Clincal Conditions Of The Hip Flashcards
Cause of primary osteoarthritis
Idiopathic
Cause unknown
Risk factors of osteoarthritis
Age
Sex female >male
Ethnicity
Nutrition
Genetics- runs in family
Causes of secondary osteoarthritis
Obsesity
Trauma
Malalignment
Infection
Inflammatory arthritis - RA
Metabolic disorders affecting joints
Haematological disorders
Endocrine abnormalities
Symptoms of osteoarthritis in hip
Joint stiffness
Morning stiffness < 1 hour
Pain + tenderness
Crepitus
Reduced mobility
Trendelenburg sign
Pain reduced by rest
How is osteoarthritis diagnosed
By clinical presentation
Supported by X rays - LOSS
X ray changes of osteoarthritis
LOSS
Loss of joint spac
Osteophytes
Subarticular sclerosis
Subchondral cysts
Management of osteoarthritis of hip
Activity modifications - if it hurts don’t do it
Weight loss
Physiotherapy
Medications - NSAIDs, COX-2 inhibitors
Injections - corticosteroids to reduce inflammation
Hip replacement surgery
Types femur fracture
intracapsular fracture - NOF
extracapsular fracture - trochanteric + subtrochanteric
Why does a intracapsular fracture of the femur have a high risk of avascular necrosis?
Damage to medial femoral circumflex artery
Causes of a vascular necrosis
Mechanical disruption - fracture
Excess alcohol
Excessive steroid use
Post-trauma
Thrombosis
Hypertension
Signs + symptoms of proximal femur fractures
Decreased mobility
Sudden inability to bear weight
Pain in hip, groin or knee
Short
Externally rotated
ABducted
Management of NOF fracture
- if un-displaced: screws
- if displaced: hemiarthroplasty or total hip replacement
What is the most common hip dislocation? Why?
Posterior
Only ischiofemoral ligament on posterior surface - weakest
What does a posterior hip location present as?
- Shortened
- Internally rotated
- ADducted
- Flexed
iPDF - internal rotation | Posteior | ADducted | flexed
What nerve can be damaged in posterior hip dislocation?
Sciatic nerve
Complication of hip dislocations
Avascular necrosis
Post traumatic OA
Recurrent dislocation
Sciatic nerve injury
Infection
Superior gluteal nerve injury
How does an anterior hip dislocation present?
Externally rotation
ABducted
Slightly flexed
What type of dislocation is a central hip location always?
Fracture dislocation
Where is the femoral head palpable in a central hip dislocation?
Femoral head palpable per rectum
Presentation of neck of femur fracture vs a posterior hip dislocation
NOF fracture - shortened
- ABducted
- externally rotated
Dislocation - shortened
- ADducted
- internally rotated
Mechanism of a pulled hamstring
Sudden muscular exertion - stretching of posterior thigh muscles
Causes of hamstring injuries
Muscle sprain
Partial or complete tear of hamstrings from ischial tuberosity
What can a complete tear of hamstring muscles of ischial tuberosity cause?
Avulsion fracture
What muscles will be impacted by injury to superior gluteal nerve?
What does this cause?
Gluteus medius
Gluteus minimus
Weakness in ABducting hip»_space; Trendelenburg’s sign
Causes of superior gluteal nerve injury
- Hip surgery complication
- Buttock injection
- Greater trochanter fracture - insertion of gluteus medius
- Hip joint dislocation
What type of nerve injury causes Trendelenburg’s sign?
Why?
Superior gluteal nerve injury
Supplies hip ABductors - gluteus medius + minimus»_space; don’t contract to prevent tilting
VTE prophylaxis after:
- trauma hip surgery
- elective THR
- elective TKR
- trauma hip surgery: SC enoxaparin
- elective THR: SC enoxaparin then PO aspirin
- elective TKR: aspirin
