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MSK > Hip > Flashcards

Hip Flashcards

1
Q

What is a complication of head of femur fracture?

A

AVN

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2
Q

If a hip dislocates anteriorly/posteriorly describe how the leg is most likely to rotate?

A

Anteriorly - externally

Posteriorly - internally

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3
Q

When examining a patient with hip pain it is very important to establish the site of pain. If the pain is in the following regions what are you most likely thinking:

Buttocks
Groin
Lateral thigh

A

Buttocks

  • referred pain from lumbar spine/SI joints
  • could still be pathology

Groin
- most likely a hip pathology

Lateral thigh (over trochanter)
- Trochanteric bursitis
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4
Q

Where may hip pathology pain refer to?

This is because these 2 regions both have the same nerve supply. What nerves innervate this region?

A

Knee

Sciatic
Obturator
Femoral

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5
Q

What is usually the first movement which is lost with hip pathology?

A

Internal rotation

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6
Q

A patient presents with pain and tenderness over the greater trochanter and pain on abducting the hip.

What is the pathology for their condition?

A

Trochanteric bursitis

Tendons (in particular gluteus medius) insert into greater trochanter
These can become inflamed and under strain -> inflamed bursa
(similar to rotator cuff problems in shoulder)

Can also be caused by iliotibial tract rubbing against bursa in thigh

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7
Q

What is the classic patient to present with AVN of hip?

Describe their presentation

What makes the pain worse?

A

Male 35-50 years

Most commonly bilateral hip pain - in groin region
Insidious onset

Worse by stairs/impact

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8
Q

What is the difference in treatment between reversible and irreversible AVN?

A

Reversible - core decompression (drill into bone)

Irreversible - total hip replacement (THR)

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9
Q

What are the signs of OA on xray?

A

LOSS

loss of joint space
osteophytes
subchondral cysts
subchondral sclerosis

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10
Q

What is the only indication for a hip replacement?

A

Pain

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11
Q

In THR a cemented stem is always used but there is variation on whether cemented cup is used.

What patient receives an uncemented cup?

A

Younger patient - roughly 50 yo

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12
Q

What is the most commonly used THR?

A

Cemented cup and stem

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13
Q

Trochanteric bursitis can affect both younger and older patients.

What activity is the younger patient most likely to take part in which can cause the condition?

A

Running

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14
Q

Native hip dislocations are rare. If they do occur what is the most common direction?

A

Posteriorly

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15
Q

What nerve must be in particular checked for post native hip dislocation?

A

Sciatic nerve - test to see if can move ankle (supplied by tibial and fibular nerve - branches of sciatic nerve)

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16
Q

What is given for analgesia pre operatively for hip fracture?

A

Traditional - IV morphine

New model - nerve blockers (ending -caine)

17
Q

What is the target time for patients to get surgery for hip fracture?

A

Within 36hrs of admission

18
Q

Is THR or hemiarthoplasty the surgery of choice for elderly care?

A

Hemiarthoplasty

19
Q

If you find a pelvic fracture what must you now check for?

A

Other fractures/ligament damage

Pelvis is in a ring

20
Q

With lateral compression fractures of the pelvis, there will be a fracture to the pubic rami or ischium plus what?

A

Sacral compression fracture

SI joint disruption

21
Q

What type of pelvic injury has the greatest risk of injury to nerve roots?
Why?

A

Vertical shear fracture

Damage to coccyx and caudia equina

22
Q

What type of pelvic injury is associated with high levels of internal bleed?

What is damaged?

How is this managed?

A

Antero-posterial compression injury

Pubic symphysis torn at the very best

Bind pelvis w/ tight sheet or pelvic bind

23
Q

What examination is mandatory with a pelvic fracture?

What are you checking for?

A

PR exam

PR bleed - suggestive of damage to rectal canal
Loss of anal tone - Sacral nerve damage

24
Q

What type of pelvic fracture is most likely to be caused by low energy injuries in the elderly.

How are these managed?

A

Lateral compression fracture

Mainly conservatively in elderly

25
Q

Who is more likely to present with acetabular fracture?

What is the best way to view these fractures?

A

Young in high energy injuries

CT scans as can be difficult to view on typical X-rays

26
Q

Why are intracapsular fractures at an increased risk of AVN than extracapsular arteries?

A

The circumflex arteries that supply the hip joint with the majority of their blood supply sit in the intracapsular region

27
Q

What are the 3 ways a hip joint fracture can be described?

What are the boundaries for these?

A

Intracapsular - proximal to the greater trochanter

Trochanteric - between greater and lesser trochanter

Subtrochanteric - inferior to lesser trochanter

28
Q

What bedside tests should be done for hip fracture patients to prep them for surgery?

A

ECG

Bloods

29
Q

What is Shenton’s line?

What can a distribution to it indicate?

A

Curved, hooked line starting from medial line of shaft of femur and curving along femur neck, head and superior pubic rami

Neck of femur fracture

30
Q

In general what is the surgical management for intracapsular vs extra capsular?

What is the target surgery time?

A

Intra = replace
High function = THR
Low function = hemiarthroplasty

Extra = fix

Within 36hrs

31
Q

Why is THR reserved for patients with higher function?

A

Increased risk of dislocation but does give better function

32
Q

Under what circumstances would you offer an intracapsular fracture a fixation over THR?

A

Young patient with minimally displaced and with no previous arthritis

Better to keep own hip

33
Q

What classification system is used for hip/neck of femur fractures?

A

Garden

MSK (41 decks)

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