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MSK > Hip fractures Hip dislocation Trochanteric bursitis Femoral artery pulse > Flashcards

Hip fractures Hip dislocation Trochanteric bursitis Femoral artery pulse Flashcards

1
Q

What is the typical mechanism of injury for hip fractures in the elderly?

A

A low impact fall

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2
Q

What percentage of patients with hip fractures are over 60 years old?

A

92%

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3
Q

What is the predominant gender affected by hip fractures?

A

73% of patients are female

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4
Q

What are the common risk factors associated with hip fractures?

A

Osteoporosis, smoking, alcohol use, malnutrition, neurological impairment, impaired vision, low BMI

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5
Q

What is the mortality rate at one year for individuals with hip fractures?

A

30%

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6
Q

How are hip fractures classified in terms of intracapsular and extracapsular fractures?

A

Based on their location in relation to the intertrochanteric line

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7
Q

What are the subdivisions of intracapsular fractures?

A

Subcapital and transcervical fractures

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8
Q

What are the potential complications of intracapsular fractures?

A

Femoral head AVN and non-union

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9
Q

What classification system is used for intracapsular fractures, predicting union and risk of AVN?

A

The Garden classification

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10
Q

Why are intracapsular fractures prone to femoral head AVN and non-union?

A

They can damage the medial femoral circumflex artery

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11
Q

Why are AVN and non-union rare in extracapsular fractures?

A

The blood supply to the head of the femur remains intact

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12
Q

What are the typical symptoms of hip fractures?

A

Hip/groin pain, swelling, inability to weight bear

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13
Q

What signs might be observed in a patient with a hip fracture?

A

Shortened and externally rotated lower limb on the affected side, potential cognitive impairment, signs of dehydration, and altered neurovascular status of the lower limb

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14
Q

How are hip fractures typically diagnosed using X-rays?

A

Most are visible on pelvic and lateral hip X-rays; loss of Shenton’s line indicates a hip fracture

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15
Q

What alternative imaging may be required if X-rays do not show the fracture, despite clinical suspicion?

A

MRI after 10 days or immediately in cases of persistent clinical suspicion

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16
Q

What is the primary treatment for hip fractures and why?

A

Surgical management followed by early mobilization to prevent complications from prolonged bed rest

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17
Q

What is the recommended approach for pain management in hip fractures?

A

Local nerve blocks rather than strong opiates

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18
Q

What is the 30-day mortality rate for hip fractures?

A

5-10%

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19
Q

What percentage of patients experience a decline in independence after a hip fracture?

A

Half of the patients

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20
Q

What are two major risk factors for hip fractures?

A

Increasing age and osteoporosis

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21
Q

Which gender is more commonly affected by hip fractures?

A

Females

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22
Q

Why are hip fractures generally prioritized on the trauma list?

A

Due to the significant morbidity and mortality associated with them

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23
Q

What is the goal timeline for performing surgery after a hip fracture?

A

Within 48 hours

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24
Q

What is the specialty that focuses on the medical co-morbidities of orthopedic inpatients, particularly elderly patients with hip fractures?

A

Orthogeriatrics

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25
Q

How are hip fractures categorized?

A

Into intra-capsular and extra-capsular fractures

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26
Q

Name the basic structures at the top of the femur.

A

Head, Neck, Greater trochanter, Lesser trochanter, Intertrochanteric line, Shaft (body)

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27
Q

What structures does the hip joint capsule attach to?

A

Attaches to the acetabulum on the pelvis and the intertrochanteric line on the femur

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28
Q

Why is a displaced intra-capsular fracture concerning?

A

It can damage the blood vessels supplying the femoral head, leading to avascular necrosis

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29
Q

What surgical interventions might be necessary for patients with a displaced intra-capsular fracture?

A

Femoral head replacement with hemiarthroplasty or total hip replacement

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30
Q

What concept regarding blood supply to the head of the femur influences the choice of operation for hip fractures?

A

Retrograde blood supply determines the choice of operation

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31
Q

How did understanding intra-capsular or extra-capsular fractures impact the management of patients with hip fractures during an FY1 job in trauma and orthopedics?

A

It facilitated the identification and justification of the choice of operation, making trauma meetings less stressful

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32
Q

What is the area affected in intra-capsular fractures?

A

The area proximal to the intertrochanteric line

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33
Q

What is the purpose of the Garden classification in intra-capsular neck of femur fractures?

A

It classifies these fractures based on completeness and displacement

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34
Q

How are non-displaced intra-capsular fractures managed?

A

Internal fixation (e.g., with screws) to hold the femoral head in place while the fracture heals

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35
Q

What is the treatment for displaced intra-capsular fractures (Grade III and IV)?

A

Head of the femur needs to be removed and replaced

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36
Q

What does hemiarthroplasty involve in treating hip fractures?

