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Orthopedics > 3 - Hip > Flashcards

3 - Hip Flashcards

1
Q

In general, hip fracture surgery should be performed within ______ hours in medically stable patients

A

24-48 hours

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2
Q

Following a hip dislocation serial x-rays and hip MRI are needed at ____ weeks to make sure there is no avascular necrosis.

A

6 weeks

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3
Q

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

A

c. intertrochanteric

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4
Q

What is the most common adolescent hip disorder?

A

Slipped Capital Femoral Epiphysis (SCFE)

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5
Q

Meralgia paresthetica is caused by an entrapment of the __________ nerve as it passes under or through the inguinal ligament.

A

lateral femoral cutaneous

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6
Q

A patient presents with a shortened limb, adducted and internally rotated hip. What type of dislocation is this?

A

posterior hip dislocation

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7
Q

A “painless limp” is a buzzword for what pediatric hip problem?

A

Legg-Calve Perthes Disease

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8
Q

What is the recommended imaging study for avascular necrosis?

A

MRI

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9
Q

Hip fractures look like an _______ hip dislocation.

A

anterior hip dislocation

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10
Q

What is the most common type of hip fracture?

a. femoral head
b. femoral neck
c. intertrochanteric
d. lesser trochanter
e. greater trochanter

A

b. femoral neck

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11
Q

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?

A

osteoarthritis

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12
Q

What muscle is associated with a lesser throchanteric fracture?

A

Iliopsoas

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13
Q

With any major pelvic fracture what do you also need to assess?

A

internal injuries and bleeding

especially the bladder -> put in a foley and check for hematuria; if you see blood = get a CT cystoscopy

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14
Q

Following a hip dislocation you can begin jogging/running at _____ weeks, and return to sports at _____ months

A 
jogging/running = 6-8 weeks
sports = 3-4 months
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15
Q

What is the difference in anatomic location between a intracapsular vs. extracapsular hip fracture?

A
  • intracapsular = femoral head/neck

- extracapsular = intertrochanteric region

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16
Q

A patient presents with a shortened limb, abducted and externally rotated hip. What is the diagnosis?

A

anterior hip dislocation

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17
Q

What nerve can be injured with an anterior hip dislocation?

A

femoral nerve

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18
Q

What classification system is used for a femoral neck fracture?

What classification system is used for a femoral head fracture?

A
  • neck = Garden classification

- head = Pipkin classification

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19
Q

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

A

b. Pure sensory

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20
Q

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

A

f. Osteoporosis

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21
Q

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 ______.

A

months!

22
Q

What is the best technique for reducing a hip?

A

“Captain Morgan” technique

23
Q

Paresthesia or hypesthesia over the anterolateral thigh with no motor or vascular compromise is consistent with this diagnosis.

A

meralgia paresthetica

24
Q

If you find a hip dislocation what is the first step in management?

A

emergent closed reduction

to prevent avascular necrosis of the femoral head

25
Q

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
A

F. Obesity

26
Q

What is the biggest risk factor for SCFE?

a. obesity
b. male
c. endocrine abnormalities
d. down syndrome

A

a. obesity

27
Q

Anterior hip pain with a locking, clicking, or catching sensation is consistent with this hip pathology.

A

labrum tear

28
Q

This is defined as displacement of the capital femoral epiphysis from the rest of the femur through the growth plate.

A

Slipped Capital Femoral Epiphysis (SCFE)

29
Q

What muscle is associated with a greater throchanteric fracture?

A

hip abductors

30
Q

The ______ is the longest, strongest, heaviest bone in the body

A

femur

31
Q

The vast majority of hip dislocation are ______.

A

posterior (90%)

32
Q

Which autoimmune condition is associated with sacrioilitis?

A. Gout
B. Lupus
C. Ankylosing spondylitis
D. Scleroderma
E. Sjogren’s syndrome
A

C. Ankylosing spondylitis

33
Q

Unlike knee osteoarthritis, hip osteoarthritis is frequently ________.

A

unilateral

34
Q

A crescent sign on plain films is consistent with this hip pathology.

A

avascular necrosis of the hip

35
Q

What is the treatment for greater trochanteric pain syndrome?

A

self-limiting

  • exercise/PT best treatment*
  • if refractory get an MRI and consider surgery*
36
Q

What nerve can be injured with a posterior hip dislocation?

A

sciatic nerve (OR common peroneal division of sciatic nerve)

37
Q

A 13 year old obese patient presents with dull aching right hip pain with and isolated knee pain. What is the diagnosis?

A

Slipped Capital Femoral Epiphysis (SCFE)

38
Q

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
A
  • Gluteus medius/minimus tendinopathy
39
Q

What is the mechanism for an anterior hip dislocation?

A

hip is flexed, abducted, and externally rotated

40
Q

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

A

c. diabetes

41
Q

______ trochanteric fractures result in lateral pain, especially with abduction and extension

______ trochanteric fractures result in groin pain, especially with flexion and internal rotation

A
  • 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
42
Q

Which of the following types of hip fracture is at an increased risk for avascular necrosis?

a. intracapsular
b. extracapsular

A

a. intracapsular

43
Q

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?

A

piriformis syndrome

44
Q

What is the mechanism for a posterior hip dislocation?

A

hip is flexed, adducted, and internally rotated

45
Q

What is the greatest atraumatic risk factor for avascular necrosis? (2)

  • Alcohol
  • Sickle Cell Disease
  • Exogenous steroids
  • Pancreatitis/Pregnancy
  • Trauma
  • Infection
  • Collagen vascular disease
A
  • Exogenous steroids

- Alcohol

46
Q

This is defined as an avascular necrosis of proximal femoral head from compromised blood supply in pediatrics.

A

Legg-Calve Perthes Disease

47
Q

What should you do if patient has persistent pain or cannot ambulate and suspicion is high for injury, but plain films are negative?

A

get a CT scan or MRI

48
Q

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?

A

greater trochanteric pain syndrome

49
Q

If a patient presents with refractory sacroiliitis what should you work him up for?

A

inflammatory/autoimmune conditions

50
Q

Tight belts are associated with this hip pathology.

A

meralgia paresthetica

51
Q

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

A

f. subtrochanteric fracture

* subtype referred to as insufficiency fracture*

52
Q

What is the best imaging to test for a hip labral tear?

A

MRA

Orthopedics (5 decks)

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