Lower Limb Conditions- HIP Flashcards
Epidemiology of AVN
Males 35-50, bilateral in 80% of cases
Pathogenesis of AVN
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
Causes of AVN
Primary: Idiopathic
Secondary: Steroid/alcohol abuse
Other causes: Factors that increase coagulation
RARE cause: Caisson’s disease
Symptoms of AVN
Groin pain, worse on stairs or impact, normal examination unless collapse/OA
Complications of AVN
Secondary OA due to femoral head collapse + irregularity of articular surface
Diagnosis of AVN
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
Treatment of AVN
Early: Drill hopes + fluoroscopy into bones to decompress
Late: THR
Epidemiology of trochanteric bursitis/gluteal cuff syndrome
Females, young runners
Causes of trochanteric bursitis
Repetitive straining of the IT band causing tendonitis and degeneration
Symptoms of trochanteric bursitis
Pain on lateral aspect of the hip and on palpation of the greater trochanter
Treatment of trochanteric bursitis
NSIADS, physiotherapy, steroid injection, NOT surgery
Describe CAM type femoroacetabular impingement syndrome
Femoral deformity
Describe PINCER type femoroacetabular impingement syndrome
Acetabular deformity
Symptoms of femoroacetabular impingement syndrome
Groin pain on movement, FADIR positive, C sign positive
Treatment of femoroacetabular impingement syndrome
CAM: surgery
PINCER: peri-acetabular osteotomy
Older/OA: Arthroplasty
Epidemiology of ITOH
Middle aged men, pregnant women in third trimester
Causes of ITOH
Local hyperaemia + impaired venous return, causing marrow oedema and increased intramedullary pressure
Symptoms of ITOH
Groin pain progressing over several weeks, difficulty weight bearing, unilateral
Diagnosis of ITOH
Elevated ESR, XR showing osteopenia, thinning of cortices, preserved joint spaces
MRI= gold standard
Treatment of ITOH
Self-limiting in 6-9 months, analgesia, protected weight bearing to avoid stress fracture
Describe a lateral compression fracture
One half of pelvis is displaced medially due to side impact (RTA), fractures in the pubic rami/ischium and sacral fractures/SI joint disruption
Describe a vertical shear fracture
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
Describe an anteroposterior compression fracture
Open book pelvis fracture, wide disruption at the pubic symphysis
Treatment of pelvic fractures
Assessment + resuscitation: PR exam mandatory for sacral nerve root function, fluids + blood
