Hip Pain + Fractures Flashcards
where does hip pain typically present
groin – may radiate to knee buttock pain
why might pain from hip problem be felt in knee
obturator nerve supplying both joints
what nerve supplies the hip adductors
obturator nerve
what nerve supplies the hip abductors
superior gluteal nerve
what does a positive trendellenburg sign indicate
weakness of hip abductors (glut minimus + glut medius)
what is the first movement affected in hip pathology
loss of internal rotation
what is the gold standard total hip replacement made of
cemented metal/polyethene
early complications of a THR
infection nerve injury - sciatic nerve dislocation leg length discrepancy
late complications of THR
early loosening late infection late dislocation
how does avascular necrosis present
groin pain
what can AVN be secondary to
alcohol abuse steroids thrombophilia hyperlipidaemia
late AVN signs on XRAY
patchy sclerosis of femoral head
lytic zone underneath - formed from granulation tissue
“hanging rope sign”
treatment of AVN that is detected early
drill holes into femoral neck to relieve pressure, promote healing and prevent collapse
treatment of AVN that is detected late
THR
presentation of trochanteric bursitis
pain + tenderness in region of greater trochanter
pain on abduction of hip
what is hip impingement syndrome
groin pain linked to sports
pain on internal rotation
how are hip fractures classified
intracapsular
extracapsular
blood supply of femoral head
anastamotic ring formed from medial + lateral circumflex arteries (branches of profunda femoral artery)
what is an intercapsular fracture also known as
subcapital fracture
what is the main risk of a intercapsular fracture
avascular necrosis of femoral head due to disrupted blood supply
what are the two treatment options for intercapsular fracture
THR (replacing femoral head + acetabulum)
Hemi-arthroplasty (replacing femoral head alone)
when would a hemi-arthroplasty be chosen over a THR in an intercapsular hip fracture
patients with low mobility / cognitively impaired
disrupted shentons lines on XRAY are a sign of which hip fracture
intracapsular
why is an extracapsular fracture better to have than an intercapsular fracture
less risk of AVN
higher union rate
treatment of extracapsular hip fracture
dynamic hip screw
what patiens do subtronchanteric fracutres typically occur in
elderly patients with osteoporosis who fall on their side
why do subtrochanteric fractures take a while to heal
poor blood supply
non-union common
treament of subtrochanteric fractures
IM nail
what can be used pre-operatively to stabilise a subtrochanteric fracture
Thomas splint
