Thigh/Hip Flashcards
Primary blood supply of the femoral head
Medial femoral circumflex artery
Anatomic axis of Femur
Line drawn along axis of femur
Mechanical axis of femur
line drawn between center of femoral head and intercondylar notch
Knee axis
line drawn along the inferior aspect of both femoral condyles
Vertical axis
Vertical line, perpendicular to ground
Lateral femoral angle
angle formed between the knee axis and the femoral axis
Complication of hip dislocation
femoral head AVN
Direction of hip dislocation most common?
Posterior
Physical exam of ant vs post hip locations
Ant: ABducted, flexed, ER Post: ADducted, flexed, IR
XR findings in hip dx
Fermoral heads appear different sizes
Posterior hip dx classification
Thompson classification
I: No or minor post wall fx
II: Large posterior wall fx
III: Comminuted acetabular fx
IV: Acetabular floor fx
V: Femoral head fx
Anterior hip dx classification
Epstein classification
I(ABC): superior
II(ABC): Inferior
A: No associated fx
B: Femoral head fx
C) acetabular fx
Physical exam femoral neck fx
elderly most common, LE shortened abducted, ER
Femoral neck fx classification
Garden classification
I: Incomplete fx; valgus impaction
II: Complete fx; nondisplaced
III: Complete fx; partial displacement, (varus)
IV: Complete fx, total displacement
Classification for intertrochanteric fractures?
Evans/Jensen classification
Type 1A: nondisplaced
Type 1B: 2 part displaced
Type 2A: 3 part, GT fragment
Type 2B: 3 part, LT fragment
Type 3: 4 part
Mortality of intertrochanteric fx
20% at 6 months
Classification for Femoral shaft fx?
Winquis/Hansen classification
0: no comminution
I: Minimal comminution
II: Comminuted >50% cortices intact, unstable
III: Comminuted
Subtrochanteric fx
Russell-Taylor classification
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
Distal femur fracture
AO/Muller classification
A: extraarticular subtypes 1,2,3
B: unicondylar subtypes 1,2,3
C: bicondylar subtypes 1,2,3
Thigh impingement test
Supine: flex, adduct, IR hip. Pain may be indicative of FAI
Patrick/FABER
Flex, Abduct, ER, SI joint pathology
Log roll test
Supine, hip extended: IR/ER. Pain c/w hip arthritis
Stinchfield
Resisted straight leg raise, pain = hip pathology
Thomas sign
Supine; one knee to chest. If opposite thigh elevates off table, flexion contracture
Ober sign
On side: flex and abduct hip. Extend and adduct hip, if stays in abduction, ITB contracture
Piriformis sign
On side: adduct hip. Pain in hip/pelvis indicates tight piriformis (compressing sciatic n)
90-90 straight leg
Flex hip and knee 90°, extend knee. >20° of flexion after full extension = tight hamstrings
Ely’s test
Prone, passively flex knee. If hip flexes as knee is flexed, tight rectus femoris
Leg length
ASIS to medial malleolus. >1cm = positive
Meralgia test
Compression medial to ASIS. Pain = LFCN entrapment
Ortolani
Hips at 90°. Abduct hips. Clunk indicates relocation
Barlow
Hips at 90°, posterior force. Clunk indicates dislocation
Galeazzi test
Supine, flex hips and knees. Any discrepancy in knee hight= dislocated hip or short femur
Innervation of adductor magnus?
Obturator and sciatic
Hamstring tendon used in ACL repair?
SemiT
What nerve penetrates the psoas?
Genitofemoral branch of femoral nerve
When does femoral artery change name?
Changes to popliteal artery after adductor hiatus
What artery is at risk in anteromedial approach to hip?
Descending branch of the lateral femoral circumflex
Which artery runs under quadratus femoris
Medial femoral circumflex
Cam vs pincer FAI
Cam: femoral nonsphericity Pincer: Acetabulum overcoverage
Femoral neck stress fracture Types, common pt, best imaging, best treatment
Tension: superior neck Compression: inferior neck Common in military recruits Need MR Treat tension type with percutaneous pinning
Snapping hip (coxa saltans)
3 types: External: ITB over GT Internal: psoas over femoral head or iliopectineal eminence Intraarticular: loose body.
Signs of OA
1: Joint space narrowing 2: Osteophytes 3: Subchondral sclerosis 4: Bony cysts
Modified Ficat classification
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
Signs of RA
1: Joint space narrowing 2: Periarticular osteoporosis 3: Joint erosions 4: Ankylosis
Absolute and relative contraindications in THA
Absolute: Infection, medically unstable, neuropathic pain Relative: Young, active pts
Cause of osteolysis
Macrophage response to submicron sized wear particles.
Hilgenreiner’s line
Horizontal line through tri-radiate cartilage.
Perkin’s line
Vertical line through the lateral edge of acetabulum
Shenton’s line
Curved line from the femur and pelvis
DDH
Abnormal hip development causing dislocation, subluxation, or laxity of the hip
Risk factors for DDH?
Female, first born, breech, family hx,
1 cause of intoeing?
femoral anterversion
Legg-Calve-Perthes disease
idiopathic AVN of femoral head. 4-8 year old boys
Slipped capital femoral epiphysis (SCFE)
Displacement of the femoral epiphysis through the physis. 10-16, obese
Smith-peterson approach IN planes Dangers
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.
Ludloff approach IN planes Dangers
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
Watson-Jones approach IN planes Dangers
Anterolateral hip InterMUSCULAR planesL TFL (SGN) and gluteus medius (SGN) Dangers; Descending branch of LFCA, femoral n
Hardinge approach IN planes Dangers
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
Moore/southern approach IN plane Dangers
Posterior hip IN plane: split gluteus maximus (IGN) Dangers; Sciatic nerve, inferior gluteal artery, MFCA
Lateral thigh approach IN plane Dangers
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.
Hip arthoscopy portals (3)
Anterior - LFCN, femoral n, ascending branch of LFCA Anterolateral - SGN Posterolateral - Sciatic n.
