MS1: Affectations of Hip Flashcards
the largest and most constant bursa of hip
iliopsoas bursa
what are the 2 types of trochanteric bursa
subgluteus med and subglutes max
what is ischiogluteal bursa
aka weavers bottom; in sitting
discuss the etiology of osteonecrosis of FH
trauma - mga fractures, disloc basta pag impair sa blood supply
impairment of circulation - mga diabetes, sickle celll, gaucher’s
- prolonged steroid use
idiopathic - LCPV
discuss the pathology of osteonecrosis of Fh
total or incomplete
what are the stages of osteonec of FH
- degeneration and disapperance ng osteocytes - hyperemia or new blood vessels from around the bone na necrotic
- revascularization - invasion of new bv and ct on infarc area
- osteoclastic resorption tas replace new bone
what is crescent sign
result ng subchondral fracture bc of the osteoclastic activity sa onstenecro ng FH
bc weak so mag collapse yung head or flatten
clinical features of osteonecro of FH
pain on hip; if children referred to knee
limited abd and IR
treatment of osteonecro of FH
children - abduction brace
adults - surgery
what is LCPD
idiopathic osteonecrosis sa children
aka coxa plana
occurence of LCPD
mga below 7 yo
more in boys and mas madalas unilat
YOUNG THIN SHORT BOYS
pathology of LCPD
80% can recover - self limited for 2-3 yrs
necrosis of epiphysis kaya mag llead to growth disturbance - short femur
clinical features of LCPD
LIMP - most constant
pain referred in knee
limited abd and IR
may lead to OA
FABER
what are the stages of LCPD
caterall staging
group 1 - only anterior head; BEST PROGNOSIS
2 - 1/2 and collapsed na yung gitna
3 - most of head
4 - total head
what are indication of poorer prognosis is LCPD
caterall 3 or 4 - diffuses metaphyseal resorption
defect in epiphysis - gage’s sign
calcification
lat subluxation
GIRLS
how is transient synovitis DD from LCPD
movement produces pain
how is juvenile RA DD from LCPD
pain in diff parts of body like fingers
discuss good prognosis of LCPD
caterall 1
younger and slender children - dont put too much weight
BOYS
FH is contained well in acetabulum
- above 30 may lead to OA
treatment of LCPD
traction in early stages - to relieve spasms
abduction brace - abd and IR; walking with brace
surgical - older than 6, caterall 3 or 4
which is more common congenital coxa vara or valga
VARA
describe congenital coxa vara
developmental or infantile; not detected at birth sa pag grow
lesser angle ng neck - TOWARDS 90 deg
clinical features of congenital coxa vara
painless waddling gait - + trendelenburg
limited abd and IR; inc add and ER
prominent greater trochanter
shorter leg
desrcibe coxa valga
towards 180 deg - greater than 135 angle
bc children unable so stand - paralytic mga polio, CP
can lead to OA
longer leg
discuss the occurrence of slipped capital femoral epiphysis
adolescent OBESE BOYS
earlier in girsl ng 2 yrs kase puberty
mostly uni; 25% bilat
bc of trauma or strain
etiology and pathology of SCFE
idiopathic
rapid growth, oblique physis and minor trauma mga trip or fall ganun
head slips down
what are the types of SCFE
acute - severe trauma; least common
acute superimposed on chronic - mild pain or dicommfort followed by mild trauma
chronic - gradual; weak to months - limp
clinical features of SFCE
affected limb becomes shorter and smaller
limited abd and IR
finds comfort in obligatory ER; when walking
- flex add ER
discuss the degrees of slippage in SFCE
minimal - widening of physis or less than 1/3
moderate - 1/3 to 1/2
severe - more than 1/2
discuss diagnosis of SFCE
pain is referred to knee or medial thigh thats why need xray to confirm
discuss treatment of SFCE
acute na less than 2 wks
- manipulation and pinning; traction
more than 3 wks
- no manipulation kase ma disrupt vessels = osteonecro
mild to moderate - pinning
severe - surgery
LOSE WEIGHT
clinical features of iliopec/psoas bursitis
tenderness on ant hip s inguinal lig
relieve by flex, abd and er
pain by ext, add and ir
dd for iliopec/psoas bursitis
femoral hernia - nawawala bukol
psoas abcess - back
arthritis
treatment for iliopec/psoas bursitis
bed rest tas traction - gentle rom
clinical features of deep trochanteric bursitis
LE held in abd in ER to relax glut max bursa
tender behind greater trochanter
pain radiate to back thigh
clinical features of superficial trochanteric bursitis
pain in extreme add
discuss ischiogluteal bursa
tender over sit bone tas pain radiates s post thigh
pillow or sit cushion
what is congenital hip dysplasia
can be DDH - developmental
bc sublaxation from shallow acetabulum or deformed head
