocks, that worsens with walking or squatting. He says he can’t sit down with his wallet in his back pocket. What is the diagnosis?
piriformis syndrome
What is the mechanism for a posterior hip dislocation?
hip is flexed, adducted, and internally rotated
What is the greatest atraumatic risk factor for avascular necrosis? (2)
- Alcohol
- Sickle Cell Disease
- Exogenous steroids
- Pancreatitis/Pregnancy
- Trauma
- Infection
- Collagen vascular disease
- Exogenous steroids
- Alcohol
This is defined as an avascular necrosis of proximal femoral head from compromised blood supply in pediatrics.
Legg-Calve Perthes Disease
What should you do if patient has persistent pain or cannot ambulate and suspicion is high for injury, but plain films are negative?
get a CT scan or MRI
A patient presents with lateral hip pain that is worse with pressure or prolonged standing. When you ask the patient to point to the pain they point over the greater trochanter. What is the diagnosis?
greater trochanteric pain syndrome
If a patient presents with refractory sacroiliitis what should you work him up for?
inflammatory/autoimmune conditions
Tight belts are associated with this hip pathology.
meralgia paresthetica
Long term bisphosphonates has been associated with this type of hip fracture.
a. femoral head
b. femoral neck
c. intertrochanteric
d. lesser trochanter
e. greater trochanter
f. subtrochanteric fracture
f. subtrochanteric fracture
* subtype referred to as insufficiency fracture*
What is the best imaging to test for a hip labral tear?
MRA
