Outline the anatomy of the hip joint.
Acetabulum and labrum with head of femur
Outline the vasculature of the hip joint.
Supplied by profunda femoris- medial and lateral circumflex arteries anastomose, forming a circle around the femur
What ligaments support the hip joint?
- Iliofemoral (Strongest) - Ischiofemoral (Posterior) - Pubofemoral (Anterior-inferior) - Ligament of head of the femur (carrying artery of head of the femur/acetabular branch of obturator artery)
What normally causes hip #s in the elderly?
Osteroperosis + minor trauma
What normally causes hip #s in the younger Pt?
Trauma
What are the risk factors for osteoperosis?
Age + Shattered
Steroids
Hyperthy/parathy
Alcohol/smoking
Thin (BMI<22)
Testosterone low
Early menopause
Renal/liver disease
Erosive bone disease e.g. myeloma
Diet (Low Ca, malabsorption)
What are the key questions in the history?
- Mechanism
- Risk factors
- Baseline level of activity and mobility
- Co-morbidities
- MMSE
What imaging is used in hip #s?
XR- AP and lateral films
What is Shenton’s Line?
What should you look for on XR?
- Intra vs extra capsular
- Displaced or non-displaced
How does a hip # present?
- Pain
- Inbility to WB
- History of trauma/low impact injury
What are the signs of a hip #?
Shortened, externally rotated limb
What bloods should be done?
- UsEs- rhabdomyolysis
- Coag Studies
- Cross match 2 units
- FBC- platelets
Why might a urine dip or CXR be useful?
Cause of injury
Outline Garden classification.
INTRACAPSULAR ONLY
- Incomplete #
- Complete #, undisplaced
- Complete #, partially displaced
- Complete #, fully displaced (much of the way)
What other XRs should you have?
- AP Pelvis
- Full length femoral
What is the initial management?
RAN
Resuscitation
Analgesia
NV examination
How are they surgically managed by Garden classification?
1/2 ORIF with cancellous screws
3/4
- <55yo- ORIF with screws, arthroplasty if AVN
- 55-75/active THR
- 75+/inactive Hemiarthroplasty
When is a girdlestone indicated?
Usually a temprorary measure:
- Failed arthroplasty
- Failed fixation
What are the complications of a hip fracture?
- AVN- medial circumflex
- Mortality 30% at one year
- NV Damage
- Post-op
- Bleed
- Infection (including prostheses)
- Metalwork prominence
How is an extracapsular # surgically treated?
DHS (Dynamic Hip Screw)
What does a DHS look like on XR?
