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MSK SOH > Hip Pathologies > Flashcards

Hip Pathologies Flashcards

1
Q

Hip bones (3)

A

Ilium - superior and largest part of the hip bone
Ischium - forms the postero-inferior part of the hip bone and acetabulum
Pubis - forms the antero-medial part of the hip bone

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2
Q

Acetabulum

A

Socket of the hip bone.
The head of the femur fits into here
Helps to give the hip more stability

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3
Q

Which type of joint is the hip?

A

Ball and socket joint

Synovial joint

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4
Q

The hip/shoulder joint is more stable?

A

Hip joint

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5
Q

Movements of the hip

A

Flexion-extension
Abduction-adduction
Medial-lateral rotation
Circumduction

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6
Q

Extracapsular ligaments

A

Anterior: iliofemoral, pubofemoral
Posterior: ishiofemoral

Function - the extracapsular joints strengthen the joint capsule

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7
Q

Intracapsular ligaments

A

Ligamentum Teres

Function: this contains the arterial supply to the head of femur (branch of obturator artery)

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8
Q

Arterial supply

A

Medial and lateral circumflex arteries
- arise from deep femoral artery (profundus femoris artery) and anastomose at the base of the neck of femur to form a ring

Branch of obturator artery supplies the head of femur

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9
Q

Nerve supply

A

Femoral nerve
Obturator nerve
Nerve to quadratis femoris
Superior gluteal nerve

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10
Q

Trochanteric bursitis - definition

A

Similar to rotator cuff problems of the shoulder

Inflammation of the bursa which lies over the greater trochanter

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11
Q

Trochanteric bursitis - cause

A

Stresses at muscle insertions on the greater trochanter
Friction between trochanter and ilio-tibial band cause painful bursa
OA of hip
Lower back or knees

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12
Q

Trochanteric bursitis - clinical features

A

Pain and tenderness at the greater trochanter region

Pain more intense when lying on the affected side

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13
Q

Trochanteric bursitis - examination

A

Tenderness when palpating the greater trochanter

Pain during resisted abduction and external rotation

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14
Q

Trochanteric bursitis - management

A

Rest
Analgesia
NSAIDs
Steroid injection if severe

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15
Q

Avascular necrosis - definition

A

Interruption of the blood supply to the bone causing the bone to die

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16
Q

Avascular necrosis - causes

A

Dislocation or fracture of the femur

Chronic steroid use

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17
Q

Avascular necrosis - clinical features

A

Initial pain when weight is placed on hip

Pain in groin, buttocks and down the front of the thigh

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18
Q

Avascular necrosis - investigations

A

X Ray

  • only shows abnormalities in late stage disease
  • patchy sclerosis
  • hanging rope sign

MRI

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19
Q

Avascular necrosis - management

A

Early detection: drill holes in the femoral neck to relieve pressure

Late detection: total hip replacement

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20
Q

Avascular necrosis - associated conditions

A

Perthes

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21
Q

Total hip replacement - when to consider it

A

When conservative measures fail to control symptoms

Older patients

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22
Q

Total hip replacement - when is it not recommended

A

Younger patients

- they tend to put more demand on hip so try to delay surgery

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23
Q

Total hip replacement - components

A

Cemented metal or polyethylene

24
Q

Total hip replacement - complications

A

Post op infection
- take hip replacement out for 3 months then re-fit

Metal-on-metal
- can get local reaction to metal debris which results in a inflammatory pseudotumour which causes necrosis

Blood loss
DVT/PE
sciatic nerve damage

25
Q

Hip fractures - types

A

Intracapsular
Extracapsular
Depends upon the position of the fracture in relation to the hip capsule

26
Q

Intracapsular fracture - definition

A

Fracture is within the capsule so the arterial supply to the femoral head could be disrupted (in a displaced fracture)

27
Q

Intracapsular fracture - location

A

Subcapital - below the femoral head

Basicervical - across the base of the femoral neck

28
Q

Intracapsular fracture - complications

A

Avascular necrosis

Non-union of the fracture

29
Q

Intracapsular fracture - management

A

Total hip replacement
OR
Hemi-arthroplasty (replacing the femoral head alone)