always w other congenital diseases
most common hip disorder in children
congenital hip dysplasia
discuss the occurence for CHD
0.1 % born w dislocated hip
1% hip sublaxation - mas common
80% female children
more common on left hip 60%
multifactorial
clinical features of CHD
less than 6 mo. - LOM and limb shortening; more lines = shorter
toddlers - restricted motion, limp and waddling gait
adolescent - fatigue and pain in hip, thigh, knee
dec abd so also do FABER; ROM normal if infant bx no contractures pa
risk factors of CHD
female and if firstborn
packaging problems
- premature acetabulum
- congenital disloc of knee, torticollis
- family history
discuss barlow and ortolani
for CHD
barlow - dislocation
ortolani - relocation
what is galeazzi test
for CHD UNILATERAL ONLY
pag mas mababa isa edi yun yung involved - positive
management of DDH
0-6 mo tas dysplastic - pavlik harness
6-18 or older 18 tas dislocated - surgery
classifications of hip dislocation
anterior - trauma while flex, abd, ER
posterior - flex, add, IR; MOST COMMON
central disloc - pumasok yung femoral head; basag acetabulum
discuss hip pointer
direct trauma to iliac crest
pain and tenderness; ambulation and abd
discuss IT band syndrome
lateral thigh, hip or knee pain
+ ober’s
snapping hip
extra - tight sila
- IT band over greater trochanter
- iliopsoas sa iliopectineal eminence
intra
- labral tear
most common n snapping hip
IT BAND
PE of snapping hip
IT
- sa greater trochanter during flex-ext, add tas IR
iliopsoas
- sa groin during ext-flex, abd tas ER
causes of acetabular fracture
MVA
fall from height tas naka stand
direct impact sa greater trochanter
indirect - dashboard
complications of acetabular fracture
sciatic nerve palsy - MOST COMMON
sup gluteal artery or vein injury
ossification
avascular necro
chondrolysis
arthritis
etiology of pelvic fracture
MVA or fall from height
avulsion fracture - bc of pull ng muscles; ischium - hamstring
osteoporosis - pubic rami
kinds of pelvic fracture
anteroposterior - dapa tas nagulungan
- open book pelvis
lateral - one side of pelvis
vertical - jump
classes of pelvic fracture
A- stable; sa iliac crest lng ganun
B - vertical stable; rot unstable
C - vertical and rot unstable
comlications of plevic fracture
hemorrhage
lumboscaral plexus injury
bladder and urethra injurt
DVT to lungs kaya high mortality rate
clinical features of pelvic fracture
pain over pelvis
flank or buttocks contusion
leg lenthg discrep
pag avulsion pain worse in contracting muscle
treatment of pelvic fracture
conservative - type a or b
surgery - type c
etiology of femoral head fracture
occus w hip disloc
from trauma
or fatigue
- osteopenic or subchondral impaction
what are complications ans ssx of FHF
avascular necrosis and arthritis
pain and deformity ng head
conservative treatment of FHF
conservative
- pag acute and dapat ma reduce within 6 hrs
- weight bearing 4-6 eks
- no add and IR
surgery pag pipikin 2 - 4 or dislocated tas old
discuss femoral neck fracture
common in osteoporotic elderly sa ward’s
- fall
pwd din sa young pag major fall or trauma
complications of FNF
avascular necrosis
infection
DVT and embolism - kaya high mortality s 1st yr
SSx of FNF
pain
involved is shorter
limp or cant ambulate
tenderness sa greater trochanter
discuss intertrochanteric fracture
usually sa mas old tas mild fall lng
pwede young pero MVA or high energy trauma
complication ng intertrochanteric fracture
varus collapse
wound infect
non union RARE
avascular necro RARE
mortality s 1st yr 30%
discuss PE of foot in intertrochanteric and subcapital fractures
shorter leg kase na ppull ng rectus, adductors tas hamstring
lat rot kase pull ng glut max, piriformis and gemeli
what is arthroplasty
surgery to relief pain and restore motion tas early ambulate
sa mga arthritis, fracture and avascular necro
SA OLD LANG WAG YOUNG
pre-requesites ng arthroplasty
WAG NA PAG TUBERCOLOSUS
need dapat controlled ng 1 yr yung infection bago mag opera
well motivated patieny
healthy muscles and joint
what are the 2 types nf arthroplasty
total - papalitan acetabulum at head
partial - head lanf
discuss hemiarthroplasty
unipolar - pag less active and old na kase pwede mag erode
bipolar - replace head and neck tas acetabulum
discuss the types of fixation in arthroplasty
cemented - for old para makalakad agad; less active dapat
cementless - bine grow into prosthesis; pag YOUNG
INDICATION NG ARTHROPLASTY para di madislocate
no flexion BEYOND 90
no abd BEYONG 45
no add BEYOND midline
no ROTATION
complications of arthroplasty
dislocation
fracture
sciatic impinge
