Musculoskeletal-Hip, Pelvis, Knee Flashcards
Straight Leg Test: Pelvis
-Radiating pain-Radiculopathy
SI Stress Test: Pelvis
-Press Iliac crest, sacrum
-SI ligament injury -
Trendelenburg Sign: Pelvis
Standing-lift one leg
-Weight on affected side-normal hip drops
-Abductor weakness
Log Roll: Hip exam
-Supine with hip extended
-Internally or externally rotated; pain-arthritis
Patrick (FABER) test: Hip exam
-Flex, Abduct, ER hip
-Pain-hip or SI joint pathology
Stinchfield Test: Hip exam
-supine; straight leg raise to 30o (knee in full extension); pt resists downward force (towards the table) applied just proximal to the knee
Pain – intra-articular hip pathology
Pelvic Fractures
-Posterior SI ligament is key to pelvic stability
-40% have associated intra abdominal injuries – high energy injuries
Monitor for urologic injuries
-Long recovery with high risk of blood clots
Pelvic Fractures Exam and Tx
-Affected lower extremity shortened
-Blood at the uretheral meatus
-Neurological exam
-Tx:
Stable-protected weight bearing.
Pelvic binder-hemodynamically unstable
-Operative
External fixation, ORIF
Femoral Head Fractures
-Almost all are associated with hip dislocations
-High energy injury
-Tx: stable-protected weight bearing
-Operative
ORIF
Bipolar hemiarthroplasty
Total hip arthroplasty
Femoral Neck Fractures
-Vascularity of femoral neck
-High morbidity rate (25%)
-Low energy – fall
-Associated with osteoporosis
-High energy - MVA, fall from height
-Stress – athletes
Femoral Neck Fracture Exam and Tx
-Affected extremity is usually shortened and externally rotated
-Tx: Stable – protected weight bearing - RARE
-Operative
Open reduction, internal fixation (PSF, FNS) – impacted, stable fracture
Open reduction, internal fixation (DHS) – young, active patient
Bipolar hemiarthroplasty - displaced
Total hip arthroplasty - < 73, active
Subtrochanteric Femur Fractures
-Fracture across the shaft of the femur, between the lesser trochanter and a point 5 cm distal
-Low energy mechanisms - elderly with minor fall
-High energy mechanisms - young with MVA, GSW, falls from height
Subtrochanteric Femur Fractures; Exam and Tx
-Affected extremity usually shortened and externally rotated
-Stable-protected weight bearing-RARE
-Operative-intramedullary nailing
Femoral Shaft Fractures
-Orthopedic Emergency!
-Most often result of high energy trauma
-May have multiple associated injuries
-Potential source of significant blood loss
Femoral Shaft Fracture Exam and Tx
-Obvious deformity, check distal pulses, open fracture
-Operative-intramedullary nailing
-Complications-Neurovascular injury, nonunion, hardware failure, knee injury
Hip Dislocation
-Native hip dislocation -High energy trauma
-Total hip arthroplasty: Simple twisting motion
—Orthopedic emergency!
-Posterior is the most common
-May be associated with other injuries
Femoral neck fracture
Acetabular fracture
Hip Dislocation exam and tx
-posterior-adducted, flexed, internally rotated
-Anterior-abducted, flexed, externally rotated
-Extreme pain with movement
-Tx
Immediate closed reduction
Repeat x-rays to assure proper reduction
Abduction brace – 60 degrees flexion and 15 degrees abduction
Surgical-if associated with fracture
Complications
Avascular necrosis
Sciatic nerve injury (posterior)
Femoral artery and nerve injury (anterior)
Instability and recurrence
Osteoarthritis
Heterotopic ossification
Osteoarthritis
-Damage to articular cartilage
-May be due to trauma, infection, developmental, metabolic or idiopathic
Exam
—-Chronic hip/groin pain that is increasing over time
—-Decreased ROM
—-+ log roll test
—-May have flexion contracture with antalgic gait
Tx: NSAIDs, PT, Steroid Injection
-Operative-Total Hip athroplasty
Inflammatory Arthritis
-Host immunologic response results in inflammatory response (gout, lupus, gout)
-Exam: pain & stiffness, may involve other joints, antalgic gait
-Tx: NSAIDs, PT
-Operative: Synovectomy - early, Total hip arthroplasty - late
Avascular Necrosis
-Necrosis of femoral head-vascular disruption
-Associated with trauma, ETOH, steroid use, RA
-Exam: Increasing pain with internal and external rotation
-Tx: symptom control, Operative: Total hip arthroplasty
Valgus Stress-Knee exam
Laxity – MCL injury
Varus stress test-knee exam
Laxity – LCL injury
Apley Compression-Knee Exam
-Pain, popping or clicking-meniscal injury/arthritis
Lachman Test: Knee exam
Knee flexed to 20-30 degrees
Hand on femur/tibia
Laxity – ACL injury
Anterior Drawer Test: Knee exam
Knee flexed to 90 degrees
Pull tibia forward
Laxity – ACL injury
Knee Dislocation
-Rare – ORTHOPEDIC EMERGENCY
-Usually high energy injury
-Ligaments and other soft tissue disrupted
-May be associated with other injuries
-High incidence of neurovascular injury
Patellofemoral Syndrome
-Damage or softening of the patellar articular cartilage
-Runner’s knee
Multiple etiologies: Trauma, Dislocation, Malalignment
Compartment Syndrome
-Trauma to thick, closed fascial compartments
edema or hemorrhage
inability to expand
creates high pressures leading to:
decreased tissue perfusion,
necrosis
loss of function
-PAIN
-Paresthesia-most reliable
-Increased pressure-greater than 30
-Paralysis-late sign
-Pallor/decreased pulses-late sign.
Compartment Syndrome
-Trauma to thick, closed fascial compartments
edema or hemorrhage
inability to expand
creates high pressures leading to:
decreased tissue perfusion,
necrosis
loss of function
-PAIN
-Paresthesia-most reliable
-Increased pressure-greater than 30
-Paralysis-late sign
-Pallor/decreased pulses-late sign.T
Treatment of Compartment Syndrome
-Elevate to level of heart-not above-too high decreases arterial flow
-Remove splints/casts/circumferential dressings
-Correct hypotension
-Fasciotomies - w/in 12 hours to prevent ischemia
release of compartments
delayed closure
possible skin graftingq
