Hip, Thigh, Ankle and Foot Flashcards
Likely cause of anterior thigh pain
Lateral cutaneous nerve syndrome
Likely cause of lateral hip pain
Greater trochanter bursitis or snapping Hip Syndrome
Likely cause of inquinal pain
Oestearthritis and avascular necrosis
Likely cause of medial thigh pain
Fractured femur
What special test do you do if no suspicion of hip/thigh fracture
Internal and external rotation starting at neutral and with flexion to 90 degrees
Describe the Faber test
stress with flexed and internally rotated hip, increased pain with Sacro-Iliac joint pathology or non-organic pain
Is an orthopaedic emergency and should be reduced ASAP in order to decrease the risk of osteonecrosis (NV status before and after reduction).
hip dislocation
Complications of a hip dislocation
- early OA
- Osteonecrosis
* secondary to cartilage damage of the femoral head and acetabulum - avascular necrosis
What type of dislocations are most common
posterior
Risk factors for AVN
- secondary to trauma
- stress fractures
- chronic steroid use (RA, COPD, organ transplant)
- alcohol
- ***Hip fracture (/any bone)
causes of fracture of the pelvis
- low-energy trauma (elderly)
2. high energy trauma (multisystem trauma)
With a fracture of the pelvis you must assess neuro-vascular status (STAT), because of
common injuries to peripheral nerves and sometimes damage to spinal nerve roots.
W/ a fracture of the pelvis, it is important to get
stat x-rays and CT scan
Tx of pelvic fractur
Usually in need for immediate surgery if stable or possible external fixation, depending on severity and instability.
- Major bleeds are common w/ pelvic fx
- Morbidity and mortality decreases when they are fixed early within 48 hrs!
morbidity and mortality associated w/ pelvic fxs are decreased when fixed within __
48hrs
Xray view points for pelvic fxs
- Judet (oblique) view- posterior wall or sacro iliac joint/ fx through acetabulum
- inlet/outlet view– look for fx in front or a shift in the front or back
- AP Pelvis
What should you do with an open-book pelvis fracture
- Open-Book Pelvic Fracture: this will bleed and the patient will die if you do not slow down the bleed! (CLOSE THE SI JOINT)
- Slow down the bleed w/ a pelvic binder (pressure) or clamp (iliac crest)
- the faster you can close the pelvis the better outcome for the patient
-External fixation (rods on the legs) to slow down the bleeding
What is an open book pelvic fracture
This causes disruption of pubic symphysis and the pelvis opens like a book
Most common fracture in elderly pts
hip fracture
who most commonly gets hip fractures
elderly with the incident of hip fractures doubling past age 50 and with women > men.
___ in ___ with a hip fracture die between one year after fracture and 50% of them never return to previous level of ambulation and independence.
1 in 4 pts
Intra-capsular (femoral neck) fx are usually associated with
a high risk for non-union secondary to AVN
Extra-capsular (intertrochanteric or above the lesser trochanter): requires
a stronger fixation** and has better chance of healing
With a displaced prox. femur fracture, the injured limp is ___
externally rotated, abducted and shortened