hip injuries Flashcards
what is osteoarthritis?
degenerative disorder caused by breakdown of articular hyaline cartilage
non-inflammatory condition
what are the risk factors associated with primary osteoarthritis?
- Age
- Female sex
- Ethnicity
- Genetics (OA runs in families)
- Nutrition
what are the risk factors associated with secondary osteoarthritis?
- Obesity
- Trauma (including sports and occupational risk factors)
- Malalignment (incorrect alignment)
- Infection e.g. septic arthritis, tuberculosis
- Inflammatory arthritis
- gout
- haematological disorders
- endocrine abnormalities
what are the symptoms of osteoarthritis?
- a deep aching joint pain
- reduced range of motion and crepitus (grinding)
- stiffness during rest
what is the pathology of osteoarthritis?
- risk factors cause damaged to hyaline cartilage covering the articular surface
- hyaline cartilage is swollen due to increased proteoglycan synthesises by chondrocytes (attempt to repair cartilage damage)
- proteoglycan content eventually falls and cartilage softens and loses elasticity — flaking and fibrillation develops along the smooth articular surface
- cartilage is eroded down to bone resulting in lose of joint space
- eburnation occurs — bone becomes thickened and denser at areas of pressure
what are the 4 cardinal signs of osteoarthritis on an X-ray?
L - loss of joint space
O - osteophytes
S - subchondral scelrosis
S - sunchondral cysts
what measures can be taken to control symptoms of osteoarthritis?
- weight loss
- walking sticks
- pain killers
- anti-inflammatories (NSAID’s)
- steroid injections into joint
how is hip osteoarthritis cured?
total hip replacement
what is a fractured neck of femur?
fracture of proximal femur up to 5 cm below the lesser trochanter
what are the 2 types of fractured neck of femur?
- intracapsular
- extracapsular
which blood supply is likely to be compromised in an intracapsular neck of femur fracture?
ascending cervical branches of medial femoral circumflex artery (MFCA)
- this increases risk of avascular necrosis since artery of ligamentum teres cant meet metabolic demands
which blood supply is likely to be compromised in an extracapsular neck of femur fracture?
retinacular arterial supply
what are the symptoms of neck of femur fractures?
reduced mobility
pain which may be felt in hip, groin or knee
what are the observations seen in a neck of femur fracture?
leg is shortened, abducted and laterally rotated
pain on palpation of greater trochanter + pain exacerbated by rotation of the hip
why does the leg appear shorter, abducted and laterally rotated in neck of femur fracture?
shorter - thigh muscles pull fragment of femur upwards
abducted - strong abductors that attach to the greater trochanter abduct the femur distal to fracture site
laterally rotated - the deep muscles of the hip contract and laterally rotate the femoral shaft
what is meant by dislocation of the hip?
head of femur is fully displaced out of the cup shaped acetabulum
what is the term given to describe a partially displaced hip?
subluxation
what are the 2 category of causes of a hip dislocation?
congenital causes:
- developmental dysplasia of the hip (DDH)
traumatic causes:
- severe injury
what are the most common types of hip dislocations?
posterior
(1 posterior ligament vs 2 anterior ligaments)
what are the observations seen in a posterior hip dislocation?
limb is shortened, flexed, adducted and medially rotated
why does the leg appear shorter, medially rotated after posterior hip dislocation?
shorter - head of femur is pulled up by gluteus maximus and hamstrings
medially rotated - fibres of gluteus medius and minimus pull on posteriorly displaced greater trochanter
what are the observations seen in an anterior hip dislocation?
leg is laterally rotated and abducted with slight flexion
What observations are seen in a central hip dislocation?
head of femur is driven into pelvis through the acetabulum
femoral head is palpable on rectal examination
