Hip pathology

Question 1

Fractured neck of femur

Answer 1

Common pathological fracture in elderly, high energy in the young
Pain in the hip after trauma/fall
Shortened, externally rotated leg

Question 2

Intracapsular fracture

Answer 2

Blood supply to the femoral head is disrupted

If elderly + poor mobility => Hemi-arthroplasty (metal ball to replace head and pole into femur)

If elderly but mobile (69 and independent etc) => total hip arthroplasty (Ball AND SOCKET replaced)
(reduced risk of needing to go in again for surgery)

If young, active and undisplaced fracture => intra-medullary nail or dynamic hip screw

Question 3

Extracapsular fracture

Answer 3

Blood supply to femoral head not disrupted

Mx: Dynamic hip screw or intermedullary nail

Question 4

Pubic ramus fractures

Answer 4

Tend to be high energy fracture patters in young patient
- depends on fracture patterns

Elderly - fragility fracture, managed non-operatively

Can cause impingement of bladder, vagina, perineum

Question 5

Greater trochanter bursitis

Answer 5

Inflammation of bursa
Common in elderly
Associated with autoimmune diseases
Localised pain on the bus, pain when lying down on that side or walking up stairs

Management
Conservative - NSAIDs, rest, physio, steroid injections

Question 6

Transient synovitis of the hip

Answer 6

Self limiting inflammation of the synovium of the hip joint
Most common cause of hip pain/limp in a child

Usually preceding URTI

Ix - bloods, Xray, US

Mx
Conservative - NSAIDs, rest, crutches if required

Question 7

Transient synovitis vs Septic arthritis

Answer 7

Kocker criteria - determines risk for septic joint

Measures ESR >40, Fever and WBC > 12 and weight bearing on affected side

If 4/4 - 99% probability of SA