Orthopaedics & Rheumatology / Hip And Groin Injuries

Question 1

Soft tissue injuries commonly associated with pain in hip after a direct blow that increases with rotation or with lateral bending

Answer 1

Iliac crest bone contusion (hip pointer)

Question 2

Soft tissue injury commonly associated with runner started running stairs to prepare for upcoming climbing trip. Point tenderness posterior to greater trochanter, pain with resisted abduction, and lateral thigh rotation

Answer 2

Trochanteric bursitis

Question 3

What is the most common site for a thigh hematoma?

Answer 3

Quadriceps

Question 4

An osteoporotic woman slips, hears a snap, and is unable to bear weight. She reports it is very painful. On examination, you don’t notice any swelling, but see that her left lower limb is externally rotated and noticeably shorter than the right. What are you worried about?

Answer 4

Avascular necrosis (AVN) and deep vein thrombosis (DVT) with a femoral neck fracture

Question 5

An osteoporotic woman slips, hears a snap, and is unable to bear weight. She reports it is very painful. On examination, you don’t notice any swelling, but see that her left lower limb is externally rotated and noticeably shorter than the right.

what type of fracture are you worreid about?

In addition to management of her fracture, what additional medical therapy would your recommend?

Answer 5

• Fracuture = femoral neck fracture
• Anticoagulate to decrease risk of DVT while in the hospital
• bone health evaluation
• appropriate medication prior to discharge (calcium, vitamin D, bisphosphonate)

Question 6

What is the most common cause of a limp in toddlers?

Answer 6

• Infected joint (septic joint, osteomyelitis, toxic synovitis)

Question 7

What is the initial workup for a child that presents with a limp?

Answer 7

• Radiographs of affected joint and above and below joint
• FBC
• ESR
• CRP

Question 8

What are the most common causes of a limp in adolescents and teens?

Answer 8

• Slipped capital femoral epiphysis (SCFE)
• juvenile rheumatoid arthritis (JRA)
• avascular necrosis of the femoral head (Legg-Calve-Perthes disease)

Question 9

A mother brings in her 6-year-old son who presents with 2 months of a painless limp, along with complaints of mild knee pain. On examination, you notice that he has limited internal rotation, and the affected leg appears smaller than the other. What diagnosis do you suspect?

Answer 9

Legg-Calve-Perthes disease

Question 10

What is the etiology of Legg-Calve-Perthes disease?

Answer 10

Avascular necrosis of the femoral head of unknown etiology

Question 11

What is the treatment of Legg-Calve-Perthes disease?

Answer 11

• Observation if mild
• bracing or hip abduction with a Petrie cast it moderate
• Osteotomy if severe

Question 12

What occurs when acute or repetitive microtraumas cause the femoral head to shear off the femoral neck prior to epiphyseal closure, and causes painful abduction and lateral rotation?

Answer 12

SCFE (slipped capital femoral epiphysis)

Question 13

What are the risk factors for SCFE(slipped capital femoral epiphysis)?

Answer 13

• Obesity
• male gender
• African American ethnicity
• history of hypothyroidism
• 10-14 years old

Question 14

What radiographic views should you order when you suspect SCFE(slipped capital femoral epiphysis)?

Answer 14

Radiographs of both hips in AP and frog-leg lateral to look for posterior and medial displacement of the femoral head

Question 15

What is the underlying dysfunction associated with a snapping hip from repetitive hip flexion?

Answer 15

Iliopsoas dysfunction or tendinitis

Question 16

Pain in the groin or buttock associated with popping clicking and catching suggests what injury?

Answer 16

Acetabular labral tear

Question 17

Acute posterior proximal leg/gluteal pain after forcible flexion of the hip with the knee extended is characteristic of what injury?

Answer 17

Avulsion fracture of ischial tuberosity at proximal attachment of biceps femoris and semitendinosus (Hurdler injury)

Question 18

In what activities is avulsion fracture of ischial tuberosity at proximal attachment of biceps femoris and semitendinosus (Hurdler injury) most likely to occur?

Answer 18

Acceleration sports such as sprinting, soccer, basketball, and martial arts