Hip

Question 1

Quadriceps contusion

Answer 1

Due to direct trauma.
Patient complain of dull aching pain and there is TOP , swelling and often diffuse hematoma
Pain is increased by knee flexion
Treatment - Phase1: limit swelling and haemorrhage by using rest, ice, elevation and compressive dressing for 24-48 hours. Phase 2: restore motion to muscle while continuing with ice. Active movements and WB is only allowed when it does not cause significant pain. Phase 3: functional rehabilitation

Question 2

Femoral shaft fracture

Answer 2

MOI: direct blow or indirect force transmission through the flexed knee. In children fall from height.
Femoral shaft are associated with significant bleeding
Patient presents with significant pain and usually have visible deformities. The thigh will be swollen and tense secondary to haemorrhage. Neurovascular examination should be performed.

Question 3

Septic arthritis

Answer 3

70% of septic arthritis of hip (native joint) occurs in children aged 4 years or younger. The infection usually reaches the hip joint from a focus of osteomyelitis within the joint capsule. The osteomyelitis is usually hematogenous origin and arises in the metaphysis by way of nutrient vessel.
Characteristically patients present with fever and severe pain in the affected hip. On examination, there is tenderness anteriorly in the groin accompanied by grossly restricted ROM in all directions.
In children, diagnosis is confirmed in 4 out 5 of the following: temperature >38.2, localised hip pain with painful passive ROM, swelling, systemic symptoms, positive response to antibiotics

Question 4

Avascular Necrosis (femoral head)

Answer 4

Any condition that disrupts the blood supply to femoral head can cause this disorder. Trauma to the major blood vessel is the most common cause eg with femoral neck fracture or hip dislocation.
Steroid use and alcohol ingestions are associated with 90% of atraumatic cases.
The articular cartilage covering the necrotic head initially survives because it derives its nutrients from the synovial fluid but undergoes degeneration when the subcondylar bone cortex collapses.
The most common complaint is hip pain and joint motion is decreased and painful esp. hip IR. It is not the death of bone cells that cause pain but rather the collapse and fracture of subchondral bone.

Question 5

What group of patients are predisposed to hip injuries or pain and why?

Answer 5

1. Frail, older patients with osteoporosis - pathological fracture
2. Patients with cardiovascular disease - increased risk of developing aortoiliac arterial insufficiency