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Musculoskeletal MBCHB > Pelvis, Hip and Thigh Conditions > Flashcards

Pelvis, Hip and Thigh Conditions Flashcards

1
Q

What is the aetiology of pelvic fracture?

A
  • High energy injuries in the young - typically RTA or fall from height
  • Frailty fractures of older osteoporotic bone
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2
Q

What is the pathophysiology of pelvic fracture?

A
  • Bony ring disruption usually affects more than one site, so they are usually multiple (either bones or symphysis/SI joints)
    • Joints more likely to be affected in high energy injuries
  • Young-Burgess classification is used to classify pelvic ring fractures
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3
Q

What is the presentation of pelvic fracture?

A

Pain and inability to bear weight

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4
Q

What are the investigations for a high energy pelvic fracture?

A
  • If pelvis is the only site of injury → x-ray first
  • In polytraumatic patients → CT first
  • CT can also provide details of fractures already shown by x-ray
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5
Q

What are the investigations for a low energy pelvic fracture?

A
  • These fractures are often undisplaced, with normal x-rays
  • CT is more sensitive than x-ray, especially when fractures start to heal
  • MRI is the most sensitive - test of choice
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6
Q

What is the management of pelvic fractures?

A
  • Initial management for high energy mechanisms - pelvic binder (controls circulatory loss)
  • Conservative - analgesia, weight bearing as tolerated
  • Operative - ORIF, external fixators, internal fixators
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7
Q

What is the aetiology of a pelvic soft tissue injury?

A
  • Sports related pelvic soft tissue injury is common
    • Acutely this is typically due to muscle tear or tendon avulsion
    • Chronic overuse can cause bone or soft tissue pain at site of tendon or ligament attachment
  • Can also occur secondary to pelvic fracture
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8
Q

What are the investigations of pelvic soft tissue injuries?

A
  • US can show acute injuries affecting superficial structures
  • MRI is imaging method of choice as it provides a more complete assessment of all soft tissues and bones
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9
Q

What is the management of pelvic soft tissue injuries?

A

Rest, ice, compression, elevation (RICE)

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10
Q

What is the aetiology of hip dislocations?

A

Typically due to impact during RTA or contact sports with the hip flexed

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11
Q

What is the pathophysiology of hip dislocations?

A
  • Most commonly posterior
    • Force is driven along the femur proximally, so femoral head typically dislocates posteriorly with an acetabular rim fracture
  • Associated fractures - posterior acetabular wall, femoral
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12
Q

What is the presentation of hip dislocations?

A

Flexed, internally rotated and adducted knee

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13
Q

What are the investigations of hip dislocations?

A
  • Neurovascular assessment (particularly sciatic nerve)
  • X-ray
  • CT after reduction if further injury suspected
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14
Q

What is the management of a hip dislocation?

A

Immediate

  • Urgent reduction
  • Stabilise in tractions if required

Definitive

  • Fixation of associated pelvic fractures
  • Fixation of other injuries in poly-trauma patients
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15
Q

What are the complications of a hip dislocation?

A
  • Sciatic nerve palsy
  • AVN femoral head
  • Secondary OA of hip
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16
Q

What are the risk factors for hip fractures?

A
  • Osteoporosis
  • Smoking, alcohol use
  • Malnutrition
  • Neurological impairment
  • Impaired vision
  • Low BMI
17
Q

What is the aetiology of hip fractures?

A
  • Typical mechanism of injury is a low impact fall in the elderly
    • 92% patients are over 60
  • Often associated with osteoporosis
    • 73% of patients are female
  • Young adults - caused by high energy trauma
18
Q

What is the pathophysiology of hip fractures?

A
  • 30% mortality at one year
  • Fractures are classified as either intracapsular or extracapsular
19
Q

What are intracapsular hip fractures and how are they categorised?

A
  • Occur proximal to the intertrochanteric line
  • Involve the femoral head and neck
  • Subdivided into subcapital and transcervical fractures
  • Can be displaced or undisplaced
  • Prone to femoral head AVN and non-union
    • Intracapsular fractures can damage the medial femoral circumflex artery
  • Intracapsular fractures are classified using the Garden classification - predicts union and risk of AVN, which influences treatment
20
Q

What are the extracapsular hip fractures?

