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Orthopedics > Hip > Flashcards

Hip Flashcards

1
Q

Hip dislocations should be reduced within what time frame and why

A

within 6 h to decrease risk of AVN of the femoral head

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2
Q

Hip precautions following dislocation

A

no extreme hip flexion, adduction, internal or external rotation for 6 weeks post-reduction

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3
Q

Concurrence of hip dislocations and fractures

A

up to 50% of patients with hip dislocations suffer fractures elsewhere at the time of injury

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4
Q

Anterior hip dislocation mechanism

A

posteriorly directed blow to knee with hip widely abducted

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5
Q

Anterior hip dislocation clinical features

A

shortened, abducted, externally rotated limb

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6
Q

Anterior hip dislocation treatment

A

■ closed reduction under conscious sedation/GA

■ post- reduction CT to assess joint congruity

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7
Q

Posterior hip dislocation mechanism

A

severe force to knee with hip flexed and adducted

■ e.g. knee into dashboard in MVC

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8
Q

Posterior hip dislocation clinical features

A

shortened, adducted, internally rotated limb

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9
Q

Posterior hip dislocation treatment

A

■ closed reduction under conscious sedation/GA only if no associated femoral neck fracture or ipsilateral displacement

■ ORIF if unstable, intra-articular fragments, or posterior wall fracture

■ post-reduction CT to assess joint congruity and fractures

■ if reduction is unstable, put in traction x 4-6 wk

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10
Q

Rochester method to reduce posterior dislocations

A
  • Patient lying supine with hip and knee flexed on injured side
  • Surgeon stands on patient’s injured side
  • Surgeon passes one arm under patient’s flexed knee, reaching to place that hand on patient’s other knee (thus supporting patient’s injured leg)
  • With other hand, surgeon grasps patient’s ankle on injured side, applying traction, while assistant stabilizes pelvis
  • Reduction via traction, internal rotation, then external rotation once femoral head clears acetabular rim
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11
Q

Complications for all hip dislocations

A
  • post-traumatic OA
  • AVN of femoral head
  • fracture of femoral head, neck, or shaft
  • sciatic nerve palsy in 25% (10% permanent)
  • HO
  • thromboembolism – DVT/PE
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12
Q

Hip fracture clinical features

A
  • acute onset of hip pain
  • unable to weight-bear
  • shortened and externally-rotated leg
  • painful ROM
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13
Q

Xray features of subcapital hip fractures

A
  • Disruption of Shenton’s line (a radiographic line drawn along the upper margin of the obturator foramen, extending along the inferomedial side of the femoral neck)
  • Altered neck-shaft angle (normal is 120-130°)
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14
Q

DVT prophylaxis in hip fractures

A

LMWH (i.e. enoxaparin 40 mg SC bid), fondaparinux, low dose heparin on admission, do not give <12 h before surgery

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15
Q

Femoral neck (subcapital) fracture definition

A

Intracapsular

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16
Q

Femoral neck (subcapital) fracture mechanism

A

Young: MVC, fall from height

Elderly: fall from standing, rotational force

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17
Q

Femoral neck (subcapital) fracture special clinical features

A

Same as general

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18
Q

Femoral neck (subcapital) fracture investigations

A

Xray
AP hip
AP pelvis
Cross table lateral hip

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19
Q

Femoral neck (subcapital) fracture complications

A

DVT

Non-union

AVN

dislocation

20
Q

AVN of femoral head

A
  • Distal to proximal blood supply along femoral neck to head (medial and lateral femoral circumflex arteries)
  • Susceptible to AVN if blood supply disrupted

Etiology: femoral neck fracture, chronic systemic steroid use, SCFE, Legg-CalvéPerthes, SLE, RA

21
Q

Intertrochanteric fracture stable vs unstable

A

Stable: intact posteromedial cortex

Unstable: non-intact posteromedial cortex

22
Q

Intertrochanteric fracture definition

A

Extracapsular fracture including the greater and lesser trochanters and transitional bone between the neck and shaft

23
Q

Intertrochanteric fracture mechanism

A

Same as femoral neck fracture Direct or indirect force transmitted to the intertrochanteric area

