Hip conditions Flashcards
What is the risk of intramuscular injection in the gluteal region?
Injury to sciatic nerve
What are the two safe sites of intramuscular injection in the gluteal region?
Dorsogluteal site
Ventrogluteal site
Which site is used for children 3-7 years?
Dorsogluteal site
What is the dorsogluteal site?
Posterior surface
Upper lateral quadrant
Which site is for children aged 7+ and adults?
Ventrogluteal site
What is the ventrogluteal site?
Palm over greater trochanter
Thumb toward inguinal region
Index finger to ASIS
Spread out finger
Inject between PIP joints of index and middle finger
What are the risk factors of osteoarthritis to the hip joint?
Past injury to hip joint
Obesity
Genetic component
What are the symptoms of osteoarthritis of the hip joint?
Joint pain, and pain in gluteal region, groin
Joint stiffness
Joint grinding
What are the signs of osteoarthritis of the hip joint?
Joint deformity
What is a pelvic fracture?
Fracture of the hip bone
Do fractures of the hip bone involve a single fracture or multiple fractures? Why?
Multiple fractures
Polo mint principle
How do fractures of the hip bone occur? Give some examples of each
Direct trauma to hip bone e.g. car accident
Force transmitted from lower limb e.g. fall on feet
Why are hip bone fractures often complicated?
Nearby soft tissues
easily damaged
Which soft tissues tend to be damaged in hip bone fractures?
Nerves, vessels
Bladder, urethra
Forces to anterior of hip bone will fracture the…?
Pubic rami
Forces to lateral hip bone will fracture the…?
Ilium
Acetabulum
Forces transmitted up lower limb will fracture the…?
Acetabulum
In people younger than 17, how does the acetabulum fracture?
Through the triradiate cartilage
bones have not yet fused
How are proximal femur fractures classified?
Intracapsular
Extracapsular
What is an intracapsular fracture of femur?
Occurs within hip joint capsule
What is an example of an intracapsular fractures?
Neck of femur fractures
What is a complication of intracapsular fractures?
Damage to medial circumflex artery and its branches
What is the risk of a damaged medial circumflex artery?
Avascular necrosis of head of
because artery to ligament of femoral head is inadequate
Why is the neck of femur a commonly fractured site on the femur?
Weakest part of femur, narrowest part of bone
At an oblique angle to femoral shaft
What group of people are intracapsular fractures common in?
Elderly women with osteoporosis
fracture results from a minor fall
What are the possible treatment options for neck of femur fractures?
Total hip replacement
Hemiarthroplasty
Dynamic hip screw
What is a total hip replacement?
Surgically removing acetabular cartilage
femoral head
replace them with artifical structures
When is total hip replacement used for treatment?
When avascular necrosis of head of femur has occurred
Non-subsiding osteoarthritis
What is hemiarthroplasty?
Removing femoral head
replacing it with artifical structure
When is hemiarthroplasty used for treatment?
Avascular necrosis of head of femur has occurred
What is a dynamic hip screw?
Involves screw in neck and head of femur
can slide over plate in femoral shaft
When is dynamic hip screw used for treatment?
Undisplaced fractures
Extra-capsular fractures
What are extracapsular fractures?
Occur outside of hip joint capsule
What are some examples of extracapsular fractures?
Intertrochanteric fractures
Subtrochanteric fractures
What type of fracture pattern do proximal femur fractures usually show?
Impacted fractures
Are proximal femur fractures usually displaced or undisplaced?
Displaced
How are the bony fragments displaced in a proximal femur fracture?
Distal fragment is pulled upwards by flexors, adductors
Laterally rotated by ilopsoas
Do proximal femur fractures show shortening of the thigh or not? Why?
Yes they do
because bony fragments override each other
What causes a femoral shaft fracture?
Direct trauma
What type of fractures are femoral shaft fractures usually?
Spiral fractures
Comminuted fractures
Is there shortening of the thigh with spiral fractures or not? Why?
Yes
bony fragments override each other
by pull of muscles
Do the fragments in a comminuted fracture of the thigh displace or not? Why?
Yes
due to pull of muscles attached on the fragments
What are the cimplications of femoral shaft fractures?
Injury to neurovascular structures
e.g. femoral nerve, artery
What is a hip dislocation?
Femoral head not properly located in acetabulum
What are the types of hip dislocations?
Congenital
Acquired
- anterior
- posterior
What is congenital hip dislocation?
Hip joint does not develop properly in utero
What are the clinical features of congenital hip dislocation?
Limited abduction at hip joint
Affected lower limb is shorter - femoral head is superior to acetabulum
Positive tredelenburg sign - looks like it
What causes a posterior hip dislocation?
Force on femur
drives it posteriorly through acetabulum
How is the joint capsule affected in a posterior hip dislocation?
Torn posteriorly and inferiorly
Where does the femoral head lie in a posterior dislocation?
Posterior to acetabulum
Is there shortening of the thigh with a posterior hip dislocation or not? Why?
Yes
Because femoral head has moved further up along the hip bone
What does the lower limb look like with a posterior hip dislocation?
Shortened
Medially rotated
What is a complication of a posterior hip dislocation?
Injury to sciatic nerve
What are the consequences of injury to sciatic nerve?
Loss of function in posterior thigh muscles, all leg muscles
Loss of sensation in all of leg
apart from medial leg and medial foot which is supplied by saphenous nerve, branch of femoral nerve
What causes anterior hip dislocations?
Hip is forced into extension, abduction, lateral rotation
Where does the femoral head lie with an anterior hip dislocation?
Anteriorly and inferiorly to acetabulum
What are anterior hip dislocations associated with?
Fracture to femoral head
giving fracture-dislocation of hip joint
What are the features of superior gluteal nerve injury?
Positive tredelenburg sign
Tredelenburg gait
Weakened medial rotation
What is a pulled hamstring?
Stretched posterior thigh muscles
partial or complete tear
What causes a pulled hamstring?
Sudden exertion of posterior thigh muscles
e.g. sprinting
What are some complications of pulled hamstrings?
Rupturing of blood vessels, haematoma
Avulsion fracture of ischial tuberosity
What are the possible causes of swelling in the popliteal fossa?
Baker’s cyst - inflammation of semimembranosus bursa
Popliteal aneurysm
Abscess
Enlarged lymph nodes
Benign or malignant tumour of bone, muscle, connective tissue
