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My MSK > Lower Limb Conditions- HIP > Flashcards

Lower Limb Conditions- HIP Flashcards

1
Q

Epidemiology of AVN

A

Males 35-50, bilateral in 80% of cases

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2
Q

Pathogenesis of AVN

A

Failure of blood supply, coagulation of intraoesseous microcirculation –> venous thrombosis –> retrograde arterial occlusion –> decreased blood flow to femoral head –> ischaemia –> necrosis –> subchondral fracture and collapse

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3
Q

Causes of AVN

A

Primary: Idiopathic
Secondary: Steroid/alcohol abuse
Other causes: Factors that increase coagulation
RARE cause: Caisson’s disease

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4
Q

Symptoms of AVN

A

Groin pain, worse on stairs or impact, normal examination unless collapse/OA

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5
Q

Complications of AVN

A

Secondary OA due to femoral head collapse + irregularity of articular surface

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6
Q

Diagnosis of AVN

A

Early: MRI changes
Late: Patchy sclerosis on weight bearing areas of femoral head, lytic zones due to granulation tissue from repair, hanging rope on CR

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7
Q

Treatment of AVN

A

Early: Drill hopes + fluoroscopy into bones to decompress
Late: THR

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8
Q

Epidemiology of trochanteric bursitis/gluteal cuff syndrome

A

Females, young runners

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9
Q

Causes of trochanteric bursitis

A

Repetitive straining of the IT band causing tendonitis and degeneration

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10
Q

Symptoms of trochanteric bursitis

A

Pain on lateral aspect of the hip and on palpation of the greater trochanter

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11
Q

Treatment of trochanteric bursitis

A

NSIADS, physiotherapy, steroid injection, NOT surgery

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12
Q

Describe CAM type femoroacetabular impingement syndrome

A

Femoral deformity

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13
Q

Describe PINCER type femoroacetabular impingement syndrome

A

Acetabular deformity

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14
Q

Symptoms of femoroacetabular impingement syndrome

A

Groin pain on movement, FADIR positive, C sign positive

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15
Q

Treatment of femoroacetabular impingement syndrome

A

CAM: surgery
PINCER: peri-acetabular osteotomy
Older/OA: Arthroplasty

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16
Q

Epidemiology of ITOH

A

Middle aged men, pregnant women in third trimester

17
Q

Causes of ITOH

A

Local hyperaemia + impaired venous return, causing marrow oedema and increased intramedullary pressure

18
Q

Symptoms of ITOH

A

Groin pain progressing over several weeks, difficulty weight bearing, unilateral

19
Q

Diagnosis of ITOH

A

Elevated ESR, XR showing osteopenia, thinning of cortices, preserved joint spaces
MRI= gold standard

20
Q

Treatment of ITOH

A

Self-limiting in 6-9 months, analgesia, protected weight bearing to avoid stress fracture

21
Q

Describe a lateral compression fracture

A

One half of pelvis is displaced medially due to side impact (RTA), fractures in the pubic rami/ischium and sacral fractures/SI joint disruption

22
Q

Describe a vertical shear fracture

A

Axial force on one hemipelvis (fall from height) displacing it superiorly with high risk of injury to sacral nerve roots/lumbosacral plexus + major haemorrhage, on the affected side leg appears shorter, fractures in pubic rami + sacrum/SI joint

23
Q

Describe an anteroposterior compression fracture

A

Open book pelvis fracture, wide disruption at the pubic symphysis

24
Q

Treatment of pelvic fractures

A

Assessment + resuscitation: PR exam mandatory for sacral nerve root function, fluids + blood

25
Q

Risk factors of proximal femur fractures

A

Osteoporosis, smoking, malnutrition, excess alcohol

26
Q

Symptoms of proximal femur fractures

A

Shortened and externally rotated leg can be intracapsular or extra capsular (subtrochanteric, intertrochanteric, basicervical)

27
Q

Treatment of intracapsular proximal femur fractures

A

Undisplaced + good function: DHS
Unidisplaced + poor function: Hemiarthroplasrt
Displaced, young, good function: DHS
Displaced, old, good function: THR
Displaced, old, poor function: Hemiarthroplasty

28
Q

Treatment of extra capsular proximal femur fractures

A

Intertrochanteric: DHS
Basocervical: DHS
Subtrochanteric: IMN
Reverse oblique: IMN

29
Q

What is the most common hip dislocation

A

Posterior

30
Q

Symptoms of hip dislocation

A

Flexed, internally rotated + abducted knee

31
Q

Complications of hip dislocation

A

Sciatic nerve palsy, AVN of femoral head, secondary OA of hip

32
Q

Treatment of hip dislocation

A

Urgent reduction then fixation of associated pelvic fractures

My MSK (7 decks)

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