Hip Pathologies Flashcards
What % of hip injuries occur in every 65yr olds? what % occurs in females? How many happen a year in the UK? How do hip injuries occur? How do patients present?
90% 70% 60,000 younger patients = high energy trauma older patients = low energy falls Pt's present with foreshortening and external rotation of affected leg
Describe Shenton’s Line and how it should be
an imaginary line drawn along the inferior border of the superior pubic ramus (superior border of the obturator foramen) and long the inferno-medial border of the NOF - should be continuous and smooth
Name the 4 main hip classifications
Subcapital neck #
transcervical neck #
intertrochanteric #
subtrochanteric #
What are the garden classifications of #s to the hip?
- Stable # with impaction
- Complete # with non-displaced fragments
- Partially displaced with contact between the 2 fragments
- Completely displaced with no contact between # fragments
What does treatment depend on? Describe the treatment for each of the garden classifications
treatment depends on severity of #
1 & 2 = #s repaired using internal fixation (garden screws)
3 & 4 = blood supply of femoral head likely to be disrupted, if # fragments were fixated and bloody supply was impaired, surgery would be unsuccessful, hip prosthesis is the most successful option
How does a sub capital # occur? What is a sub capital #? What is the treatment?
impacted
it is an intracapsular # which can be affected by avascular necrosis
treatment depends on the #s garden classification
What is a transcervical #? What is the treatment?
more neck on show before # it is an intracapsular # which can be affected by avascular necrosis #s and treatment are the same as sub capital #s
What is an intertrochanteric #? What is the treatment?
between trochanters
Dynamic Hip Screw (DHS) pin/plate fixation devices used to stabilise # and are expected to heal although reduction in motility of elderly patients post surgery will be evident - mortality is 20-30% during 1st year after #
an extra-capsular #
What is a subtrochanteric #? What is the treatment?
below trochanters (comminuted) for the more severe unstable intertrochanteric #s, an intra-medullary device should be considered as there is less blood loss, better function and fewer re-op's an extra-capsular #
What are the 3 types of hip dislocations that can occur? which is most common? what is the most common cause?
what are they often associated with? what % of cases present with internal rotation?
Posterior, anterior and central posterior is most common RTA is most common cause often associated with 3 of acetabulum and spinal injury 90%
how many dislocations are posterior?
what is the treatment for a posterior dislocation?
any post op meds?
how long until back to full mobility?
9/10
closed reduction under anaesthetic or if unsuccessful then open reduction under anaesthetic then WB & gentle exercise as injury permits
analgesia & anti-inflammatory drugs
can take up to 3 months to get full mobility back
what else can a posterior dislocation involve and what can happen as a result of this?
can involve nerve & blood vessel complications which need to be dealt with as they can cause further damage to the development of the bone/cartilage
how is an anterior dislocation caused?
what are the physical characteristics of an anterior dislocation?
caused by violent abduction
affected limb will not be shortened and will be externally rotated, virtually immoveable and extremely painful
what other injuries may occur due to an anterior dislocation?
vascular injury is more prevalent as it can cause arterial insufficiency in the leg and injury to the femoral nerve results in paralysis & numbness in the femoral nerve distribution - pt will be in shock
what is the treatment for an anterior dislocation?
any post op meds?
how long until back to full mobility?
closed reduction under anaesthetic or if unsuccessful then open reduction under anaesthetic then WB & gentle exercise as injury permits
analgesia & anti-inflammatory drugs
can take up to 3 months to get full mobility back although any associated injuries will make recovery time longer
how does a central dislocation occur?
head of femur is driven through the #ed acetabulum following a fall/force directed along the length of femur (e.g. car dashboard/fall from height onto feet)
what does leg deformity depend on in a central dislocation?
what are the physical characteristics of a central dislocation?
leg deformity depends on the extent of penetration into the pelvis
leg will be shortened, abducted/adducted and internally/externally rotated
what else must be treated alongside a central dislocation?
what is the treatment for the central dislocation?
must also treat associated injuries and the shock
closed reduction under anaesthetic or if unsuccessful then open reduction under anaesthetic then WB & gentle exercise as injury permits
analgesia & anti-inflammatory drugs
can take up to 3 months to get full mobility back although associated injuries will make recovery time longer
what are the symptoms for Paget’s Disease?
who is it more common in?
what is Paget’s Disease?
usually asymptomatic
in older people - onset 45-55
a metabolic disorder affecting osteolytic and sclerotic phases of bone re-modelling causing alteration to the trabeculae pattern & bone becomes larger
How is Paget’s Disease treated?
what can pt’s be more prone to and why?
can treat with analgesia if pt has pain which will manage the symptoms as there is NO CURE
some use of bisphosphinates can slow down progression of the disease
as the bone structure is affected, some pt’s may be more prone #s
what is OA?
a degenerative disorder affecting the joints whereby the articular cartilage & sub-chondral bone are worn away
give 3 symptoms of OA
pain
tenderness
reduction of movement
give 4 basic treatments for OA
give a drastic treatment for OA
exercise
changes in lifestyle
anti-inflammatory drugs
analgesia
joint replacement surgery may be necessary as the disease progresses