A

It involves replacing the head of the femur but leaving the acetabulum in place, often offered to patients with limited mobility or significant co-morbidities

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37
Q

When is total hip replacement generally offered in the context of hip fractures?

A

Generally offered to patients who can walk independently and are fit for surgery

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38
Q

Why doesn’t the blood supply to the head of the femur need to be replaced in extra-capsular fractures?

A

Extra-capsular fractures leave the blood supply to the head of the femur intact

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39
Q

How are intertrochanteric fractures treated?

A

Treated with a dynamic hip screw (sliding hip screw)

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40
Q

What is the preferred treatment for subtrochanteric fractures?

A

Intramedullary nail (a metal pole inserted through the greater trochanter into the central cavity of the shaft of the femur)

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41
Q

What are the typical symptoms seen in a patient with a hip fracture?

A

Pain in the groin or hip, inability to weight bear, shortened, abducted, and externally rotated leg

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42
Q

Why is assessing patients with a new hip fracture for acute illnesses important?

A

Often there is a good reason for the fall and identifying acute illnesses such as anemia, electrolyte imbalances, arrhythmias, etc., is crucial for optimizing the patient and minimizing surgery delays

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43
Q

What is meant by the term “mechanical fall” in the context of hip fractures?

A

It implies a simple explanation for why the patient fell, but it’s important to explore the fall in more detail as there might be an underlying medical or social cause that’s correctable

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44
Q

What is Shenton’s line, and where can it be visualized on an X-ray?

A

It is a continuous line formed by the medial border of the femoral neck and extends to the inferior border of the superior pubic ramus, visible on an AP x-ray of the hip

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45
Q

How can a fracture be confirmed if X-rays are negative but still suspected?

A

MRI or CT scanning may be employed

46
Q

What essential management steps occur upon a patient’s admission with a hip fracture?

A

Appropriate analgesia, diagnostic investigations (e.g., x-rays), venous thromboembolism risk assessment and prophylaxis, pre-operative assessment, and input from orthogeriatrics

47
Q

According to NICE guidelines, when should surgery ideally be performed after admission for a hip fracture?

A

Within 48 hours, either the same day or the day after admission

48
Q

Why is the operation for hip fractures aimed to allow weight bearing immediately post-surgery?

A

To enable physiotherapists to start mobilization and rehabilitation as soon as possible

49
Q

Why is post-operative analgesia crucial in hip fracture management?

A

It encourages patients to mobilize quickly after the operation

50
Q

What are the two primary classifications of hip fractures based on their anatomic location?

A

Intracapsular and extracapsular fractures

51
Q

How are intracapsular fractures defined in relation to the hip joint?

A

They occur in the region of the femoral head and neck within the joint capsule of the hip

52
Q

Where do extracapsular fractures occur within the femur?

A

They occur outside the fibrous joint capsule, in the intertrochanteric or subtrochanteric area of the femur

53
Q

Why are hip fractures more common in the elderly population?

A

Due to associated conditions such as osteoporosis, Vitamin D, and calcium deficiency

54
Q

What is the typical presentation of a hip fracture patient after a fall?

A

An acutely shortened, externally rotated leg compared to the contralateral side

55
Q

What are some clinical features indicating a hip fracture?

A

Hip or back pain, joint deformity, and the inability to bear weight

56
Q

Which type of fracture is more at risk of avascular necrosis and displacement of the femoral head?

A

Intracapsular fractures

57
Q

Why are intracapsular fractures more prone to avascular necrosis?

A

Disruption of the retinacular arteries branching from the medial circumflex femoral arteries, affecting blood supply to the femoral head

58
Q

Why are extracapsular femoral neck fractures less likely to undergo avascular necrosis?

A

The retinacular arteries are not disrupted, maintaining their blood supply function

59
Q

What imaging techniques are primarily used to confirm the diagnosis of a hip fracture?

A

Anterior-posterior and lateral hip x-rays

60
Q

What might be done if x-rays are inconclusive despite strong clinical suspicion of a hip fracture?

A

A CT scan

61
Q

How can intracapsular fractures be identified on imaging, particularly regarding Shenton’s line?

A

Identified by a loss of Shenton’s line, a line drawn from the inferior border of the superior pubic rami along the inferomedial border of the femoral neck

62
Q

What are key visual indicators of an intracapsular hip fracture?

A

Prominent lesser trochanter, external rotation, shortening, or angulation of the femoral neck

63
Q

Where do extracapsular fractures typically occur?

A

Intertrochanteric fractures between the greater and lesser trochanter or subtrochanteric fractures distal to the trochanters in the subtrochanteric region

64
Q

What are the surgical options for managing hip fractures?

