Hip Flashcards
What is femoroacetabular impingement syndrome, and what are the types?
irregular shape of the hip joint bones, causing rubbing
CAM:
Femoral deformity, common in athletic males
Can be related to previous SUFE
Can tear labrum -> predispose to OA
PINCER:
Acetabular overhang
More common in females
COMBINED:
Both
Femoroacetabular impingement syndrome-
How does it present?
groin pain
Difficulty sitting
C sign and FADIR positive
C sign- clutching above greater trochanter of affected hip
FADIR- (pain during) Flexion, ADduction, Internal Rotation
How is femoroacetabular impingement syndrome investigated and managed?
X-ray, MRI, CT
MRI good for looking at labrum damage and bone marrow oedema
Treatment:
Non surgical ie lifestyle mods
Surgical- arthroscopic/open correction of affected bone
Debridement of labral tears
What is Avascular necrosis, and what causes it?
Loss of blood supply to a bone (can be temp or permanent)
ID STARS-
Idiopathic
Decompression sickness
Steroids
Trauma
Alcoholism
Radiation
Sickle cell (haematological disease)
How does AVN present and how is it classified?
Groin pain made worse by stairs, usually unremarkable examination
Steinberg classification
How is AVN investigated and managed?
MRI gold standard- bone marrow oedema in early stages
Management:
Bisphosphonates
Core decompression +/- bone grafting
Osteotomy
THR
What is Idiopathic Transient Osteonecrosis of the Hip (ITOH)?
Who tends to get it?
How does it work?
Localised hyperaemia and subsequent impairment of venous drainage -> increases intramedullary pressure -> femoral head death
Common in middle aged men, and pregnant women in 3rd trimester
How does ITOH present, how is it investigated, and how is it treated?
Several week history of unilateral progressive groin pain + weight bearing issues
MRI gold standard- shows bone marrow oedema
X-ray shows osteopenia of femoral head and neck with cortical thinning
ESR high
Self limiting- manage with analgesia and it self resolves
Crutches help with weight bearing issues MRI gold
What can cause trochanteric bursitis?
Repeat trauma due to stress and overuse (iliotibial band tracking over bursa causing inf.)
More common in females, and also more common in athletes and old people
How does trochanteric bursitis present, and how is it investigated and treated?
Lateral hip pain, especially on palpation of greater trochanter, painful abduction
Investigated and diagnosed clinically, MRI not really needed
NSAIDs, physio, steroid injections
What causes dislocation of the hip?
High impact ie RTA
Sporting injury when hip is flexed and internally rotated
How does a hip dislocation present and what are the associated fractures?
Slightly flexed, internally rotated, adducted knee
Severe pain in groin radiating in legs, with swelling
Associated with posterior acetabular wall, femoral
How are hip dislocations investigated and treated?
What are some complications?
X-ray, CT to assess further injury and possible nerve damage
Treated with urgent reduction and stabilisation, and fixation of associated fractures
Complications:
Sciatic nerve palsy
Femoral head AVN
Secondary OA
What causes hip fractures and what are some risk factors?
High impact injury (impact required lessens as patients get older)
92% are over 60, 73% female
Commonly associated with osteoporosis
Smoking + alcohol
Malnutrition
Neuro symptoms
Low BMI (fragility)
What are the types of hip fractures?
Intracapsular- proximal to intertrochanteric line (involves femoral head and neck)
Risk of AVN and non union of the femoral head
Can damage medial femoral circumflex artery
extracapsular- distal to intertrochanteric line
Lower risk of AVN as head of femur remains intact
How do hip fractures present, and how are they investigated and managed?
Severe groin/hip pain with inability to bear weight
Limb shortening on affected side
Investigate with X-ray, usually quite easy to see via loss of contour of shentons line. Can do MRI if more subtle
Assess neurovascular status
surgical management:
Intracapsular:
High function patient- THR if displaced, CHS if not displaced
Low function patient- Hemiarthroplasty
Extracapsular:
Interochanteric- DHS
Subtrochanteric- IM nail
