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Netter's Orthopaedics > Thigh/Hip > Flashcards

Thigh/Hip Flashcards

1
Q

Primary blood supply of the femoral head

A

Medial femoral circumflex artery

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2
Q

Anatomic axis of Femur

A

Line drawn along axis of femur

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3
Q

Mechanical axis of femur

A

line drawn between center of femoral head and intercondylar notch

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4
Q

Knee axis

A

line drawn along the inferior aspect of both femoral condyles

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5
Q

Vertical axis

A

Vertical line, perpendicular to ground

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6
Q

Lateral femoral angle

A

angle formed between the knee axis and the femoral axis

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7
Q

Complication of hip dislocation

A

femoral head AVN

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8
Q

Direction of hip dislocation most common?

A

Posterior

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9
Q

PE of ant vs post hip locations

A

Ant: ABducted, flexed, ER
Post: ADducted, flexed, IR

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10
Q

XR findings in hip dx

A

Fermoral heads appear different sizes

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11
Q

Thompson classification

A 
Posterior hip dx
I: No or minor post wall fx
II: Large posterior wall fx
III: Comminuted acetabular fx
IV: Acetabular floor fx
V: Femoral head fx
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12
Q

Epstein classification

A 
Anterior hip dx
I(ABC): superior
II(ABC): Inferior
A: No associated fx
B: Femoral head fx
C) acetabular fx
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13
Q

PE femoral neck fx

A

elderly most common, LE shortened abducted, ER

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14
Q

Garden classification

A 
Femoral neck fx
I: Incomplete fx; valgus impaction
II: Complete fx; nondisplaced
III: Complete fx; partial displacement, (varus)
IV: Complete fx, total displacement
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15
Q

Evans/Jensen classification

A 
Intertrochanteric
Type 1A: nondisplaced
Type 1B: 2 part displaced
Type 2A: 3 part, GT fragment
Type 2B: 3 part, LT fragment
Type 3: 4 part
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16
Q

Mortality of intertrochanteric fx

A

20% at 6 months

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17
Q

Winquis/Hansen classification

A 
Femoral shaft fx
0: no comminution
I: Minimal comminution
II: Comminuted >50% cortices intact, unstable
III: Comminuted:
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18
Q

Russell-Taylor classification

A

Subtrochanteric fx
Type 1: No piriformis fossa extension/involvement
A: Intact LT
B: detached LT
Type 2: Fracture involves the piriformis fossa
A: Intact LT
B: detached LT

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19
Q

AO/Muller classification

A

Distal femur fracture
A: extraarticular subtypes 1,2,3
B: unicondylar subtypes 1,2,3
C: bicondylar subtypes 1,2,3

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20
Q

Thigh impingement test

A

Supine: flex, adduct, IR hip. Pain may be indicative of FAI

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21
Q

Patrick/FABER

A

Flex, Abduct, ER, SI joint pathology

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22
Q

Log roll test

A

Supine, hip extended: IR/ER. Pain c/w hip arthritis

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23
Q

Stinchfield

A

Resisted straight leg raise, pain = hip pathology

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24
Q

Thomas sign

A

Supine; one knee to chest. If opposite thigh elevates off table, flexion contracture

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25
Q

Ober sign

A

On side: flex and abduct hip. Extend and adduct hip, if stays in abduction, ITB contracture

26
Q

Piriformis sign

A

On side: adduct hip. Pain in hip/pelvis indicates tight piriformis (compressing sciatic n)

27
Q

90-90 straight leg

A

Flex hip and knee 90°, extend knee. >20° of flexion after full extension = tight hamstrings

28
Q

Ely’s test

A

Prone, passively flex knee. If hip flexes as knee is flexed, tight rectus femoris

29
Q

Leg length

A

ASIS to medial malleolus. >1cm = positive

30
Q

Meralgia test

A

Compression medial to ASIS. Pain = LFCN entrapment

31
Q

Ortolani

A

Hips at 90°. Abduct hips. Clunk indicates relocation

32
Q

Barlow

A

Hips at 90°, posterior force. Clunk indicates dislocation

33
Q

Galeazzi test

A

Supine, flex hips and knees. Any discrepancy in knee hight= dislocated hip or short femur

34
Q

Innervation of adductor magnus?

A

Obturator and sciatic

35
Q

Hamstring tendon used in ACL repair?

A

SemiT

36
Q

What nerve penetrates the psoas?