A

Open reduction and internal fixation (ORIF) or arthroplasty

65
Q

What is open reduction and internal fixation (ORIF)?

A

A type of open surgery where the fractured bone is reconstructed using screws, plates, intramedullary rods, or a combination

66
Q

What does arthroplasty involve in the context of hip fractures?

A

Partial or total replacement of the femoral and acetabular components of the hip joint

67
Q

What potential complications might arise due to a hip fracture?

A

Sciatic nerve damage, chronic pain, nonunion, future arthritic changes, and dislocation

68
Q

What symptoms might occur if the sciatic nerve is damaged due to a hip fracture?

A

Paraesthesia in the sciatic nerve’s dermatomal distribution, and weakness in knee flexion, ankle dorsiflexion, and ankle plantar flexion

69
Q

What traumatic events commonly cause hip dislocations?

A

Motor vehicle collisions, especially head-on collisions

70
Q

Which type of hip dislocation is most frequent, and what percentage of dislocations do they account for?

A

Posterior dislocations, amounting to approximately 90%

71
Q

What is a common example of a high-velocity car accident causing a posterior dislocation?

A

Dashboard injury, which leads to hip forced into flexion, adduction, and internal rotation

72
Q

How does hyper-abduction with extension cause anterior dislocation, and in what scenario might this occur?

A

Motorcycle crashes, where the legs are hyper-abducted while riding

73
Q

Who is at an increased risk of hip dislocations, particularly posterior ones?

A

Individuals with hip replacements

74
Q

What are the common symptoms experienced by individuals suffering from a hip dislocation?

A

Audible “pop” or “clunk,” pain, and inability to bear weight

75
Q

What are the typical findings on examination for a posterior dislocation?

A

Shortening and internal rotation of the affected limb

76
Q

How is a diagnosis of hip dislocation confirmed?

A

X-ray

77
Q

What complications can result from hip dislocations, especially posterior ones?

A

Sciatic nerve damage, labral tears, and associated hip fractures

78
Q

What repetitive actions can lead to trochanteric bursitis?

A

Repetitive actions such as climbing stairs

79
Q

What causes the inflammation in trochanteric bursitis?

A

Tendons from the gluteus medius and minimus compressing the trochanteric bursa against the greater trochanter

80
Q

How is trochanteric bursitis diagnosed based on clinical symptoms?

A

Chronic pain in the lateral thigh and point tenderness over the greater trochanter

81
Q

How can pain be elicited to diagnose trochanteric bursitis?

A

Manually resisting abduction of the thigh while the person is lying on the unaffected side

82
Q

Where can the femoral artery be located in the femoral triangle, and how is it identified?

A

It can be palpated distal to the inguinal ligament at the mid inguinal point, which is halfway between the pubic symphysis and anterior superior iliac spine

83
Q

What information can assessing the femoral pulse provide in a clinical context?

A

It can offer insights into blood flow to the limb, especially in cases of peripheral artery disease, and it’s a significant location for catheterization in therapeutic and diagnostic procedures

84
Q

Why is the femoral artery important in cardiac catheterization procedures?

A

It can be used for cardiac catheterization for both diagnostic angiography and therapies such as stent placement

85
Q

What is retroperitoneal hemorrhage, and what can cause it during catheterization?

A

It occurs when blood tracks into the retroperitoneal space due to puncturing the posterior wall of the common femoral artery, and if arterial puncture is done above the inguinal ligament

86
Q

Why is retroperitoneal hemorrhage potentially life-threatening, and what are its clinical signs?

A

External compression can’t be applied in the retroperitoneal space, potentially leading to fatal bleeding; clinical signs include hemodynamic instability, flank pain, and a significant drop in hemoglobin

87
Q

In what situations is the femoral artery prone to injury?

A

Proximal femur fractures, hip surgery, and traumatic events where it can be lacerated due to its superficial position within the femoral triangle

88
Q

What causes varicose veins and what complications can arise due to venous insufficiency?

A

Varicose veins develop due to venous insufficiency, leading to pooling of blood in the leg veins, causing complications such as painful thrombosis, edema, and cosmetic issues

89
Q

How is the Trendelenburg test or tourniquet test utilized in diagnosing venous insufficiency?

A

It involves raising the affected leg above the head, manually draining the leg’s veins, applying a tourniquet at the saphenous opening, and observing for the reappearance of varicose veins upon standing

90
Q

What does the reappearance of varicose veins upon standing after the tourniquet is placed at the saphenous opening indicate?

A

The problem is distal to the level of the tourniquet, as the veins are filling again, signifying an incompetent valve lower down

91
Q

What is a saphena varix, and what are its clinical characteristics?

A

It is a dilation of the saphenous vein at its junction with the femoral vein in the groin, clinically presenting as a groin swelling that enlarges with increased intraabdominal pressure

92
Q

How is a saphena varix differentiated from a femoral hernia?

