S3_L1 Trauma to the Pelvis and Hip Flashcards
The most common disorder of the hip in adolescence
Slipped capital femoral epiphysis
It is the relocation maneuver used to reduce hip dislocation
Ortolani
It is the dislocation maneuver done first to assess the instability of the hip
Barlow
Most appropriate diagnostic tool for the evaluation of avascular necrosis
A. X-ray
B. CT Scan
C. Angiography
D. MRI
D. MRI
Most frequent long-term complication of hip dislocation
A. avascular necrosis
B. sciatic nerve injury
C. femoral nerve and artery injury
D. post-traumatic arthritis
D. post-traumatic arthritis
Most common cause of proximal femur fractures
A. Trauma
B. Stress fracture
C. Fall
D. Motor vehicular accident
C. Fall
Most pelvic fractures are demonstrated on this radiograph
A. AP pelvis
B. Pelvic oblique
C. AP axial inlet
D. AP axial outlet
A. AP pelvis
Note: The other choices are optional imaging evaluation for fractures of the pelvis.
Most common treatment for slipped capital femoral epiphysis
A. Conservative treatment
B. Surgical fixation
C. Total hip arthroplasty
D. In situ pinning
D. In situ pinning (Accept the deformity, pin it to prevent further collapse)
Diagnostic study of choice for diagnosing stress fractures
A. CT Scan
B. X-ray
C. MRI
D. Radionuclide bone scans
C. MRI
Diagnostic modality of choice for evaluating labral tears
A. X-ray
B. CT Scan
C. Radionuclide bone scans
D. MR Arthrography
D. MR Arthrography
TRUE OR FALSE: In slipped capital femoral epiphysis, the proximal femur epiphysis displaces posteriorly, medially and inferiorly.
True
A 45 yo female patient consulted due to bilateral hip pain. On Xray you see subchondral collapse of the head involving more than 30% of the femoral head. Using the Steinberg Classification/Staging, What is the stage of the patient’s AVN.
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
C. Stage III
This hip position during a dashboard injury will result in a posterior hip dislocation and concomitant posterior wall acetabular fracture
a. Hip flexion and adduction
b. Hip flexion and abduction
c. Hip extension and adduction
d. Hip extension and abduction
b. Hip flexion and abduction
This hip position during a dashboard injury will result in a posterior hip dislocation, but with a less chance for a posterior wall acetabular fracture
a. Hip flexion and adduction
b. Hip flexion and abduction
c. Hip extension and adduction
d. Hip extension and abduction
a. Hip flexion and adduction
- Avulsion
- Pelvic ring disruptions
- Individual bone fractures
A. Low-energy injury
B. High-energy injury
C. Both
D. Neither
- A
- B
- A
True of high-energy injuries, except
A. X-rays: more extensive trauma survey is necessary
B. Pelvic fractures are often accompanied by life-threatening visceral injuries
C. A CT scan of the thorax-abdomen-pelvis (TAP) can be done to quickly assess injuries
D. None
D. None
True of low-energy injuries, except
A. Pelvis AP view can be used to view the walls of the acetabulum
B. Pelvis AP view is used to assess the location of injuries
C. CT Scan is used for evaluating fractures in complex areas
D. None
D. None
Modified TF
A. In the pelvic inlet view, the central ray is angled at 40 degrees cephalad.
B. In the pelvic outlet view, the
central ray is angled at 30 degrees caudal.
FF
A. In the pelvic inlet view, the central ray is angled at 40 degrees caudal (superior to inferior).
B. In the pelvic outlet view, the
central ray is angled at 30 degrees cephalad (inferior to superior).
