Hip Pathologies

Question 1

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?

Answer 1

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

Question 2

Describe Shenton’s Line and how it should be

Answer 2

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

Question 3

Name the 4 main hip classifications

Answer 3

Subcapital neck #
transcervical neck #
intertrochanteric #
subtrochanteric #

Question 4

What are the garden classifications of #s to the hip?

Answer 4

1. Stable # with impaction
2. Complete # with non-displaced fragments
3. Partially displaced with contact between the 2 fragments
4. Completely displaced with no contact between # fragments

Question 5

What does treatment depend on? Describe the treatment for each of the garden classifications

Answer 5

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

Question 6

How does a sub capital # occur? What is a sub capital #? What is the treatment?

Answer 6

impacted
it is an intracapsular # which can be affected by avascular necrosis
treatment depends on the #s garden classification

Question 7

What is a transcervical #? What is the treatment?

Answer 7

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

Question 8

What is an intertrochanteric #? What is the treatment?

Answer 8

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 #

Question 9

What is a subtrochanteric #? What is the treatment?

Answer 9

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 #

Question 10

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?

Answer 10

Posterior, anterior and central 
posterior is most common
RTA is most common cause
often associated with 3 of acetabulum and spinal injury 
90%

Question 11

how many dislocations are posterior?
what is the treatment for a posterior dislocation?
any post op meds?
how long until back to full mobility?

Answer 11

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

Question 12

what else can a posterior dislocation involve and what can happen as a result of this?

Answer 12

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

Question 13

how is an anterior dislocation caused?

what are the physical characteristics of an anterior dislocation?

Answer 13

caused by violent abduction

affected limb will not be shortened and will be externally rotated, virtually immoveable and extremely painful

Question 14

what other injuries may occur due to an anterior dislocation?

Answer 14

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

Question 15

what is the treatment for an anterior dislocation?
any post op meds?
how long until back to full mobility?

Answer 15

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

Question 16

how does a central dislocation occur?

Answer 16

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)

Question 17

what does leg deformity depend on in a central dislocation?

what are the physical characteristics of a central dislocation?

Answer 17

leg deformity depends on the extent of penetration into the pelvis
leg will be shortened, abducted/adducted and internally/externally rotated

Question 18

what else must be treated alongside a central dislocation?

what is the treatment for the central dislocation?

Answer 18

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

Question 19

what are the symptoms for Paget’s Disease?
who is it more common in?
what is Paget’s Disease?

Answer 19

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

Question 20

How is Paget’s Disease treated?

what can pt’s be more prone to and why?

Answer 20

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

Question 21

what is OA?

Answer 21

a degenerative disorder affecting the joints whereby the articular cartilage & sub-chondral bone are worn away

Question 22

give 3 symptoms of OA

Answer 22

pain
tenderness
reduction of movement

Question 23

give 4 basic treatments for OA

give a drastic treatment for OA

Answer 23

exercise
changes in lifestyle
anti-inflammatory drugs
analgesia

joint replacement surgery may be necessary as the disease progresses