Hip problems Flashcards
what are the two main types of hip fracture?
intracapsular and extra capsular
what is the significance of the location of the fracture in the hip?
if it is intracapsular then this risks AVN of the femoral head
if extra capsular then the blood supply usually remains intact
What is the blood supply of the femoral head?
lateral and medial femoral circumflex artery
small amount by a branch of the obturator artery in the fovea
What is the management of an undisplayed hip fracture?
internal fixation or hemiarthroplasty if unfit
What is the management of a displaced hip fracture?
if young and fit (<70yrs) - reduction or internal fixation
older - hemiarthroplasty or total hip replacement
What is the management of an extra capsular hip fracture
dynamic hip screw
if reverse oblique, transverse or subtrochanteric: intramedullary device
wHat are the clinical features of hip fractures?
pain
shortened and externally rotated leg
What classification system is used for grading hip fractures of the femoral neck?
garden classification
I - incomplete undisplaced fracture
II - complete undisplaced fracture through the neck
III - complete neck fracture w partial displacement
IV - fully displaced fracture
What usually causes hip dislocation?
direct trauma - RTA, falls from great height
What are the types of hip dislocation? which is the most common? how do they present?
- posterior - 90% of dislocations, leg is shortened, adducted and internally rotated and flexed
- anterior - leg is abducted, externally rotated w no leg shortening
- central
What is the management of hip dislocations?
- ABCDE
- Analgesia
- Reduction under GA within 4 hrs to reduce risk of AVN
- Long term - physiology to strengthen msucles
What are the potential complications of hip dislocations?
- sciatic or femoral nerve injury
- AVN
- OA
- recurrent dislocation
What are the potential causes of hip pain in adults?
- hip fracture
- hip dislocation
- OA
- inflammatory arthritis
- referred lumbar pain
- trochanteric bursitis
- meralgia paraesthesia
- pubic symphysis dysfunction
- transient idiopathic osteoporosis
What is the presentation of OA of the hip?
- pain exacerbated by exercise nd relieved by rest
- reduction in internal rotation
What are the RFs of OA of the hip?
age
obesity
prev. joint problems
How does inflammatory arthritis of the hip usually present? what blood test can help confirm?
pain in morning w systemic features
elevated ESR/CRP
What usually causes referred lumbar pain? What test can confirm this?
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
What causes trochanteric bursitis?
What is it also known as?
How does it present?
What group of people does it usually affect?
- repeated movement of the fibroelastic iliotibial band
- greater trochanteric pain syndrome
- pain and tenderness over lateral side of the thigh
- women 50-70s
What Is meralgia paraesthetica? what causes it ?
burning sensation over antero-lateral aspect of thigh
compression of the lateral cutaneous nerve of the thigh
What is pubic symphysis dysfunction?
What group of people are affected?
What are the symptoms?
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