A

Genitofemoral branch of femoral nerve

37
Q

When does femoral artery change name?

A

Changes to popliteal artery after adductor hiatus

38
Q

What artery is at risk in anteromedial approach to hip?

A

Descending branch of the lateral femoral circumflex

39
Q

Which artery runs under quadratus femoris

A

Medial femoral circumflex

40
Q

Cam vs pincer FAI

A

Cam: femoral nonsphericity
Pincer: Acetabulum overcoverage

41
Q

Femoral neck stress fracture

Types, common pt, best imaging, best treatment

A 
Tension: superior neck 
Compression: inferior neck
Common in military recruits
Need MR
Treat tension type with percutaneous pinning
42
Q

Snapping hip (coxa saltans)

A

3 types:
External: ITB over GT
Internal: psoas over femoral head or iliopectineal eminence
Intraarticular: loose body.

43
Q

Signs of OA

A

1: Joint space narrowing
2: Osteophytes
3: Subchondral sclerosis
4: Bony cysts

44
Q

Modified Ficat classification

A

Osteonecrosis of femoral head

0: asymptomatic, nl XR and MR
1: SymptomaticL nl XR and MR
2: XR: sclerosis, no collapse
3: XR: sclerosis + collapse (crescent sign)
4: Flat femoral head, nl acetabulum
5: joint space narrowing, early DJD
6: Advanced DJD including acetabulum

45
Q

Signs of RA

A

1: Joint space narrowing
2: Periarticular osteoporosis
3: Joint erosions
4: Ankylosis

46
Q

Absolute and relative contraindications in THA

A

Absolute: Infection, medically unstable, neuropathic pain
Relative: Young, active pts

47
Q

Cause of osteolysis

A

Macrophage response to submicron sized wear particles.

48
Q

Hilgenreiner’s line

A

Horizontal line through tri-radiate cartilage.

49
Q

Perkin’s line

A

Vertical line through the lateral edge of acetabulum

50
Q

Shenton’s line

A

Curved line from the femur and pelvis

51
Q

DDH

A

Abnormal hip development causing dislocation, subluxation, or laxity of the hip

52
Q

Risk factors for DDH?

A

Female, first born, breech, family hx,

53
Q

1 cause of intoeing?

A

femoral anterversion

54
Q

Legg-Calve-Perthes disease

A

idiopathic AVN of femoral head. 4-8 year old boys

55
Q

Slipped capital femoral epiphysis (SCFE)

A

Displacement of the femoral epiphysis through the physis. 10-16, obese

56
Q

Smith-peterson approach
IN planes
Dangers

A

Anterior hip
IN plane: superficial - sartorius (femoral) + tensor fascia latae (superior gluteal nerve)
Deep - Rectus femoris (femoral n) + Gluteus minimums (SGN)
Dangers: LFCN, femoral N, ascending branch of the femoral circumflex a.

57
Q

Ludloff approach
IN planes
Dangers

A

Medial hip
interMUSCULAR planes: superficial: adductor longus (obturator) and gracillis (obturator)
Deep: Adductor brevis: obturator + adductor magnus (sciatic and obturator)
Dangers: Obturator n (ant div), medial femoral circumflex artery, obturator nerve (post. div), external pudendal artery

58
Q

Watson-Jones approach
IN planes
Dangers

A

Anterolateral hip
InterMUSCULAR planesL TFL (SGN) and gluteus medius (SGN)
Dangers; Descending branch of LFCA, femoral n

59
Q

Hardinge approach
IN planes
Dangers

A

Lateral hip
IN planes: split gluteus medius (SGN) and vastus lateralis (femoral n)
Dangers: superior gluteal a, femoral nerve, femoral artery and vein, superior gluteal nerve

60
Q

Moore/southern approach
IN plane
Dangers

A

Posterior hip
IN plane: split gluteus maximus (IGN)
Dangers; Sciatic nerve, inferior gluteal artery, MFCA

61
Q

Lateral thigh approach
IN plane
Dangers

A

IN plane: split vastus lateralis (femoral nerve) or elevate it.
Dangers: descending branch of lateral femoral circumflex artery, perforators from profunda femoris, superior lateral geniculate artery.

62
Q

Hip arthoscopy portals (3)

A

Anterior - LFCN, femoral n, ascending branch of LFCA
Anterolateral - SGN
Posterolateral - Sciatic n.

Netter's Orthopaedics (7 decks)

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