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CORE: MSK > Hip > Flashcards

Hip Flashcards

1
Q

acetabulum composed of?

A

ilium, pubis, ischium; fused with triradiate cartilage

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2
Q

insertion site at greater/lesser trochanter apophyses

A

greater: gluteus medius, minimus, obturator internus/externus and piriformus
lesser: iliopsoas

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3
Q

classification system for acetabular fracture

A

Judet Letournel

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4
Q

intracapsular femoral fractures? extracapsular?

A

intracapasular: femoral head and neck fractures
extracapsular: intertrochanteric and subtrochanteric

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5
Q

complication of intracapsular fracture? blood supply

A

osteonecrosis due to injury to medial circumflex femoral arteries at femoral head; little blood supply from ligamentum teres

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6
Q

classification for femoral head fractures

A

Pipkin

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7
Q

association with femoral head fractures

A

posterior hip dislocations , AVN, post traumatic arthritis

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8
Q

categories of femoral neck fractures

A

subcapital, transcervical, basicervical

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9
Q

subcapital femoral neck fracture classification system

A

Garden classification

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10
Q

Garden classification

A

I: incomplete/impacted fracture; valgus
II: complete, nondisplaced; varus ~160
III: complete, partially displaced; varus < 160
IV: complete, displaced; head/neck/acetabulum aligned

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11
Q

intertrochanteric extracapsular fracture classification?

A

Boyd-Griffin and Evans classification for intertrochanteric fractures by orthopedics

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12
Q

subtrochanteric extracapsular fracture classification?

A

Fielding or Seinsheimer classifications by orthopedics; inferior/lesser trochanter

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13
Q

optimizing hip MRI with hardware

A
  • low field strength, fast spin echo sequences (not GRE)
  • increased receiver bandwidth (increase number of aquisitions/NEX, since noise increases)
  • direct artifacts in superior/inferior plane so region medial/lateral to implant will not be obscured
  • decrease voxel size (decrease slice thickness, increase matrix)
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14
Q

hip fracture on MRI

A

T1/2 hypointense; hyperintense edema on T2

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15
Q

Stress fracture types

A

fatigue: abnormal stress, normal bone
insufficiency: normal stress, demineralized/abnormal bone

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16
Q

Stress fracture imaging appearance (XR, MRI)

A

XR:band of sclerosis
MR: hypointense fracture line with hyperintense T2 bone marrow edema

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17
Q

common location for stress fracture in hip? atypical locations?

A

inferomedial femoral neck

superior femoral head fractures may also occur, indistinguishable from AVN

atypical: lateral/transverse femoral diaphyseal fracture (secondary to bisphosphonate use)

18
Q

primary blood supply of the femur

A

medial femoral circumflex artery

19
Q

traumatic AVN cause:

nontraumatic AVN cause:

A

traumatic: fracture in elderly, transient subluxation in athletes
nontraumatic: sickle cell disease, abnormal marrow packing (Gaucher disease), steroids, alcohol, immunosuppression; more likely to be bilateral

20
Q

how can spleen help you narrow down cause of AVN?

A

splenomegaly: Gaucher

small calcified spleen: sickle cell

21
Q

most common sites of AVN

A

proximal femur, second is the proximal humor

22
Q

XR staging system for AVN hip

A

Ficat system, radiographic system

Stage 1: Normal radiograph, with signs of AVN visible on MRI (discussed below) or bone scan (reduced tracer uptake in the femoral head). Treatment is core femoral head drilling.
Stage 2: Cystic and sclerotic changes. Treatment is same as stage I.
Stage 3: There is loss of the normal spherical shape of the femoral had due to collapse of subchondral bone. A subchondral lucent line representing the crescent sign may be visible on radiographs. Treatment is variable.
Stage 4: Flattening of the femoral head and secondary osteoarthritis. Treatment is joint replacement.

23
Q

MR classification for AVN hip

A

Mitchell system or modified Ficat system?

24
Q

MR findings for AVN

A

geographic subchondral lesion with serpentine low signal rim (T1)

  • anterior/superior portions
  • 10 o’clock
  • 2 o’clock

double line sign on T2WI with peripheral low intensity rim and inner high intensity band (pathognomonic)

include presence of collapse, size of T1 signal abnormality (percentage of femoral head), secondary involvement of acetebulum

25
Q

transient osteoporosis/bone marrow edema

A

combination of disorders that include SNS overactivity, stress fracture, transient ischemia (diagnosis of exclusion)

26
Q

Demographics of TBME

A

lasts a few months
young to middle aged adults, usually men
pregnant women

27
Q

Radiographic findings of TBME

A

XR: regional osteopenia, no degenerative changes/arthritis

MR: T1 low signal, T2 high signal

28
Q

Cause of labral injury

A

acute trauma, chronic repetitive microtrauma

DDH or femoral acetabular impingement may predispose to labral injury

29
Q

Common location for labral injury

A

anterosuperior

30
Q

abnormal abutment of femur with acetabulum at extremes ROM

A

FAI; femoracetabular impingement

31
Q

types of FAI

A

cam type and pincer type

32
Q

Cam type most common in what population?

A

young athletic males

33
Q

XR findings of Cam

A

pistolgrip deformity, large alpha angle

34
Q

Treatment Cam deformity

A

femoral osteoplasty

35
Q

Cause of cam

A

SCFE, hip dysplasia (acetabular undercoverage), malunited fx

36
Q

Cause of pincer type FAI

A

overcoverage of acetabulum

37
Q

Pincer type most common in what population?

A

middle aged females

38
Q

XR findings of pincer type FAI

A

crossover sign

39
Q

treatment for pincer type

A

acetabular rim trimming

40
Q

Mixed type impingement

A

abnormalities of femoral head/neck junction and acetabulum

41
Q

best view for acetabular walls? pelvic ring fractures?

A

Judet views: actebular views

Inlet/outlet: pelvic ring fx

CORE: MSK (13 decks)

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