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Year 3 Trauma And Orthopaedics > Hip pathology > Flashcards

Hip pathology Flashcards

1
Q

OA on xray

A

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

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2
Q

RF for OA

A 
Age > 45 yrs old 
Female
Ethnicity - African
FHx 
Obesity 
Trauma 
Malalignment - developmental dysplasia 
Infection - sepsis 
Inflammatory arthritis - RA, ankylosing spondylitis 
Gout 
DM - charcot foot
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3
Q

Presentation of OA

A

Ache exacerbated by movement, relieved by rest
Pain radiates to knee
Reduced ROM - difficulty putting socks on
Crepitus
Stiffness - less than 1 hr in morning

End stage OA:
Fixed flexion deformity
Trendelenurg gait

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4
Q

Pathophysiology of OA

A

Non-inflammatory damage to the hyaline cartilage due to excessive uneven loading.

  1. Swelling - increased proteoglycan synthesis
  2. Flaking and fibrillation - softer and less elastic
  3. Loss of hylaine cartilage
  4. Eburnation - subchondral bone thickens
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5
Q

Treatment of OA

A

Conservative:

  • weight reduction
  • avoid sports that precipitates pain
  • walking aid
  • analgesia
  • hot water bottle
  • strengthening + exercise

Surgery:

  • arthroscopy
  • total or hemiarthroplasty
  • steroid injection
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6
Q

3 types of NOF

A

Intracapsular - between head and intertrochanteric line

Extracapsular:

  • intertrochanteric - involves lesser trochanter
  • subtrochanteric - within 5cm of lesser trochancter
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7
Q

Intracapsular fracture summary

A

Fracture of femoral neck involving capsule
Likely to disrupt the medial femoral circumflex artery causing avascular necrosis

Mx:

  • hemiarthroplasty - if elderly with low mobility
  • total hip replacement - if good mobility
  • Cannulated screws - if less than 60 as hip replacement lasts 10 - 15 years
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8
Q

RF for NOF fracture

A

Menopause - osteoporosis

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9
Q

What position would NOF leg be in

A

Shortened
Slightly abducted
Externally rotated

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10
Q

Symptoms of NOF fracture

A

Reduced mobility
Inability to bear weight
Pain in hip, groin and knee

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11
Q

Most common way to dislocate hip

A

Posteriorly

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12
Q

Causes of hip dislocation

A

Developmental dysplasia

Trauma - high energy

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13
Q

Complications of hip dislocation

A

Sciatic nerve palsy

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14
Q

Position of leg with dislocated hip

A

Shortened
Slightly flexed
Adducted
Internally rotated

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15
Q

Central hip dislocation

A

Head of femur driven into acetabulum.
Always fracture and dislocation
Requires hemiarthroplasty or total hip replacement

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16
Q

Investigations of hip fracture

A

AP and lateral hip Xray
Bloods - FBC, U+Es, coagulation, group + save, CK if rhabdomyolysis suspected
ECG - cause of fall
Urine dip - WCC - UTI may cause confusion and fall
CXR - anaesthetic
Hip Xray

17
Q

Shenton’s lines

A

If disturbed - fracture

18
Q

Extracapsular fracture mx

A

Internal fixation:

Intertrochanteric - Dynamic hip screw
Subtrochanteric - Inter medullary nail

19
Q

Protection against osteoporosis

A

Bisphophonates
Calcium and Vitamin D
Thyroid function control
Prevent falls

20
Q

Post surgery risks

A

DVT - TED compression stockings and LMWH bridging stopped 12 hrs before surgery

21
Q

How to assess mx of hip and knee OA

A

Oxford hip/knee score

22
Q

Ix for OA

A

Bloods - FBC, U+Es, LFTs, ESR, CRP

Xray

23
Q

Hand changes in OA

A

Herbeden’s nodes
Bouchard’s nodes
Square thumb

24
Q

Leg changes in OA

A

Fixed flexion deformity

Varus deformity

25
Q

RA

A

Autoimmune inflammatory response causing symmetrical polyarthropathy commonly of small joints

26
Q

RF for RA

A

Smoking
Genetics - HLA DR
60+ yo
Women

27
Q

Presentation of RA

A 
Morning stiffness that occurs longer than 1 hr 
Swelling of joints especially hands 
Symmetrical 
Rheumatoid nodules 
Abnormal serum RF 
Erosions on Xray
28
Q

Tratment of RA

A

Conservative:

  • weight loss
  • Smoking cessation
  • occupational therapist

Pharmacological:
Paracetamol
NSAIDS
DMARDs

29
Q

DMARDS

A

Methotrexate - 1st line

Sulfasalazine

30
Q

Perthe’s disease presentation and pathophysiology

A

Idiopathic avascular necrosis of femoral head

Presentation:
Pre - puberty - 4 - 8 yo 
M>F 5:1
Progressive hip pain - weeks 
Limp 
Stiff and reduced ROM
31
Q

Septic arthritis presentation

A

Pyrexia
Drowsiness
Pain
Limited ROM

32
Q

Developmental dysplasia

A

Congenital hip joint deformity in which the femoral head is or can be completely / partially displaced.

More common in females

Often identified in newborns with Barlow’s test or Ortolani’s test

  • unequal skin folds and leg length
33
Q

Transient synovitis

A

Acute hip pain associated with viral infection commonly in children ages 2 -10 yo

Settles after 2-3 days

34
Q

SUFE

A

Slipped upper femoral epiphysis

  • postero - inferiorly
  • ages 10 - 15
  • obese males

Causes pain radiating to knee or distal thigh
Loss of internal rotation of the leg in flexion
Symptoms over weeks to months

35
Q

Garden classification of intracapsular NOF fractures

A

I - Non displaced, incomplete
II - Non displaced, complete
III - Partially displaced, complete
IV - Fully displaced, complete

36
Q

Investigations for developmental dysplasia of hip

A
  • Screening
  • Asymmetric skin folds
  • Limp / abnormal gait
  • US is v. specific
37
Q

Mx of developmental hip dysplasia

A 
Mx: maintain abduction
• Double nappies
• Pavlik harness
• Plaster hip spica
• Open reduction: derotation varus osteotomy
38
Q

Perthe’s disease X-ray

A

Decreased femoral head size and flattening

39
Q

Complications of hip fracture

A

Joint dislocation
Aseptic loosening
Peri-prosthetic fracture
Deep infection/prosthetic joint infection

Year 3 Trauma And Orthopaedics (25 decks)

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