Disorders of the Hip/Pelvis

Question 1

What are the two main types of hip dislocations? what type of accidents do they occur in?

Answer 1

1. anterior
2. posterior

high energy accidents

Question 2

which of the two types of hip dislocations is more common?

Answer 2

posterior

Question 3

describe posterior hip dislocations:

Answer 3

Most common
Mechanism:
Hip typically in a flexed position
Leg typically shortened, adducted, internally rotated

Question 4

Describe anterior dislocations:

Answer 4

Mechanism
Hip extension and external rotation
Hip is flexed, abducted, and externally rotated

Question 5

What is the treatment for a hip dislocation?

Answer 5

Closed Reduction if no Fx
Increased risk of AVN of the femoral head
Sciatic Nerve injury 10-20% of cases
Crutches
Physical Therapy

Question 6

What is congenital dysplasia of the hip

Answer 6

Shallow development of acetabulum

Question 7

what are you at risk for with CDH? what puts you at risk for CDH?

Answer 7

Increased risk of dislocations
Increased risk of Osteoarthritis (OA)

Firstborn
Breech Birth or Breech Presentation
Associate with Club Foot, Torticollis, Metatarsus Adductus

Question 8

What are the signs/symptoms of CDH?

Answer 8

Pain in Groin
Anterior Thigh pain or Knee pain
Hyper mobile
Decreased Activity Level
History of hip dislocation or subluxation

Question 9

What is the treatment for CDH?

Answer 9

Conservative :
Bracing (pediatric population)
NSAIDs
Corticosteroid injections (Under Fluoro)
Modify activity

Surgeries:
Osteotomy–> try to replace the acetabulum, not really used anymore
Hip resurfacing
Total Hip Arthroplasty

Question 10

What are two tests that might suggest a hip dysplasia?

Answer 10

Barlow Maneuver (dislocatable hip)
Ortolani Maneuver (relocates the hip)

Question 11

What is Hip Protrusio? and what disease states do we see it with

Answer 11

Movement of the femoral head into the acetabulum

Osteoarthritis
Infection
Tumors
Paget’s disease

Question 12

What are the signs of Hip Protrusio?

what is the treatment?

Answer 12

PAIN
Hip Impingment
Hip Contracture
Trendelenburg limp
Leg Length Discrepancy
tx: surgery

Question 13

what is Legg-Calve-Perthes?

Answer 13

-Temporary develop AVN Femoral Head
—->Egg shape development of femoral head
Self Limited Disease
Unknown Etiology

Question 14

who does legg-calve-perthes affect?

Answer 14

3-12 Years of Age
Increase incidence 4-6 years of age
More Common in Males

Question 15

What are the signs and symptoms of legg-calve-perthes

Answer 15

Pain in Anterior Thigh or Knee
Groining Pain
Presents with a Limp
Decrease ROM
Abduction
Internal rotation
Leg Length discrepancy

Question 16

What is the treatment for legg-calve-perthes?

Answer 16

NEED TO DO MRI TO EVAL FOR BLOOD FLOW
Treatment
Braces for 2-3 years (Abduction)
Osteotomy
Total Hip Arthroplasty

Question 17

What is Slipped Capital Femoral Epiphysis, and who is it common in?

Answer 17

Weakening of the Epiphysis Plate
Displacement of Growth Plate
common in boys 11-16

Question 18

what are the body type risk factors for SCFE? what does it put those at risk for later in life?

Answer 18

Body Type
Tall, slender, and rapid growth
Obese and underdeveloped sex characteristics
Risk factor for Early Osteoarthritis

Question 19

what are the signs of SCFE?

Answer 19

Pain with Weight Bearing
Groin, Thigh, or Knee Pain
Pain with Extremes of Motion
Unable to Internally Rotate

Question 20

What is klein’s line?

Answer 20

Line drawn parallel to the superior border of the femoral neck
Epiphysis should project superiorly to the line

Question 21

is SCFE an ortho emergency?

Answer 21

yes!!! needs to be pinned!!

Question 22

What is the treatment for OA?

Answer 22

Ice
Modify Activity Level
Weight Loss (1lb = 3lbs pressure)
Use of an assistive device
Long Term NSAIDs
Cortisone Injections (Fluoroscopy)
Surgery

Question 23

What are some of the risks associated with choosing a total hip arthroplasty as the means of fixing an OA hip?

Answer 23

Deep venous thrombosis: 6%
Pulmonary embolisms: 0.3%
Infections: 3%
Nerve palsies or neuropraxia: 1%

Question 24

What long term complications can come from a total hip arthroplasty?

Answer 24

Aseptic Loosening
5-7% Failure within first 10 years
Polyethylene Wear
Dislocation 4%
Increased Failure Risk

Question 25

What are some of the causes for AVN of the femoral head?

Answer 25

Hip fx
Alcoholism
Prednisone
Diabetes
Sickle cell
90% unknown etiology

Question 26

What the most common cause of AVN to the femoral head?

Answer 26

unknown etiology

Question 27

what are the three types of hip fractures?

Answer 27

Femoral Neck
Intertrochanteric
Subtrochanteric

Question 28

most hip fractures are explained by what two things?

Answer 28

1. underlying bone mass

2. age

Question 29

after a hip fracture, an individual is a t a high risk for?

Answer 29

mortality

Question 30

what is a trochanteric bursitis?

Answer 30

Mechanism: Compression, Trauma, or Overuse

due to all the muscle attachments in that area

Question 31

What signs will you see with a trochanteric bursitis? what test will be positive? what will be negative?

Answer 31

Pain Located Lateral Side
Generally Very Tender
Positive Ober’s Test
X-rays are Negative

Question 32

what are symptoms with a gluteus tendon rupture?

Answer 32

same as trochanteric bursitis

Question 33

how do you diagnose a gluteal tendon rupture?

whats the treatment?

Answer 33

MRI

surgery is only treatment