Hip Flashcards
What is a complication of head of femur fracture?
AVN
If a hip dislocates anteriorly/posteriorly describe how the leg is most likely to rotate?
Anteriorly - externally
Posteriorly - internally
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
Buttocks
- referred pain from lumbar spine/SI joints
- could still be pathology
Groin
- most likely a hip pathology
Lateral thigh (over trochanter) - Trochanteric bursitis
Where may hip pathology pain refer to?
This is because these 2 regions both have the same nerve supply. What nerves innervate this region?
Knee
Sciatic
Obturator
Femoral
What is usually the first movement which is lost with hip pathology?
Internal rotation
A patient presents with pain and tenderness over the greater trochanter and pain on abducting the hip.
What is the pathology for their condition?
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
What is the classic patient to present with AVN of hip?
Describe their presentation
What makes the pain worse?
Male 35-50 years
Most commonly bilateral hip pain - in groin region
Insidious onset
Worse by stairs/impact
What is the difference in treatment between reversible and irreversible AVN?
Reversible - core decompression (drill into bone)
Irreversible - total hip replacement (THR)
What are the signs of OA on xray?
LOSS
loss of joint space
osteophytes
subchondral cysts
subchondral sclerosis
What is the only indication for a hip replacement?
Pain
In THR a cemented stem is always used but there is variation on whether cemented cup is used.
What patient receives an uncemented cup?
Younger patient - roughly 50 yo
What is the most commonly used THR?
Cemented cup and stem
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?
Running
Native hip dislocations are rare. If they do occur what is the most common direction?
Posteriorly
What nerve must be in particular checked for post native hip dislocation?
Sciatic nerve - test to see if can move ankle (supplied by tibial and fibular nerve - branches of sciatic nerve)
What is given for analgesia pre operatively for hip fracture?
Traditional - IV morphine
New model - nerve blockers (ending -caine)
What is the target time for patients to get surgery for hip fracture?
Within 36hrs of admission
Is THR or hemiarthoplasty the surgery of choice for elderly care?
Hemiarthoplasty
If you find a pelvic fracture what must you now check for?
Other fractures/ligament damage
Pelvis is in a ring
With lateral compression fractures of the pelvis, there will be a fracture to the pubic rami or ischium plus what?
Sacral compression fracture
SI joint disruption
What type of pelvic injury has the greatest risk of injury to nerve roots?
Why?
Vertical shear fracture
Damage to coccyx and caudia equina
What type of pelvic injury is associated with high levels of internal bleed?
What is damaged?
How is this managed?
Antero-posterial compression injury
Pubic symphysis torn at the very best
Bind pelvis w/ tight sheet or pelvic bind
What examination is mandatory with a pelvic fracture?
What are you checking for?
PR exam
PR bleed - suggestive of damage to rectal canal
Loss of anal tone - Sacral nerve damage
What type of pelvic fracture is most likely to be caused by low energy injuries in the elderly.
How are these managed?
Lateral compression fracture
Mainly conservatively in elderly
Who is more likely to present with acetabular fracture?
What is the best way to view these fractures?
Young in high energy injuries
CT scans as can be difficult to view on typical X-rays
Why are intracapsular fractures at an increased risk of AVN than extracapsular arteries?
The circumflex arteries that supply the hip joint with the majority of their blood supply sit in the intracapsular region
What are the 3 ways a hip joint fracture can be described?
What are the boundaries for these?
Intracapsular - proximal to the greater trochanter
Trochanteric - between greater and lesser trochanter
Subtrochanteric - inferior to lesser trochanter
What bedside tests should be done for hip fracture patients to prep them for surgery?
ECG
Bloods
What is Shenton’s line?
What can a distribution to it indicate?
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
In general what is the surgical management for intracapsular vs extra capsular?
What is the target surgery time?
Intra = replace
High function = THR
Low function = hemiarthroplasty
Extra = fix
Within 36hrs
Why is THR reserved for patients with higher function?
Increased risk of dislocation but does give better function
Under what circumstances would you offer an intracapsular fracture a fixation over THR?
Young patient with minimally displaced and with no previous arthritis
Better to keep own hip
What classification system is used for hip/neck of femur fractures?
Garden