Modified TF
A. The Hip AP view and cross-table lateral view can be used to view proximal femur fractures.
B. The anteroposterior pelvic oblique (Judet) views demonstrate the columns of the acetabulum.
TT
The following are etiologies of femoroacetabular impingement with labral pathology, except
A. Past medical history of slipped capital femoral epiphysis
B. Developmental dysplasia of the hip
C. Avascular necrosis
D. Acetabular Retroversion
E. None
E. None
- Overcoverage of femoral head by the acetabulum
- Coxa profunda
- Femoral head-neck junction is offset
- Acetabular protrusion
- Acetabular retroversion
A. Cam impingement
B. Pincer impingement
C. Both
D. Neither
- B
- B
- A (unable to fully clear the acetabular rim)
- B
- B
The following are etiologies of developmental dysplasia of the hip, except
A. Mechanical cause: in-utero position
B. Hormonal
C. Environmental
D. Genetic
C. Environmental
The following are clinical presentations of developmental dysplasia of the hip, except
A. Uneven thigh skin folds
B. Loss of motion
C. (+) Ortolani & Barlow
D. Uneven leg lengths
E. None
E. None
The following are clinical presentations of femoroacetabular impingement with labral pathology, except
A. (+) Snapping or clicking hip
B. Hip extension contractures
C. Painful provocation test
D. Loss of motion
E. None
B. Hip extension contractures
Correct answer: hip flexion contractures
Position of the hip in the painful provocation test to confirm for femoroacetabular impingement
A. Flexion, abduction, internal rotation
B. Flexion, adduction, internal rotation
C. Flexion, abduction, external rotation
D. Flexion, adduction, external rotation
B. Flexion, adduction, internal rotation
If the hip was passively positioned in this way and pain was elicited, (+) impingement
The following are etiologies/risk factors of slipped capital femoral epiphysis, except
A. Weakening of physeal plate at the head-neck junction
B. Extreme shear and weight bearing forces
C. Imbalance of growth and sex hormones
D. Obesity and trauma
E. Horizontally oriented physeal plate
E. Horizontally oriented physeal plate
Correct answer: vertically oriented physeal plate
As load is placed on the (vertically-oriented) femoral head, the risk for displacement increases
True of the radiologic findings in slipped capital femoral epiphysis, except
A. Blurring or widening of physis on AP view
B. Displacement is best demonstrated on lateral frog leg
C. Decreased height of epiphysis relative to ipsilateral hip
D. None
C. Decreased height of epiphysis relative to ipsilateral hip
Correct answer: Decreased height of epiphysis relative to contralateral hip
Modified TF
A. Osteochondritis Dissecans pertains to the infarction of the entire epiphysis of a growing child, leading to avascular necrosis.
B. Epiphyseal Ischemic Necrosis is described as a localized segmental infarction.
FF
A. Epiphyseal ischemic necrosis pertains to the infarction of the entire epiphysis of a growing child, leading to avascular necrosis.
B. Osteochondritis dissecans is described as a localized segmental infarction.
True of the clinical presentation of RA of the hip, except
A. Morning joint stiffness
B. Bilateral and symmetrical swelling of the joints
C. Pain and functional disability
D. Rheumatoid nodules
E. Rheumatoid factor test may be normal
E. Rheumatoid factor test may be normal
Correct answer: Positive rheumatoid factor test
True of the clinical presentation of avascular necrosis of the proximal femur, except
A. Nonspecific dull pain in the joint, thigh, or leg
B. Loss of motion in adulthood
C. Painful limp
D. None
D. None
True of the clinical presentation of degenerative joint disease of the hip, except
A. Loss of joint Motion
B. Difficulty in ambulation due to loss of joint congruity and increased pain upon weight-bearing
C. Progressive pain
D. (+) C Sign
E. None
E. None
The following are complications of pelvic fractures, except
A. 10-20 mortality rate
B. Infection
C. Thrombo-embolism
D. Malunion
E. Post-traumatic arthritis
A. 10-20 mortality rate
Correct answer: 5-15 mortality rate
The following are complications of acetabular fractures, except
A. Infection
B. Sciatic nerve injury
C. Heterotrophic Ossification
D. Malunion
E. None
E. None
The following are complications of acetabular fractures, except
A. Post-traumatic arthritis
B. Femoral or superior gluteal nerve injury
C. Avascular Necrosis
D. None
D. None
The following are complications of hip dislocation, except
A. Post-traumatic arthritis
B. Avascular necrosis
C. Sciatic nerve injury
D. Femoral nerve and artery injury
E. None
E. None
In hip dislocation, avascular necrosis may arise due to the ff, except
A. Dislocation is an acute injury
B. Prolonged period of dislocation prior to reduction
C. Repeated attempts at reduction
D. Instability
E. None
D. Instability
TRUE OR FALSE: In cases of hip dislocation, the prognosis is good if there were no associated fractures at the hip.
True
Modified TF
A. Sciatic nerve injury may be caused by a posterior hip dislocation.
B. Femoral nerve and artery injury may result from an anterior hip dislocation (traction injury).
TT
Acetabular fractures
- Affects iliopubic area
- Transverse fracture
- Occurs in the ilioischial area
- Complex, T-shaped configuration, has a vertical component
A. Anterior column fracture
B. Posterior column fracture
C. Both
- A
- C
- B
- C
Modified TF
A. In anterior hip dislocations, the dislocated head is larger in the pelvic AP view.
B. In posterior hip dislocations, the dislocated head is smaller in the pelvic AP view.
TT
The following describes the etiology of RA of the hip, except
A. Occurs in women more than men
B. Occurs in older adults
C. Progressive, systemic, autoimmune inflammatory disease primarily affecting synovial joints
D. None
B. Occurs in older adults
Correct answer: young adults
True of the radiologic findings in RA of the hip, except
A. Axial migration of the femoral head
B. Synovial cysts located within nearby bone
C. Sclerotic subchondral bone
D. Periarticular swelling and joint effusion
E. None
C. Sclerotic subchondral bone
NOTE: A distinct difference between DJD and RA is that RA has a minimal or absent reparative processes = NO SCLEROTIC SUBCHONDRAL BONE AND OSTEOPHYTE FORMATION in RA. If seen, it may be a concomitant RA on top of an OA.
