Hip, Pelvis & Thigh Disorders Flashcards
Sacroiliitis
Etiology (what conditions is it associated with & lead to)
Symptoms & Signs
Etiology
- inflammatory condition of the sacroiliac joint (SI joint)
- can be a result of infection, chronic inflammation or trauma (direct injury or during pregnancy{pressure})
- associated with ankylosing spondylitis & Reiter’s Syndrome (a reactive arthritis 2/2 inflammation)
- over time can lead to : fiberosis of the joint itself, erosin and ossification (soft tissue becoming boney)
Symptoms
- recent trauma, infection, or pregnancy
- pain with prolonged standing
- difficulty climbing stairs
- lower back pain: usually can point directly to SI joint as the location
- weakness of affected side, stiffness (AM)
- extremely frusterating discomfort
Signs
- focal pain at SI joint; worse when palpated
- + FABER test
sacroiliitis
Diagnosis
Treatment
Diagnosis
MRI: gold standard: to see inflammation/bone marrow edema and abscess
X-ray: shows erosion of the joint (AP pelvis)
Labs: WBC (sepsis), ESR/CRP, blood cultures (infection), HLA-B27 (for ank. spond.)
Treatment: tailored to the precipitating event
Infection: admit; IV abx. & then oral Abx. +/- surgical
Trauma: rest, NSAIDS, steroid injections
Pregnancy: symptom managment
Larger spondylopathy: PT, NSAIDS, TNF inhibitors (if a process like AS)
Coccydyina/Coccyx Fracture
Etiology
Risk Factors
Etiology
- pain or fracture of the coccyx bone (tailbone)
- more common in females: because they have a coccyx more posteriorly located
Risk Factors
- obestiy (increase weight on sitting)
- pregnancy
- osteoperosis
- osteomyleitis
usually a result of Trauma: falls: leading to brusied, broken or disloaction & chronic inflammation
- can be repetitive trauma too (over time)
- childbirth
alwasy consider osteoarthritis here, metastatic bone disease & avascular necrosis
Coccydynia/Coccyx Fracture
Symptoms & Signs
Symptoms
- pain when sitting or leaning backwards
- pain when moving from sitting to standing
- discomfort/pain which is loaclized to the tailbone
- always assess infection, malignancy and pelvic disease additional symptoms
SIgns
- external palpation of the area = reproducable pain (HOWEVER, palpation of the surrouding area will NOT produce pain)
- can be painful on internal palation
- assess lumbosacral spine
Coccydyina/Coccyx Fracture
- Diagnosis
- Treatment
Diagnosis
- imaing not always necessary
- X-ray: if pain lasting > 2 months; get AP, lateral and sitting to standing
- MRI (malignacy risk) : inflammation, soft tissue issues
Treatment
Conservative: rest, coccygeal cushion, PT/massage
Fracture: conservative & it will heal
if persistent: local CSI (corticosteroid injection), raidofrequency, coccygectomy
should be treated by a specialist!!
Pelvic Fracture
Etiology
Risk Factors
How they Occur
Etiology
- can be a single (stable) fracture or two fractures (unstable)
- location of fracture can be in the ishium or illum or pubis of pelvis
- high mortaility rate: even moreso if open fracture (usually a trauma)
Risk Factors
- osteoporosis
- smoking
- a prior hysterectomy
- older age (> 60)
- gait disturbances (fall risk)
How They occur
- commonly a trauma: MVA, pedestrian struck or crush injury
- in the eldery, an isolate pubic rami is common due to fall off chair + OP (pubic rami = pubic bones)
Pelvic Fracture
Symptoms & Signs
Symptoms: this will be a trauma call
- always consider a pelvic fracture in those who have had serious blunt trauma & diffuse pain
- in elderly: pain after a fall with associated difficulty walking & sitting
- alwasys ask about last BM, urination, intake and LMP (pregnancy) as the assocaited structures are likely impacted too
Signs (pt. can be unconscious too if trauma)
- nonweight bearing
- unexplained hypotension
- elderly: examine spine, palpate pelvis & always chcek LE for neurovascular compromise (perfusion and dermatomes)
Pelvic Fracture
- Diagnosis
- Treatment
Diagnosis: stable v unstable hemodynamics pt. decides
STABLE: CT scan to see fracture pattern
UNSTABLE & Pelvic Binder on: FAST US + Xray
if GCS is > 13, no pelvic abd. or back pain/tenderness = no xray needed
