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Lecture Notes- Orthopaedics and Fractures > The hip and thigh > Flashcards

The hip and thigh Flashcards

1
Q

What does development of the acetabulum depend on

A

The head of the femur being in its normal position and on movement of the joint

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2
Q

When does the epiphysis of the femoral head normally develop

A

4-5 months

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3
Q

What kind of gait may occur if the hip is painful

A

antalgic

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4
Q

What is a Trendelenburg gait

A

The pelvis tilts down on the opposite side of the disease hip
Sign of an abnormality with the abductor muscles

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5
Q

What conditions would present with a Trendelenburg gait

A

dislocation of the hip
Painful hip joint in OA
abnormality of the femoral neck, either being short or in a virus position

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6
Q

Describe the rotation of a hip in a femoral neck fracture

A

shortened and externally rotated on the side of a femoral neck fracture

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7
Q

Why is it difficult to determine tenderness of the hip

A

it is a deep joint

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8
Q

What are the movements of the hip joint

A

flexion and extension
abduction and adduction
internal and external rotation

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9
Q

How are abduction and adduction tested

A

Going the joint whilst the examiner keeps a hand on the opposite anterior superior iliac spine to detect pelvic movement

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10
Q

How is the true limb length measured

A

from the anterior superior iliac spine to the medial malleolus

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11
Q

What is the apparent length of the limb

A

from a midline point to the medial malleolus

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12
Q

What age group are affected by Perthes

A

boys aged 5-10

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13
Q

What are the clinical signs of Perthes

A

Minor , perhaps slight restriction of movements of the hip

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14
Q

What is seen on Xray in a patient with Perthes disease

A

Increased density of the epiphysis and widening of the medial joint space

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15
Q

How does healing occur on Xray of Perthes

A

gradual reabsroption of the dense bone and laying down of normal looking new bone

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16
Q

What is the treatment for Perthes disease

A

Position of abduction and internal rotation by either traction in bed or on an abduction frame

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17
Q

What is a slipped upper femoral epiphysis

A

a condition whereby the developing epiphysis of the hip, often in an overweight hypogonadal boy, partially slips, leading to hip pain or referred pain to the knee

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18
Q

What is the treatment for a SUFE

A

condition requires urgent surgical stabilisation with pins to prevent further stoppage of the epiphysis

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19
Q

When should septic arthritis in a child be suspected

A

Child presenting who is ill, toxic and unable to walk

Irritable and movement of the affected joint will not be possible because of pain

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20
Q

How is a diagnosis of septic arthritis in a child made

A

raised white cell count and erythrocyte sedimentation rate

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21
Q

What is the treatment for septic arthritis

A

urgent surgical drainage

22
Q

What is irritable hip or transient synovitis

A

An effusion may occur in the hip of a child who has association with a generalised viral illness and

23
Q

What is the usual infective organism of septic arthritis

A

Staph aureus

24
Q

Where is pain form the hip joint usually felt in adults

A

In the groin or on the lateral or anterior aspect of the thigh

25
Q

Describe the pain of the hip in OA

A

Pain felt in the groin or anterior thigh
Pain is made worse by walking
can keep the patient awake at night in advanced disease

26
Q

What is the treatment for OA in the hip

A

Conservative treatment
lose weight
use a stick
analgesics and NSAIDs

Total hip replacement

27
Q

What are the main risks of a total hip replacement

A

Infection
Thromboembolism
Dislocation

28
Q

What is the treatment for Paget’s disease

A

Bisphosphonates

29
Q

What can avascular necrosis (AVN) in the femoral head lead to

A

an effusion in the hip joint causing pain and stiffness

If the process continues, the femoral head may collapse producing secondary OA

30
Q

What are 4 causes of AVN

A 
idiopathic 
excess alcohol
sickle cell disease
prolonged steroid therapy 
Working in pressurised environments (deep sea divers)
Malignancy
31
Q

What is the treatment for metastatic malignancy

A

radiotherapy or bisphosphonates may slow the disease progress

32
Q

What is a painful soft-tissue condition around the hip

A

Trochanteric burstis

33
Q

Where is the pain in trochanteric bursitis

A

Over the hip of the greater trochanter rather than pain in the groin

34
Q

What is the treatment for trochanteric bursitis

A

NSAIDs or steroid injection

35
Q

What may lead to a neck of femur (NOF) fracture

A

a trivial fall

36
Q

Describe an intracapsular fracture

A

a fracture that occurs through the femoral neck just below the head of the femur

37
Q

How is the leg held in an intracapsular fracture

A

short and externally rotated

38
Q

What is the prognosis for a intracapsular fracture

A

30-40% of patients die within the following 12 months

39
Q

What are the two methods of surgical treatment for an intracapsular fracture

A

reduction of the fracture and internal fixation

Remove the ball of the femur and replace it with a prosthesis

40
Q

When is a reduction and internal fixation used

A

when the blood supply to the head of the femur is unlikely to have been damaged by the fracture

41
Q

Where do intertrochanteric fractures occur

A

In the wide metaphysical region between the two trochanters in the femur

42
Q

What is the treatment for an intertrochanteric fracture

A

Internal fixation with a dynamic hip screw

43
Q

What does a dynamic hip screw allow for

A

Controlled collapse of the fracture when the patient is weight bearing to encourage union of the fracture

44
Q

What is the immediate treatment of a femoral shaft fracture

A

Application of a Thomas splint

45
Q

What does a Thomas splint do

A

applies counter-traction to the limb and the resulting stability aids in reducing blood loss from the fracture and in providing comfort for the patient

46
Q

What is the preferred treatment for a femoral shaft fracture

A

fixation with an intramedullary nail

47
Q

What is associated with fractures of the femoral shaft

A

Anterior cruciate ligament rupture

48
Q

How can the hip joint dislocate

A

usually as a result of considerable violence

49
Q

What direction is a simple dislocation of the hip

A

usually posterior

50
Q

Describe the appearance of the leg in a hip dislocation

A

leg flexed, adducted and shortened

femoral head may be palpable in the buttock

51
Q

What is the treatment for a hip dislocation

A

Reduction

Carried out under GA

Lecture Notes- Orthopaedics and Fractures (23 decks)

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