Hip problems

Question 1

what are the two main types of hip fracture?

Answer 1

intracapsular and extra capsular

Question 2

what is the significance of the location of the fracture in the hip?

Answer 2

if it is intracapsular then this risks AVN of the femoral head
if extra capsular then the blood supply usually remains intact

Question 3

What is the blood supply of the femoral head?

Answer 3

lateral and medial femoral circumflex artery

small amount by a branch of the obturator artery in the fovea

Question 4

What is the management of an undisplayed hip fracture?

Answer 4

internal fixation or hemiarthroplasty if unfit

Question 5

What is the management of a displaced hip fracture?

Answer 5

if young and fit (<70yrs) - reduction or internal fixation

older - hemiarthroplasty or total hip replacement

Question 6

What is the management of an extra capsular hip fracture

Answer 6

dynamic hip screw

if reverse oblique, transverse or subtrochanteric: intramedullary device

Question 7

wHat are the clinical features of hip fractures?

Answer 7

pain

shortened and externally rotated leg

Question 8

What classification system is used for grading hip fractures of the femoral neck?

Answer 8

garden classification
I - incomplete undisplaced fracture
II - complete undisplaced fracture through the neck
III - complete neck fracture w partial displacement
IV - fully displaced fracture

Question 9

What usually causes hip dislocation?

Answer 9

direct trauma - RTA, falls from great height

Question 10

What are the types of hip dislocation? which is the most common? how do they present?

Answer 10

1. posterior - 90% of dislocations, leg is shortened, adducted and internally rotated and flexed
2. anterior - leg is abducted, externally rotated w no leg shortening
3. central

Question 11

What is the management of hip dislocations?

Answer 11

1. ABCDE
2. Analgesia
3. Reduction under GA within 4 hrs to reduce risk of AVN
4. Long term - physiology to strengthen msucles

Question 12

What are the potential complications of hip dislocations?

Answer 12

• sciatic or femoral nerve injury
• AVN
• OA
• recurrent dislocation

Question 13

What are the potential causes of hip pain in adults?

Answer 13

• hip fracture
• hip dislocation
• OA
• inflammatory arthritis
• referred lumbar pain
• trochanteric bursitis
• meralgia paraesthesia
• pubic symphysis dysfunction
• transient idiopathic osteoporosis

Question 14

What is the presentation of OA of the hip?

Answer 14

• pain exacerbated by exercise nd relieved by rest

- reduction in internal rotation

Question 15

What are the RFs of OA of the hip?

Answer 15

age
obesity
prev. joint problems

Question 16

How does inflammatory arthritis of the hip usually present? what blood test can help confirm?

Answer 16

pain in morning w systemic features

elevated ESR/CRP

Question 17

What usually causes referred lumbar pain? What test can confirm this?

Answer 17

compression of the femoral nerve 
Femoral nerve stretch test:
- extend hip w straight leg w pt prone
- then bend knee
- this stretches the femoral nerve and causes PAIN if +ve

Question 18

What causes trochanteric bursitis?
What is it also known as?
How does it present?
What group of people does it usually affect?

Answer 18

• repeated movement of the fibroelastic iliotibial band
• greater trochanteric pain syndrome
• pain and tenderness over lateral side of the thigh
• women 50-70s

Question 19

What Is meralgia paraesthetica? what causes it ?

Answer 19

burning sensation over antero-lateral aspect of thigh

compression of the lateral cutaneous nerve of the thigh

Question 20

What is pubic symphysis dysfunction?
What group of people are affected?
What are the symptoms?

Answer 20

increase in ligament laxity, there is excessive movement of the pubic symphysis and increased joint mobility
pain over PS, radiation to groin, medial aspect of thighs
waddling gait