The hip and thigh Flashcards
What does development of the acetabulum depend on
The head of the femur being in its normal position and on movement of the joint
When does the epiphysis of the femoral head normally develop
4-5 months
What kind of gait may occur if the hip is painful
antalgic
What is a Trendelenburg gait
The pelvis tilts down on the opposite side of the disease hip
Sign of an abnormality with the abductor muscles
What conditions would present with a Trendelenburg gait
dislocation of the hip
Painful hip joint in OA
abnormality of the femoral neck, either being short or in a virus position
Describe the rotation of a hip in a femoral neck fracture
shortened and externally rotated on the side of a femoral neck fracture
Why is it difficult to determine tenderness of the hip
it is a deep joint
What are the movements of the hip joint
flexion and extension
abduction and adduction
internal and external rotation
How are abduction and adduction tested
Going the joint whilst the examiner keeps a hand on the opposite anterior superior iliac spine to detect pelvic movement
How is the true limb length measured
from the anterior superior iliac spine to the medial malleolus
What is the apparent length of the limb
from a midline point to the medial malleolus
What age group are affected by Perthes
boys aged 5-10
What are the clinical signs of Perthes
Minor , perhaps slight restriction of movements of the hip
What is seen on Xray in a patient with Perthes disease
Increased density of the epiphysis and widening of the medial joint space
How does healing occur on Xray of Perthes
gradual reabsroption of the dense bone and laying down of normal looking new bone
What is the treatment for Perthes disease
Position of abduction and internal rotation by either traction in bed or on an abduction frame
What is a slipped upper femoral epiphysis
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
What is the treatment for a SUFE
condition requires urgent surgical stabilisation with pins to prevent further stoppage of the epiphysis
When should septic arthritis in a child be suspected
Child presenting who is ill, toxic and unable to walk
Irritable and movement of the affected joint will not be possible because of pain
How is a diagnosis of septic arthritis in a child made
raised white cell count and erythrocyte sedimentation rate
What is the treatment for septic arthritis
urgent surgical drainage
What is irritable hip or transient synovitis
An effusion may occur in the hip of a child who has association with a generalised viral illness and
What is the usual infective organism of septic arthritis
Staph aureus
Where is pain form the hip joint usually felt in adults
In the groin or on the lateral or anterior aspect of the thigh
Describe the pain of the hip in OA
Pain felt in the groin or anterior thigh
Pain is made worse by walking
can keep the patient awake at night in advanced disease
What is the treatment for OA in the hip
Conservative treatment
lose weight
use a stick
analgesics and NSAIDs
Total hip replacement
What are the main risks of a total hip replacement
Infection
Thromboembolism
Dislocation
What is the treatment for Paget’s disease
Bisphosphonates
What can avascular necrosis (AVN) in the femoral head lead to
an effusion in the hip joint causing pain and stiffness
If the process continues, the femoral head may collapse producing secondary OA
What are 4 causes of AVN
idiopathic excess alcohol sickle cell disease prolonged steroid therapy Working in pressurised environments (deep sea divers) Malignancy
What is the treatment for metastatic malignancy
radiotherapy or bisphosphonates may slow the disease progress
What is a painful soft-tissue condition around the hip
Trochanteric burstis
Where is the pain in trochanteric bursitis
Over the hip of the greater trochanter rather than pain in the groin
What is the treatment for trochanteric bursitis
NSAIDs or steroid injection
What may lead to a neck of femur (NOF) fracture
a trivial fall
Describe an intracapsular fracture
a fracture that occurs through the femoral neck just below the head of the femur
How is the leg held in an intracapsular fracture
short and externally rotated
What is the prognosis for a intracapsular fracture
30-40% of patients die within the following 12 months
What are the two methods of surgical treatment for an intracapsular fracture
reduction of the fracture and internal fixation
Remove the ball of the femur and replace it with a prosthesis
When is a reduction and internal fixation used
when the blood supply to the head of the femur is unlikely to have been damaged by the fracture
Where do intertrochanteric fractures occur
In the wide metaphysical region between the two trochanters in the femur
What is the treatment for an intertrochanteric fracture
Internal fixation with a dynamic hip screw
What does a dynamic hip screw allow for
Controlled collapse of the fracture when the patient is weight bearing to encourage union of the fracture
What is the immediate treatment of a femoral shaft fracture
Application of a Thomas splint
What does a Thomas splint do
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
What is the preferred treatment for a femoral shaft fracture
fixation with an intramedullary nail
What is associated with fractures of the femoral shaft
Anterior cruciate ligament rupture
How can the hip joint dislocate
usually as a result of considerable violence
What direction is a simple dislocation of the hip
usually posterior
Describe the appearance of the leg in a hip dislocation
leg flexed, adducted and shortened
femoral head may be palpable in the buttock
What is the treatment for a hip dislocation
Reduction
Carried out under GA