24
Q

Intertrochanteric fracture special clinical features

A

Ecchymosis at back of upper thigh

25
Q

Intertrochanteric fracture investigations

A

X-Ray: AP pelvis, AP/lateral hip

26
Q

Intertrochanteric fracture treatment

A

Closed reduction under fluoroscopy then dynamic hip screw or IM nail

27
Q

Intertrochanteric fracture complications

A

DVT,

varus displacement of proxim l fragment,

malrotation,

nonunion,

failure of fixation device

28
Q

Subtrochanteric hip fracture definition

A

Fracture begins at or below the lesser trochanter and involves the proximal femoral shaft

29
Q

Subtrochanteric hip fracture mechanism

A

Young: high energy trauma Elderly: osteopenic bone + fall, pathological fracture

30
Q

Subtrochanteric hip fracture special clinical features

A

Ecchymosis at back of upper thigh

31
Q

Subtrochanteric hip fracture investigations

A

X-Ray: AP pelvis, AP/lateral hip and femur

32
Q

Subtrochanteric hip fracture treatment

A

Closed/open under fluoroscopy, then plate fixation or IM nail

33
Q

Subtrochanteric hip fracture complications

A

Malalignment

non-union

wound infection

34
Q

Garden classification of femoral neck fractures

A 
Type I 
Displacement none 
Extent incomplete 
Alignment valgus or neutral 
Trabeculae malaligned 
Tx internal fixation to prevent displacement (valgus impacted fracture) 
Type II 
Displacement None 
Extent Complete 
Alignment Neutral 
Trabeculae aligned 
Tx interal fixation to prevent displacement 
Type III 
Displacement some 
Extent complete 
Alignment varus 
Trabeculae malaligned 
Tx young - ORIF, elderly hemi/total hip arthroplasty 
Type IV 
Displacement complete 
Extent complete 
Alignment varus 
Trabeculae aligned 
Treatment young ORIF, elderly hemi/total hip arthroplasty
35
Q

Arthritis of the hip etiology

A

OA, inflammatory arthritis, post-traumatic arthritis, late effects of congenital hip disorders, or septic arthritis

36
Q

Arthritis of the hip clinical features

A

pain (groin, medial thigh) and stiffness aggravated by activity better with rest in OA

  • RA: morning stiffness >1 h, multiple joint swelling, hand nodules
  • decreased ROM (internal rotation is lost first)
  • crepitus
  • effusion
  • ± fixed flexion contracture leading to apparent limb shortening (Thomas test)
  • ± Trendelenburg sign
37
Q

Arthritis of the hip investigations

A

X-ray: weight-bearing views of affected joint
■ OA: joint space narrowing, subchondral sclerosis, subchondral cysts, osteophytes

  • RA: osteopenia, erosion, joint space narrowing, subchondral cysts
  • blood work: ANA, RF
38
Q

Arthritis of the hip treatment

A

• non-operative
■ weight reduction, activity modification, physiotherapy, analgesics, walking aids

• operative
■ indication advanced disease
■ realign = osteotomy; replace = arthroplasty; fuse = arthrodesis

• arthroplasty is standard of care in most patients with hip arthritis

39
Q

• complications with hip arthroplasty:

A

component loosening

dislocation,

HO,

thromboembolism,

infection,

neurovascular injury,

limb length discrepancy

40
Q

Hip dislocation post-total hip arthroplasty occurrence

A

occurs in 1-4% of primary THA and 10-16% of revision THAs

41
Q

Hip dislocation post-total hip arthroplasty risk factors

A

neurological impairment

post-traumatic arthritis

revision surgery

substance abuse

42
Q

Hip dislocation post-total hip arthroplasty mechanism

A

THA that is unstable when hip is flexed, adducted, and internally rotated, or extended and externally rotated (avoid flexing hip >90° or crossing legs for ~6 wk after surgery)

43
Q

Hip dislocation post-total hip arthroplasty investigations

A

X-ray: AP pelvis, AP and lateral hip

44
Q

Hip dislocation post-total hip arthroplasty treatment

A

• non-operative
■ closed reduction: external abduction splint to prevent hip adduction (most often)

• operative
■ indication: 2 or more dislocations with evidence of polyethylene wear, malalignment, hardware failure
■ revision THA
■ conversion to hemiarthroplasty with a larger femoral head
■ resection arthroplasty is a last resort

45
Q

Hip dislocation post-total hip arthroplasty complications

A
  • sciatic nerve palsy in 25% (10% permanent)
  • HO
  • infection
46
Q

DVT prophylaxis in elective THA

A

(continue 10-35 d post-operative) Fondaparinux, low molecular weight heparin, or warfarin

Orthopedics (19 decks)

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