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