True of the radiologic findings in RA of the hip, except
A. Acetabular protrusion
B. Articular erosions located peripherally or centrally on the joint
C. Symmetrical and concentric joint space narrowing
D. Osteoporosis of periarticular areas
E. None
E. None
True of the radiologic findings in DJD of the hip, except
A. Joint space narrowing
B. Sclerotic subchondral bone
C. Osteophyte formation at the joint margins
D. Cyst formation
E. None
E. None
True of the radiologic findings in DJD of the hip, except
A. Migration of the femoral head
B. Egger’s cyst
C. Pseudocyst formation
D. None
D. None
Radiologic Staging of Avascular Necrosis of the Femoral Head
Criteria: Advanced degenerative changes
A. Stage 0
B. Stage I
C. Stage II
D. Stage III
E. Stage IV
F. Stage V
G. Stage VI
G. Stage VI
Radiologic Staging of Avascular Necrosis of the Femoral Head
Criteria: Sclerosis and/or cyst formation in femoral head
A. Stage 0
B. Stage I
C. Stage II
D. Stage III
E. Stage IV
F. Stage V
G. Stage VI
C. Stage II
Radiologic Staging of Avascular Necrosis of the Femoral Head
Criteria: Subchondral collapse (crescent sign) without flattening
A. Stage 0
B. Stage I
C. Stage II
D. Stage III
E. Stage IV
F. Stage V
G. Stage VI
D. Stage III
Radiologic Staging of Avascular Necrosis of the Femoral Head
Criteria: Normal x-ray film, normal bone scan and MRI
A. Stage 0
B. Stage I
C. Stage II
D. Stage III
E. Stage IV
F. Stage V
G. Stage VI
A. Stage 0
Radiologic Staging of Avascular Necrosis of the Femoral Head
Criteria: Normal x-ray film, abnormal bone scan, or MRI
A. Stage 0
B. Stage I
C. Stage II
D. Stage III
E. Stage IV
F. Stage V
G. Stage VI
B. Stage I
Radiologic Staging of Avascular Necrosis of the Femoral Head
Criteria: Flattening of head without joint narrowing or acetabular involvement
A. Stage 0
B. Stage I
C. Stage II
D. Stage III
E. Stage IV
F. Stage V
G. Stage VI
E. Stage IV
Radiologic Staging of Avascular Necrosis of the Femoral Head
Criteria: Flattening of head with joint narrowing and/or acetabular involvement
A. Stage 0
B. Stage I
C. Stage II
D. Stage III
E. Stage IV
F. Stage V
G. Stage VI
F. Stage V
True of the possible radiologic findings in avascular necrosis of the proximal femur, except
A. Sclerosis and cyst formation
B. Radiolucent crescent image, (+) Crescent sign
C. Normal result in initial stages
D. Femoral head collapse in advanced stages
E. None
E. None
TRUE OR FALSE: Sclerosis and cyst formation in AVN represent initial necrosis and the femoral head’s attempts at healing.
True
NOTE: The joint space is preserved at this stage.
TRUE OR FALSE: The radionuclide bone scan identifies an increased uptake at the site of the lesion in avascular necrosis of the proximal femur.
