Week 4 Flashcards
Development dysplasia of the hip
- description
- dx
- tx
- Femoral head doesn’t sit completely inside acetabulum
- 2ndary to capsular laxity and mechanical factors
2a) Ortolani’s test
- elevate hip and abduct of femur
- hip is reducible
b) Barlow’s test
- adduct and depress femur
- hip is dislocatable out the back
c) Ultrasound
- Achieve and maintain early, concentric reduction
- pavlik harness
- closed and open reduction
- osteotomies
Slipped capital femoral fracture
- description
- epidemiology
- clinical presentation
- tx
- Slip through the growth plate
- The femoral head remains in the acetabulum, the neck is displaced anteriorly and externally rotates - Seen most commonly in
- Adolescent, obese, African American boys - Presentation
• Limp
• Externally rotated gait
• Obligatory external rotation with hip flexion • Decreased hip internal rotation
• Hip, thigh
• Knee pain - referred from obturator nerve - Stick a pin going through head and neck until growth plate heals and solidifies
Femoral shaft fracture tx
- Restore limb length
- Restore alignment
- Restore rotation
- use intramedullary nail
- early stabilization important to reduce blood loss and fat emboli
Which vessels provide blood to head of femur
Circumflex femoral vessels and obturator artery
AVN
- what happens
- most common non-traumatic causes
- imaging
- tx
- occlusion of vessels leading to bone necrosis and cartilage collapse
- alcoholism and steroid use
- X-ray + MRI (for earlier stages)
TREATMENT
i. Early stages
1. Bisphosphonates
2. Anticoagulants
ii. Core decompression
1. Unpredictable outcome
iii. Rotational osteotomy
1. Cut and rotate proximal femur towards a better weight bearing area of bone
iv. Vascularized fibular strut grafting
v. Hip arthroplasty
1. Do this if there is an area of collapse
Greater trochanteric bursitis
- presentation
- tx
- pain right over the greater trochanter
- bursitis b/w greater trochanter and IT band
TX
- activity mods
- anti-inflammatories
- physical tx -> stretches to give bursa more room
- cortisone injection -> to help w/ PT
Wear and tear arthritis =
- what increases risk
- presentation in the hip
- physical exam
- imaging
- tx
osteoarthritis
-obesity, age, FH
- Stiffness in the hip
- Pain “flares”
- Groin pain - always check hip w/ groin pain
- Limp
PHYSICAL EXAM
• Decreased range of motion
• Internal rotation most often restricted
• Obligatory external rotation of the hip when flexed
• Limp
• Reproducible groin pain
XRAYS • Joint height narrowing • Sclerosis • Cystic formation • Osteophytes
Tx
- Start w/ activity mods and ice
- Anti-inflammatory
- Cortisone injection
- Only “cure” is total hip replacements
Hip fracture
-younger vs older patients
i. In younger patients -> preserve bone and cartilage as much as possible
ii. Older -> harder to heal so reduction and fixation on some and total hip replacements on others
iii. In older individuals -> very high (30-50%) 3 month mortality rate
Unique aspect of seronegative spondyloarthropathies
Enthesitis -> inflammation of insertion of ligament or tendon into the bone
Key feature to separate mechanic back pain from inflammatory
inflammatory gets better w/ exercise
Progression of anklylosing spondylitis
Bilat SI inflammation w/ pain in gluteal area -> ossification of spinal ligaments (bamboo spine)
Reactive arthritis presentation
asymmetric inflammatory oligoarthritis that develops 1-4 weeks after a nongonococcal urethritis or an infectious diarrhea; usually involves joints in the lower extremities
Triad for Reiter’s syndrome
- Nongonococcal urethritis
- Uveitis/Conjunctivitis
- Arthritis of large joints (inflammatory)
Organisms associated with Reactive arthritis
U CCSSY
Ureaplasma
Campylobacter Chlamydia Salmonella Shigella Yersinia
Other key manifestation unique to reactive arthritis
- Oral ulcers
- Keratoderma blenorrhagica—erythematous scaly hyperkeratotic skin lesions on palms and soles
- Circinate balanitis—red scaly area on the glans penis with a gray, serpiginous annular edge that spreads outwards in phases
IMAGING
-asymmetric non-marginal jug handle syndesmophytes
Unlike in RA, which phalangeal joints can be involved with psoriatic arthritis?
DIP
dactylitis w/ pitting for finger nails
Which type of arthritis with PA?
- most commonly asymmetric oligoarthritis
- can also be poly like RA
Arthritis mutilans
- associated with PA or poorly managed RA
- complete joint erosion
Imaging finding with PA
Pencil in a cup sign -> central erosion
Followed by ankylosis
Spondyloarthropathy -> comma shaped
Key points about paget’s disease
- most common location
- number of bones involved
- uni or bi lateral
- pelvis
- polyostotic
- unilateral
T1 vs T2 MR imaging
T1 -> bone, vessels, nerve (any soft tissue)
T2 -> fat suppression (appears dark)
- so fluid can show up bright
- good for looking at edema
3 general fractures
- Traumatic
- Stress
A) Fatigue - abnormal stress across normal bone
B) Insufficiency - normal stress across abnormal bone
1 cause of AVN
- trauma
- most occur at head of femur
Radiology signs of quadriceps tendon rupture
fat pad displaced anteriorly
->edema in suprapatellar bursa