A

While both become apparent when the patient coughs, a saphena varix typically has a bluish tinge and disappears when the patient is lying down

93
Q

What are the main venous graft sites used in coronary bypass surgery for coronary artery disease?

A

The great and small saphenous veins

94
Q

Why is the great saphenous vein often the preferred choice for grafting in coronary bypass surgery?

A

It’s superficial, easy to access, long enough for grafting, and has a muscular and elastic fiber-rich wall

95
Q

What is a potential complication during great saphenous vein harvesting in surgeries, and what are its associated symptoms?

A

Saphenous nerve injury, causing pain or numbness along the medial border of the lower leg and foot

96
Q

What are the clinical findings associated with saphena varix?

A

Groin swelling, often the size of a golf ball, coloration with a bluish tinge, and disappearance of swelling when the individual is lying down

97
Q

Why is the lower limb a preferred site for intramuscular injections?

A

Due to its large muscles with numerous blood vessels, which facilitates faster absorption of medication compared to subcutaneous injections

98
Q

Which is one of the most popular intramuscular injection sites in the lower limb, and why?

A

The superolateral quadrant of the gluteal region; it’s used for large volume and more viscous injections

99
Q

How can the superolateral quadrant of the buttock be marked for an injection?

A

By placing the index finger on the anterior superior iliac spine and spreading the fingers along the iliac crest, ensuring the injection is given in the triangle between the fingers, anterior to the proximal joint of the middle finger to avoid injuring the sciatic nerve

100
Q

Why should the superomedial quadrant of the buttock be avoided for injections?

A

It poses a risk of injuring the sciatic nerve and major blood vessels

101
Q

What consequences can result from injury to the superior gluteal nerve in the superomedial quadrant?

A

Presentation of a Trendelenburg gait due to impaired function of muscles like the gluteus medius, gluteus minimus, and tensor fascia latae, affecting pelvis stabilization and thigh abduction

102
Q

What is Trendelenburg gait, and how is it characterized?

A

Trendelenburg gait is characterized by tilting of the pelvis towards the unaffected side when the patient stands on the affected leg, indicating a positive Trendelenburg sign. The patient leans towards the side of the affected superior gluteal nerve to compensate and maintain balance.

103
Q

What are some common causes of Trendelenburg gait?

A

Gluteus medius and gluteus minimus weakness due to conditions like osteonecrosis of the hip, Legg-Calve-Perthes disease, developmental dysplasia of the hip, nonunion of femoral neck fractures, and hip surgery can result in a Trendelenburg gait.

104
Q

What is piriformis syndrome, and how does it develop?

A

Piriformis syndrome refers to piriformis muscle injury or hypertrophy leading to sciatica-like symptoms. The sciatic nerve runs under the piriformis muscle and can become compressed. It develops following trauma to the buttocks, piriformis muscle strain, and scarring around the nerve.

105
Q

What is the “wallet sign” associated with piriformis syndrome?

A

The “wallet sign” occurs when an individual can no longer sit on their wallet without it causing symptoms, indicating piriformis syndrome.

106
Q

What are the common causes of hamstring strains?

A

Hamstring strains typically occur due to overuse and can be seen in active individuals, particularly professional athletes. Inadequate warm-up before activity, muscle fatigue, and trauma are also contributing factors.

107
Q

What movements or actions can lead to a hamstring strain?

A

Hamstring strains occur when there is forced flexion of the hip while the hip and knee are extended, for instance, during activities such as kicking a football.

108
Q

What are the consequences and severity of hamstring strains?

A

Mild strains may cause pain, swelling, and minimal functional loss. Severe strains, including complete tears, can result in significant pain, loss of knee flexion, and even lead to large muscle hematomas. In severe cases, they can cause an avulsion fracture of the ischial tuberosity.

109
Q

How do quadriceps tendon tears typically occur?

A

Quadriceps tendon tears can occur during a sudden, forceful contraction of the quadriceps muscle, especially during activities involving deceleration from a fall or athletic activities.

110
Q

How are quadriceps tendon injuries classified?

A

Quadriceps tendon injuries can be classified in relation to the patella as either proximal or distal to the patella. Proximal injuries occur at the quadriceps tendon, causing a palpable defect above the patella, potentially pulling it down. Distal injuries occur within the patellar ligament, causing a palpable defect below the patella and potentially pulling it upwards.

111
Q

What are the clinical findings associated with quadriceps tendon tears?

A

Clinical findings include pain, inability to bear weight, loss of knee extension, rapid knee effusion, and a loud “pop” sound at the time of injury. Risk factors include anabolic steroid abuse, hypoparathyroidism, and chronic kidney disease.

MSK (21 decks)

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