pathologies related to pelvis & hip I - exam 2 Flashcards
what is a pathological hip fracture?
proximal femur fx, particularly of the neck, due to disease
causes of a pathological hip fx?
conditions with compromised bone
- osteoporosis and osteomalacia
- osteogenesis imperfecta (congenital and inherited brittle bone disease - peds)
- paget’s disease (chronic bone disorder w abnormal bone turnover that results in bigger but softer bones)
- tumors
may or may not involve a fall (break can cause fall or fall can cause break)
prevalence of pathological hip fx
mostly older
european americans
pathogenesis of pathological hip fx
gradual weakening of bone resulting in fx
S&S of pathological hip fx
fx S&S
painful snap and possible giving way
groin and possible anteromedial thigh P! to knee and lateral hip
– increased: WB
– decreased: non WB
what would you observe in someone with a pathological hip fx
shortened and excessively externally rotated LE due to displacement and pull of ERs
antalgic (painful) and asymmetrical gait
pathological hip fx:
- ROM:
- Special tests:
- several but particularly IR limitations
- (+) patellar-pubic percussion
possible sign of the buttock
what is the sign of the buttock? causes?
collection of signs indicating a serious pathology
fx
tumor
infection
hematoma
what would you find in your interview & scan for sign of the buttock?
- Hx
- Observation
- ROM
- Resisted
- possible cancer, infection or fx S&S
- gluteal swelling - one larger than the other
- hip flx limitation the same no matter knee position with empty ends feels. same degree of trunk flexion limitation in relation to femur and trunk position
- weak and painful glutes
what is the referral for someone with the sign of the buttock?
urgent referral to MD but emergent if fx due to possible displacement and/or vascular compromise
what can result from a sedentary situation in someone with a pathological hip fx?
significant morbidity, mortality and health issues
what referral for pathological hip fx?
immobilize w emergent referral due to possible displacement and potential vascular compromise
what is osteonecrosis and where is it located?
avascular necrosis (AVN) of the femoral head
true or false. osteonecrosis may be bilateral in 60% of the cases
true
who is more likely to get osteonecrosis?
older individuals
what is the cause of osteonecrosis?
insufficient arterial supply to femoral head associated with trauma
- fx/dislocation
- slipped femoral epiphysis/growth plate
where does the blood supply for the femoral head come from?
medial epiphyseal a. to supply head of femur
medial and lateral circumflex artery
what intracapsular ligament contains the blood supply of the femur head?
ligamentum teres
- attachments: acetabulum –> fovea of femoral head
what are secondary associations that could exist with osteonecrosis?
vascular abnormalities
toxicity (radiation, smoking, alcoholism)
sickle cell disease with a shortage of healthy oxygen carrying RBCs
chronic corticosteroid and oral contraceptive use
bone marrow pathology
metabolic syndrome (obesity, diabetes)