Orthopedic Procedures- Hip Flashcards
Positive ortolani’s test
Developmental dysplasia of the hip
Elevation and abduction of femur relocates a dislocated hip- reducible
Developmental Dysplasia of Hip- desciption, risk factors, diagnosis
Abnormal development or dislocation of the hip secondary to capsular laxity and mechanical factors- hip is forming outside the acetabulum, capsular laxity caused hip to push out and forms the head of femur outside the acetabulum
RFs- breech positioning, family history, female, first born child
Related problems- commonly associated with ‘packaging problems’ like torticollis, metatarsus adductus
Ultrasound is better for diagnosis, because femur is not always ossified yet
Barlow’s test
Adduction and depression of femur dislocates the hip- dislocatable
Developmental dysplasia of hip
Galeazzi sign
Clinical appearance of foreshortening of the femur on the affected side
DDH
DDH treatment
Achieving and maintains early,concentric reduction: Pavlik harness, closed and open reduction, various osteotomies, spika cast
SCFE- what is it, presents like, treatment
Disorder of the proximal femoral epiphysis- slip through growth plate, femoral head remains in the acetabulum, the neck is displaced anteriorly and externally rotates
adolescents, African american, obese
Present with- limp, externally rotated gait, obligatory hip external rotation when try to flex, decreased hip internal rotation, hip/thigh/knee pain (obturator nerve comes around, can get irritated, feel pain in the knee)
Percutaneous pinning
Femoral shaft fracture- associations and treatment
Very high energy injury: Usually associated with other injuries- other fractures (neck of femur), visceral insults, etc (need a COMPLETE physical exam/X-rays)
Restore limb length, restore alignment, restore rotation
Intramedullary nail for most- can fix all 3 of these goals
Avascular necrosis of femoral head- causes, presents with, testing, treatment
Osteonecrosis, intramuscular coagulation/arterial occlusion
Many causes of avascular necrosis** number 1 is idiopathic
Usually have a clotting abnormality, hypercoagulation, sickle cell, alcoholism, high doses of prednisone, etc.
Groin pain, X-rays/MRI: can see early stages on MRI, eventually see femoral head irregularity/collapse/sclerosis/cartilage collapse
Bisphosphonates or anti-coagulatants
Core decompression (before collapse)- surgery where drill side of femoral head, scrape out dead bone, put cement/bone graft
Rotational osteotomy- cut femoral head, put screws in, gives area of femoral area a different place to put load on
Vascularized fibular strut grafting- take dead bone out, take fibula arterial supply and plug into femur to heal
Hip arthroplasty- done after actual structural collapse
Greater Trochanteric Bursitis- cause, presents, RF’s, treatment
IT band can get tight and rub on bursa to cause pain
Pain over greater trochanter, pain may be worse at night, when lying on affected hip, when getting up from chair after sitting for awhile
RF’s- women, middle aged, elderly, repetitive stress injury, hip injury/contusion, spine diseases, leg-length inequality affecting gait, RA, previous surgery
Diagnose with palpation
Treat with activity modification, antiinflammatories, ice,crutches, PT, or lastly, cortisone injection
Osteoarthritis symptoms, exam, X-ray
Stiffness in hip, pain ‘flares’, groin pain, limp, usually point to pain anteriorly
Decreased ROM, internal rotation most often restricted by osteophytes (obligatory external rotation when flexed), limp, reproducible groin pain
Joint height narrowing, sclerosis, cystic formation, osteophytes
