The Hip Flashcards
What is the MC dislocation of the hip?
Posterior Hip dislocation
What are some MOI for a posterior hip dislocation?
Head of femur driven posteriorly (“dashboard injury”)
Posterior displacement of femoral head from acetabulum
How does a Posterior hip dislocation present?
Lower extremity in “scissors” position
Hip internally rotated, adducted and flexed
Knee flexed
Shortened extremity
What is the MOI or cause of a Anterior hip dislocation?
Abduction and external rotation of the femur
Anterior displacement of femoral head from acetabulum
How does an Anterior hip dislocation present?
Lower extremity in “helpless eversion”
Hip externally rotated and abducted
Flattened lateral hip
Prominence of femoral head in groin
What are complications that can occur with a Hip Dislocation?
Acetabular fractures
Sciatic nerve injury
Rupture of ligamentum teres artery → avascular necrosis of femoral head
What is a pathological cause of a Hip fracture?
Pathologic → metastatic and primary bone lesions
What is the presentation of someone with a Hip Fracture?
Pain radiates to groin and inner thigh
Difficulty with flexion and internal rotation
Will hold leg in external rotation and abduction
Leg may appear shorter
What imagine must be done for a hip fracture?
What can give a more detailed reading?
X-ray –> 1st line
CT for detailed evaluation
How are hip fractures repaired?
Open Reduction Internal Fixation (ORIF)
Arthroplasty
What is Avascular Necrosis of the HIP?
Loss of blood supply leads to destruction of the femoral head
What are risk factors for this?
H/o trauma long term corticosteroid use EtOH abuse radiation therapy RA & SLE
How does an Adults with avascular necrosis present?
Groin pain is initial complaint
Pain with weight bearing / limp
How do children with avascular necrosis present?
Painless limp is initial presentation
Groin, thigh or knee pain may follow
BOTH loose ROM
- internal rotation
- abduction
Based on x-ray differentiate the different Ficat stages for Avascular Necrosis
I – Normal
II – Sclerotic or cystic lesions, without subchondral
collapse
III – Subchondral collapse demonstrated by Crescent sign
IV – Osteoarthrosis with decreased articular cartilage and osteophyte formation
What is the MC finding on x-ray with avascular necrosis?
Crescent sign is often the earliest finding
What is the diagnostic image study used in avascular necrosis of the hip?
MRI
Treatment of avascular necrosis of the hip in Adults
Core decompression w/ bone graft
Total hip replacement if advanced disease or failure with graft
Treatment of avascular necrosis of the hip in children
Period of bed rest followed by progressive weight bearing
What is Femoroacetabular impingement?
Hip impingement between a femoral head/neck bump (CAM lesion) and acetabular over coverage/retro-version (Pincer lesion)
Presentation of Femoroacetabular impingement?
Pain at the groin
May experience clicking, catching and locking
How is characterized in someone with femoroacetabular impingement?
Pain is dull ache at rest/post activity
Sharp stabbing pain with turning, twisting and squatting
What test can be used to assess for femoroacetabular impingement? How is it performed?
Impingement test
Leg is flexed, adducted and internally rotated
Pain is a positive for impingement
Non surgical treatment for femoroacetabular impingement?
Activity modification
NSAIDS
PT
What is the presentation of someone with Trochanteric bursitis?
Pain and tenderness over greater trochanter
Pain worse when first rising from seated position, better after a couple steps and recurs after walking for half and hour
Inability to lay on affected side at night
Treatment options for trochanteric bursitis?
NSAIDS
Activity restrictions
Stretching IT band and gluteal muscles