True
Modified TF
A. Non-operative treatment in AVN includes prolonged avoidance of WB, traction, bracing, casting, and exercise.
B. Conservative treatment is more successful in younger patients and the prognosis is better in this age group.
TT
Surgical treatment for AVN
- For severe cases
- Multiple drilling into femoral head
- Derotate pathologic areas so WB falls into normal part of head
- Put bone graft to support the hole via cortical compression
A. Core Decompression
B. Grafting
C. Osteotomy
D. Resection
E. Arthroplasty
- D
- A
- C
- B
Modified TF
A. Conservative is usually not successful in treating SCFE.
B. Treatment can be in situ pinning or surgical fixation to prevent further inferior slippage and stabilize the physis.
TT
Modified TF
A. SCFE is the posteromedioinfeior displacement of proximal femoral epiphysis (femoral head).
B. It is occurs in childhood to adolescence, more commonly in boys as their increased activity increases their risk.
TT
The following are treatment procedures for unstable pelvic fractures, except
A. Internal fixation
B. External fixation
C. Skeletal fixation
D. A combination of these
E. None
E. None
The following are treatment procedures for stable pelvic fractures, except
A. Bed rest
B. Analgesics
C. ROME
D. Progressive mobility and ambulation with adaptive devices to limit WB on the affected side
E. None
E. None
Modified TF
A. For stable pelvic fractures, return to full function may require 6 to 12 weeks of treatment.
B. For stable fractures, excessive callus formation at the site of avulsion may result in prolonged symptoms.
TT
Modified TF
A. For DDH, a soft positioning harness (Pavlik harness) may be used in treating newborns.
B. Closed reduction under anesthesia and hip spica cast to maintain reduction may be done in children > 6 months old.
TT
Modified TF
A. The Pistol Grip Deformity is seen in a cam-type impingement.
B. The Figure Eight or Cross-over Sign represents an anterior rim that overly covers the femoral head.
TT
TRUE OR FALSE: The osseous bump at the head neck junction is a characteristic finding of a pincer lesion.
False, it is a characteristic finding of a cam lesion.
Modified TF: DJD treatment
A. In hemiarthroplasty, only the degenerative femoral head is replaced.
B. In total hip arthroplasty, both the degenerative femoral head and acetabulum are replaced.
TT
True of DDH, except
A. Common among girls
B. More common in the right hip
C. Has a familial tendency
D. Risk factors are first borne children and breech position
E. None
B. More common in the right hip
Correct answer: left hip
True of acetabular fractures, except
A. Impaction of the femoral head into the acetabular cup
B. Fracture configuration depends on position of the hip on injury
C. A neutral hip with impact on greater trochanter results in a transverse fracture
D. A flexed hip with impact through the femur results in a posterior wall acetabular fracture
E. None
E. None
TRUE OR FALSE: It is difficult to evaluate acetabular fractures on routine AP X-rays.
True
Most common type of hip dislocation
A. Superior
B. Inferior
C. Anterior
D. Posterior
D. Posterior
Hip dislocation is a type of high-energy trauma that may occur with these associated injuries, except
A. Patellar fractures
B. Femoral head fractures
C. Femoral neck fractures
D. Acetabular fractures
C. Femoral neck fractures
Modified TF
A. Intertrochanteric fracture is a type of extracapsular fracture located in the region between the greater and lesser trochanters.
B. This fracture comprises 50% of all proximal femur fractures.
TT
Modified TF
A. Subtrochanteric fracture is a type of extracapsular fracture.
B. It is located at the level of the lesser trochanter up to 5 cm below.
TT
TRUE OR FALSE: Intracapsular fractures are vulnerable to post-traumatic vascular complications because of the injury potential of blood vessels in close proximity.
True
horizontal line drawn through the junctions of the iliac, ischial, and pubic bones at the center of the acetabulum (triradiate cartilage)
A. Hilgenreiner’s line
B. Perkin’s line
C. Shenton’s line
D. Acetabular index
A. Hilgenreiner’s line
perpendicular line drawn through the outer border of the acetabulum
A. Hilgenreiner’s line
B. Perkin’s line
C. Shenton’s line
D. Acetabular index
B. Perkin’s line
The acetabular index is normally less than ___ degrees
30
More than 30 degrees = acetabular hypoplasia / shallow acetabulum, meaning (+) DDH
Line along the inferior border of the femoral neck and inferior border of the superior pubic ramus. Proximal displacement of the femoral head in congenital hip dislocation results in interruption of this line.
A. Hilgenreiner’s line
B. Perkin’s line
C. Shenton’s line
D. Acetabular index
C. Shenton’s line
TRUE OR FALSE: The femoral head is found in the inferomedial quadrant and it is not seen at birth.
True
Measure of acetabular depth from inner portion of acetabulum to outer rim of acetabulum
A. Hilgenreiner’s line
B. Perkin’s line
C. Shenton’s line
D. Acetabular index
D. Acetabular index
The following are intracapsular fractures, except
A. Femoral head
B. Subcapital
C. Femoral shaft
D. Femoral neck (transcervical or basicervical)
E. None
C. Femoral shaft
TRUE OR FALSE: On imaging for DDH, the deformity of the femoral head and acetabulum are well visualized on MRI and ultrasound even prior to ossification.
True
In intracapsular fractures, complications such as avascular necrosis, delayed union, and nonunion may occur due to compromise in the:
A. Circumflex femoral arteries, retinacular artery
B. Inferior gluteal artery
C. Superior gluteal artery
D. Internal iliac artery
A. Circumflex femoral arteries, retinacular artery
TRUE OR FALSE: In extracapsular fractures, complications are associated with fixation failure.