Elderly fall: start with Xray (AP) and then CT for occult injury
Treatment
- determined by fracture pattern: ring, single bone or acetabular fracture
- immediate ortho consult, wrap pelvis in binder
Types of Pelvic Fractures (3)
Lateral compression : due to a MVA/t-bone or struck pedestrian
- fracture at pubic bone and at the illiac/sacral area on same side (think of side force)
- most common
Anterior-posterior compression aka open book
- think of a head on collision
- force comes from front; through oubic tuberule nad out the back through the ligaments holding the pelvis bottom
Vertical Shear : jump/fall from height
- affects 1 isde of the hip; through the illac/sarcal, pubic and ishum
compounds make up the rest
Femoral Shaft Fracture
Etiology
Symptoms & Signs
Etiology
- a fracture through the mid-shaft of the femur:
- think high energy trauma: younger (GSW)
- think mets or OP: older population (metastsis, osteogenic sarcoma, pathologic fractures)
Symptoms
- trauma call (mostly)
- severe pain, inability to weight bear, recent fall
- hear a “snap” in those with OP when sit-to-stand
Signs
- notable leg length discrepency
- deformity, swelling
- must performa neurovascualr exam: as massive bleeds inot the quad can create compartment syndrome
- always asses hemodynamic stability
Femoral Shaft Fracture
Diagnosis
type of fracture by pattern
Treatment
Diagnosis
- x-ray: gold standard; AP, full femur & AP knee (assess the joint) (try to get lateral too)
- CT: if comminuted (multiple pieces) and complex
Type of Fracture (Pattern)
- transverse
- linear
- nondisplaced (line up edges)
- displaced (dont line up)
- compudn (open)
- spiral
- greenstick (edges, peds.)
- communited (multiple pieces, shattered)
Treatment
- immediate ortho/trauma
- watch vitals for stability
- will need intramedullary nail placement
What is the difference between intracapsular and extracapsular fractures of the hip
INtracapsular: the head of the femur sits in the socket of the acetabulum; a fracutre within this “capusle” will result in a higher likelihood of necrosis & less visable brusing
separation between intra and extra = intertrochanteric line
Extracapsular: below the trochanteric line; more visable brusing
Femoral Neck Fracture
Etiology
Risk Factors
Symptoms and Signs
Etiology
- an intracapsular fracture of the femoral neck
- high mortality after this fracture
- low- energy: direct via fall; or indirect vai muscle pulling weak bone
- high-energy: MVA/fall
- stress frature: everyday stress leads to fracture/edema/swelling overtime
Risk Factors
- age
- poor health
- smoking/alcohol use
- previous fractures
- fall history
- low estrogen (OP)
Symptoms/history
- recent fall (find out if conscious or LOC, chest pain or prior syncope)
- prior hip pain, preinjury ambulation status should be known
- need to know how long they were down from the fall: assess hydration and the pressure ulcer!!
Signs
- intracapsular: meaning minial brusing
- intesen pain with ROM
- tender to palpate @ groin
- shortened limb with external rotation
- if it isnt displaced: they could weight bear
Femoral Neck Fracture
Diagnosis
Treatment
Diagnosis
- X-ray: gold standard: AP, lateral * cross table (medial)
- need to establish via x-ray if displaced or non-displaced
- CT: good for preop planning
- stress fracture: MRI can be good
Treatment
Non-operative: if they are low function (wheelchair bound,etc.) = NWB for 6 weeks (HIGH MORTALIT RISK)
Operative
- non-displacede: CRPP (closed reduction percut. pinning)
- displaced: ORIF or total hip
Intertrochanteric Fractures
Etiology
Symptoms and Signs
Etiology
- a fracture through the intertronchateric line (oblique, between greater and lesser)
- low-energy: 90% from a fall
- high-energy: MVA, tall fall
- extracapsular fracture
NO Stress fractures here: onyl stress fractures at the femoral neck
Symptoms & Signs
- still need to assess how long they were down and assoscaited events (fall, syncope, etc.)
- Extracapsular: therefore lots of brusing
- pain with ROM, and palpation
- shortened limb externally rotate
- can be WB if not displaced