A
  • Occur distal to the intertrochanteric line
  • Subdivided into basicervical, intertrochanteric, reverse oblique and subtrochanteric fractures
  • Blood supply to the head of femur is intact, so AVN and non-union is rare
21
Q

What is the presentation of hip fractures?

A
  • Hip/groin pain
  • May be swelling
  • Unable to weight bear
  • Lower limb on affected side may be shortened and externally rotated
  • Assess neurology and vascular status of the lower limb
  • Assess for cognitive impairment
  • Assess for any missed injuries
  • Assess for dehydration (some patients may have been on the floor for a long time)
22
Q

What are the investigations for hip fractures?

A

X-ray

  • Most are easy to see on x-ray - pelvis and lateral hip
  • Loss of contour of Shenton’s line in pelvic x-ray indicates hip fracture
    • Fractures to femoral neck do not always cause loss of Shenton’s line
      MRI
  • Some undisplaced fractures are subtle/invisible on x-ray
  • Where clinical suspicion persists patients undergo either a repeat x-ray after 10 days or an immediate MRI

Others

  • ECG
  • Bloods
23
Q

What is the management for a high functioning patient with a intracapsular hip fracture?

A

Displaced -> Total Hip Replacement
Undisplaced -> CHS screw

24
Q

What is the management for a low functioning patient with a intracapsular hip fracture?

A

Hemi-arthroplasty

25
Q

What is the management of a intertrochanteric extracapsular hip fracture?

A

DHS screw

26
Q

What is the management of a subtrochanteric extracapsular hip fracture?

A

IM nail

27
Q

What is idiopathic transient osteonecrosis of the hip?

A

Local hyperaemia and impaired venous return with marrow oedema and increased intramedullary pressure

28
Q

What is the aetiology of idiopathic transient osteonecrosis of the hip?

A
  • Higher incidence in males
  • 2 groups: middle age men, pregnant women in third trimester
29
Q

What is the presentation of idiopathic transient osteonecrosis of the hip?

A
  • Progressive groin pain over several weeks
  • Difficulty weight bearing
  • Usually unilateral
30
Q

What are the investigations of idiopathic transient osteonecrosis of the hip?

A
  • Elevated inflammatory markers
  • X-ray - osteopenia of the femoral head and neck, thinning of the cortices, preserved joint pain
  • MRI - gold standard
  • Bone scan
31
Q

What is the management of idiopathic transient osteonecrosis of the hip?

A
  • Self limiting condition that resolves in 6-9 months
  • Analgesia
  • Protected weight (crutches) bearing to avoid stress fracture
32
Q

What is trochanteric bursitis?

A

Repetitive trauma caused by iliotibial band tracking over trochanteric bursa which causes inflammation of the bursa

33
Q

What is the aetiology of trochanteric bursitis?

A
  • Female patients
  • Young runners and older patients
  • May be linked to gluteal cuff syndrome
    • The broad tendinous insertion of the abductor muscles (predominantly the gluteus medius) is under considerable strain and is subject to tendonitis and degeneration leading to tendon tears
34
Q

What is the presentation of trochanteric bursitis?

A
  • Pain on the lateral aspect of the hip
  • Pain on palpation of the greater trochanter
  • Pain on restricted abduction
35
Q

What are the investigations of trochanteric bursitis?

A
  • Clinical diagnosis
  • X-rays usually unremarkable
  • Visible on MRI but not usually needed
36
Q

What is the management of trochanteric bursitis?

A
  • Analgesia - NSAIDs
  • Physiotherapy (to strengthen other muscles and avoid abductor weakness)
  • Steroid injection
  • No proven benefit from surgery
37
Q

What is the aetiology of a femoral shaft fracture?

A

Typically high energy injuries, major trauma patients and is often associated with other injuries

38
Q

What is the management of a femoral shaft fracture?

A
  • Initial management - Thomas splint for temporary stabilisation
  • Conservative management not typically used
  • Operative - IM nail, plate fixation (ORIF/MIPPO)
39
Q

What are the complications of a femoral shaft fracture?

A
  • Can result in significant blood loss
  • Risk of fat embolus

Musculoskeletal MBCHB (21 decks)

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