30
Q

Extracapsular fracture - definition

A

Fracture is outside of the capsule so the blood supply to the femoral head is still in tact

31
Q

Extracapsular fracture - location

A

Intertrochanteric - below the femoral neck, trochanter region

Subtrochanteric - below the trochanter region

32
Q

Extracapsular fracture - management

A

All will heal so do not need a hip replacement
Internal fixation
- dynamic hip screw
- intra-medullary nail
Fracture tends to heal in a shortened position

Subtrochanteric fractures are more difficult to treat and may require use of a thomas’ splint before internal fixation

33
Q

Shentons line

A

X-ray finding
Formed from the medial edge of the femur to the inferior edge of the superior pubic ramps

Disruption in shentons line indicates there has been a fractured neck of femur (intracapsular fracture)

34
Q

Neck of femur fracture - cause

A

Osteoporosis
Falls in elderly
Fragility fracture

35
Q

Neck of femur fracture - risk factors

A

Smoking
Excess alcohol
Malnutrition
Steroids

36
Q

Neck of femur fracture - clinical features

A

Can’t weight bear
Trochanteric bruising
Pain in hip, groin, knee
Reduced mobility

37
Q

Neck of femur fractures - examination

A 
Affected leg is classically:
-shortened
-abducted
-externally rotated 
Unable to straight leg raise 
Exacerbation of pain on palpating of the greater trochanter
38
Q

Neck of femur fracture - investigations

A

X Ray

  • shentons line distruption
  • lesser trochanter more prominent
  • sclerosis in fracture plane

MRI
-if no abnormality on X-ray

39
Q

Neck of femur fracture - management

A

Immediate: IV access, analgesia
Undisplaced: stabilise with screws to prevent displacement
Displacement: hip replacement

40
Q

Neck of femur fracture - complications

A

Avascular necrosis of femoral head

Risk of DVT/PE

41
Q

Femoral shaft fracture - cause

A

Young patient: high energy injury

Old patient: osteoporosis, fragility fracture, long term bisphosphonate use

42
Q

Femoral shaft fracture - clinical features

A

Immediate severe pain

Unable to weight bear

43
Q

Femoral shaft fracture - examination

A

Affected leg is classically:

  • shortened
  • abducted
  • externally rotated
44
Q

Femoral shaft fracture - investigations

A

X-Ray

45
Q

Femoral shaft fracture - management

A

Immediate management: analgesia, long leg splint

Open fracture - urgent cleanse, external fixation, internal fixation

46
Q

Distal femoral fracture - cause

A

Fall onto a flexed knee
young person: high energy injury
old person: osteoporosis

47
Q

Distal femoral fracture - type

A

Transverse - straight across
Comminuted - breaks into many pieces
Intra-articula - extends into the cartilage of the knee joint

48
Q

Distal femoral fracture - clinical features

A

Pain with weight bearing
Swelling
Tenderness
Deformity

49
Q

Distal femoral fracture - investigations

A

X-ray

CT scan

50
Q

Distal femoral fracture - management

A

Internal fixation (plate and screws) as fracture position is difficult to maintain in a cast

51
Q

Pelvic fracture - cause

A

Young patients: high energy injury

Old patients: osteoporosis

52
Q

Pelvic fracture - investigations

A

PR exam - assess sacral nerve root function
X-ray - if the pelvic ring is disrupted in one place it is highly likely that there will be another disruption elsewhere in the pelvic ring

53
Q

Pelvic fracture - management

A

stable - walking aids to avoid weight bearing

unstable - external fixation, open reduction internal fixation

54
Q

Pelvic fracture - open book

A

Pelvic fracture that results from an antero-posterior compression injury to the pelvis.
Pelvis opens like a book

55
Q

Pelvic fracture - open book - management

A

reduction
pelvic binder
external fixation

56
Q

acetabulum fracture - management

A

undisplaced - pain relief, walking aids
displaced young person - anatomic reduction and rigid fixation
displaced old person - total hip replacement

MSK SOH (24 decks)

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