True
TRUE OR FALSE: On physical examination, there is more external rotation of the hip in intracapsular fractures due to the pull of the hip muscles.
False, correct answer is more external rotation of the hip in extracapsular fractures
Unstable pelvic fractures
- All 4 ischiopubic rami are involved
- Involves both ischiopubic rami on one side and contralateral SI joint
A. Vertical shear or Malgaigne fracture
B. Straddle fracture
C. Bucket handle fracture
D. Dislocation
- B
- C
Unstable pelvic fractures
- Can involve one or both SI joints and the symphysis pubis
- Unilateral fractures of the superior and inferior pubic rami and disruption of the ipsilateral sacroiliac joint
A. Vertical shear or Malgaigne fracture
B. Straddle fracture
C. Bucket handle fracture
D. Dislocation
- D
- A
The following are stable pelvic fractures, except
A. Iliac wing fractures
B. Sacral fractures
C. Ischiopubic ramus fractures
D. Avulsion fractures of the ASIS, AIIS, or ischial tuberosity
E. None
E. None
In femoroacetabular impingement, pelvic and hip x-rays are used to check for alteration in proximal femur anatomy by assessing the following, except
A. Head-to-neck angle
B. Neck-to-shaft angle
C. Acetabular inclination
D. None
D. None
Modified TF
A. The pelvic AP view and CT scan are used in evaluating hip dislocation.
B. CT scan is taken after closed reduction to check for femoral head fractures, joint congruency, and intra-articular fragments.
True
Modified TF
A. In stable fractures, there are no disruptions of any articulation.
B. This type of fracture is frequently associated with internal hemorrhage, especially in the retroperitoneal area.
TF
B. Unstable fractures are frequently associated with internal hemorrhage, especially in the retroperitoneal area.
Modified TF
A. Unstable fractures involve disruptions of 2 or more sites on the pelvis.
B. Ischiopubic ramus fractures, a type of stable fracture, account for almost half of all pelvic fractures.
TT
Modified TF
A. One of the surgical treatments for DJD of the hip is wedge osteotomy, where the joint biomechanics is altered to promote weight bearing on the unaffected surface of the femur.
B. Femoral head and neck resection are other surgical options.
TT
TRUE OR FALSE: In treating hip dislocation, open reduction is done when closed reduction fails or when excision or internal fixation is required for associated femoral or acetabular fractures.
True
TRUE OR FALSE: ORIF or prosthetic replacement is the surgical treatment specifically done for extracapsular fractures.
True
TRUE OR FALSE: CT scan, MRI, or radionuclide bone scans may supplement the routine radiographs for subtle or impacted fractures of the proximal femur.
True
It is the majority of the causes for pelvic fractures
MVA
It is the continuous osseous cage formed by the paired coxal bones and the sacrum
Pelvic ring
TRUE OR FALSE: Stability determines treatment, prognosis and rehabilitation in pelvic fractures.
True
Proximal femur fractures may occur in these cases, except
A. Falls
B. Female with osteoporosis
C. MVA (trauma) in children and young adults
D. Stress fractures in distance runners, military recruits and ballet dancers (young adults)
E. None
E. None
TRUE OR FALSE: Stress fractures of the proximal femur occur due to vertical loading stresses.
False, correct answer is stress fractures of the proximal femur occur due to cylindrical loading stresses.
TRUE OR FALSE: In DDH, the head of the femur is not visualized on x-rays as it has not ossified yet, so x-rays are done for older children with DDH.
True
Modified TF: Judet views
A. The internal oblique position demonstrates the iliopubic column and posterior rim of the acetabulum.
B. The external oblique position demonstrates the ilioischial column and anterior rim of the acetabulum.
TT
TRUE OR FALSE: On the MRI, stress fractures are represented by a hypointense fracture line from cyclic loading.
True
The following are appropriate views for evaluating proximal femur fractures, except
A. AP view
B. Lateral view
C. Mediolateral frog-leg view
D. Axiolateral groin-lateral view
E. None
E. None
TRUE OR FALSE: Two cancellous screws are used in the surgical treatment of impacted nondisplaced fracture or displaced fracture in young adults.
False, correct answer is three cancellous screws
Surgical treatment for proximal femur fractures depends on the following, except
A. Amount of displacement
B. Stability of fracture site
C. Age
D. Health and prior functional status
E. None
E. None
TRUE OR FALSE: Total or Partial Hip Replacement can be used to treat femoral neck fractures in the elderly population.
True
