Hip problems Flashcards

1
Q

what are the two main types of hip fracture?

A

intracapsular and extra capsular

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2
Q

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

A

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

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3
Q

What is the blood supply of the femoral head?

A

lateral and medial femoral circumflex artery

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

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4
Q

What is the management of an undisplayed hip fracture?

A

internal fixation or hemiarthroplasty if unfit

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5
Q

What is the management of a displaced hip fracture?

A

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

older - hemiarthroplasty or total hip replacement

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6
Q

What is the management of an extra capsular hip fracture

A

dynamic hip screw

if reverse oblique, transverse or subtrochanteric: intramedullary device

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7
Q

wHat are the clinical features of hip fractures?

A

pain

shortened and externally rotated leg

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8
Q

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

A

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

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9
Q

What usually causes hip dislocation?

A

direct trauma - RTA, falls from great height

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10
Q

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

A
  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
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11
Q

What is the management of hip dislocations?

A
  1. ABCDE
  2. Analgesia
  3. Reduction under GA within 4 hrs to reduce risk of AVN
  4. Long term - physiology to strengthen msucles
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12
Q

What are the potential complications of hip dislocations?

A
  • sciatic or femoral nerve injury
  • AVN
  • OA
  • recurrent dislocation
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13
Q

What are the potential causes of hip pain in adults?

A
  • hip fracture
  • hip dislocation
  • OA
  • inflammatory arthritis
  • referred lumbar pain
  • trochanteric bursitis
  • meralgia paraesthesia
  • pubic symphysis dysfunction
  • transient idiopathic osteoporosis
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14
Q

What is the presentation of OA of the hip?

A
  • pain exacerbated by exercise nd relieved by rest

- reduction in internal rotation

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15
Q

What are the RFs of OA of the hip?

A

age
obesity
prev. joint problems

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16
Q

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

A

pain in morning w systemic features

elevated ESR/CRP

17
Q

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

A
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
18
Q

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

A
  • repeated movement of the fibroelastic iliotibial band
  • greater trochanteric pain syndrome
  • pain and tenderness over lateral side of the thigh
  • women 50-70s
19
Q

What Is meralgia paraesthetica? what causes it ?

A

burning sensation over antero-lateral aspect of thigh

compression of the lateral cutaneous nerve of the thigh

20
Q

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

A

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