Hip onwards

Question 1

what are normal paediatric structures that stimulate Fx or dislocations in the hip?

Answer 1

Ishiopubis synchondroses (can appear as a callus)

• triradiate cartilage
• Wide SI joints
• Os Acetabuli (secondary growth centre, look for smooth, non sclerotic boarders)
• nutrients canals.

Question 2

Stable vs unstable fractures in hip. Tell me

Answer 2

Stable- a single break in the pelvic ring, or a peripheral fx
Unstable- double break in the pelvic ring

Question 3

List some stable fractures in the Pelvis

Answer 3

1. Duverneys- iliac wing fracture (lateral impact injury)
2. Unilateral pubic rami (single or double break can can occur) MOI- direct fall or trauma
3. Sacral- horizontal mc. due to direct trauma or fall
   - usally occurs mid sacrum below SI joints
   - best seen on lateral vie
   - look for associated ring fracture

Question 4

List the unstable fractures of the pelvis

Answer 4

Due to sever trauma
-higher incidence of ass. visceral injury (urethra/ bladder)

1. Straddle fracture- bilateral double ring break (MOI direct impact to symphyseal region)
2. Malgaigne’s
   - double ring fx with posterior ring fx (ilium/ sacrum) ON IPSILATERAL side.
3. Bucket Handle:
   - same as above but posterior ing fracture is on CONTRALATERAL SIDE

Look for break in arcuate lines

4. Break in pubic symphysis or SI joints (potentially unstable)
5. Anterior ring and symphysis widening (unstable double break)

Question 5

What are the different types of Acetabular Fractures you can get?

Answer 5

1. Body- can be seen in isolation or in combination. (anterior and/or posterior column are involved)
2. Rim/ Wall- usually posterior rim

Question 6

When looking for ace tabular fractures look at what lines?

Answer 6

1. Iliopectineal line

2. Ilioishial line

Question 7

What are the types of intracapsular fxs you can get in the hip?
What is a complication you can get with any of the above?

Answer 7

1. Subcapital -m.c, usually impacted and easily missed
2. Mid cervical- transverse fracture through mid-neck
3. Basicervical- transverse fc at base of neck
   - pathological fractures occur here.

Question 8

What are the extra capsular fractures you can get?

Answer 8

1. Intertrochanteric
2. subtrochanteric- uncommon
3. Slipped femoral capital epiphysis (salter harris type 1)
   - knee pain common complaint
   - treatment- pinning until growth is stopped.
4. Greater/ lesser trochanter fx

Question 9

What are the hip dislocations you can get- whats most common?
What are there MOI?

Answer 9

1. Posterior’-m.c direction
   - also moves superior lateral
   - ass. with ace tabular rim, patellar femoral and tibial fractures
   - thigh is internally rotated and adducted at time
2. Anterior
   - moves inferior and medial’-extension and abduction injury.