Transcript Hip_Conditions_AFAMS

An orthopaedic overview
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Characteristic Hip Pains:
◦ Dull ache- OA, degenerative, tendinitis/ bursitis
◦ Sharp – Impingement, acute sprain, labrum tear,
subluxation/dislocation, fracture
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Pain frequently noted in groin and medial
thigh
Symptoms: pain, weakness, numbness,
clicking, giving way
Referred Pain from: Back, Abdomen, Pubic
symphysis
Refers Pain to: knee
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Mechanism: High energy:
◦ Motor vehicle crash (50-60%)
◦ Motorcycle crash (10-20%)
◦ Pedestrian versus car (10-20%)
◦ Falls (8-10%)
◦ Crush (3-6%)
Physical examination is specific for pelvic
instability, but it has a low sensitivity: high level
of suspicion
Pain, swelling, WB/NWB, deformity, crepitus,
Consider Blood loss and signs of shock
GU exam: rectal tone, bladder control,
perineum, boggy prostate, scrotal hematoma,
hematuria
digital rectal examination has a very low
sensitivity for diagnosing pelvic fractures
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Management: pelvic binder (T-pod),
IV, analgesia, Blood,
Evacuation for surgical assessment
X-ray: pelvic ring- usually disrupted
in 2 places
Tile classification: based on the
integrity of the posterior sacroiliac
complex
Young classification system is based
on mechanism of injury
Death most commonly due to
hemorrhage or multiple injuries
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Mechanism: high velocity trauma,
MVA, falls from height
Multiple fracture patterns: MOI
Pain, non WB, presentations of hip,
Neurovascular exam, abdominal
exam, LLD, position of lower limb
Stabilize, IV, analgesic,
Evacuation for X-ray, surgical
assessment
20% concomitant pelvic fracture
“People come into this world under
the brim of the pelvis and leave it
by the neck of the femur.”
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MOI: Young- MVA, fall from height
◦ Older: simple fall, Osteoporosis: abrupt
step, Runners: stress fractures
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Acute onset hip pain, unable to WB
O/E: shortened leg, external rotation,
painful ROM, crepitus
Neurovascular exam
Stabilize, IV, analgesia
Evacuation for X-ray and surgical
assessment
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Garden
Classification: 1-4
Treatment:
◦ Young: internal
fixation (+/reduction)
◦ Older: internal fixation
non displaced, hemiarthroplasty
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Extra-capsular fracture including the
greater and lesser trochanter (b/w
neck and shaft)
Traumatic force to trochanteric area
Acute pain, unable to WB, shortened,
ER
Stabilize, IV, analgesic
Evacuation for X-ray, surgical
assessment
Treatment: Dynamic Hip Screw
fixation
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Mechanism: high energy trauma
Pain, deformity, Non WB
Neurovascular status: urgent reduction?
Procedural sedation, blood loss into
fracture site…1000mL
Reduction, immobilize, IV, analgesia,
Blood products, +/- antibiotics
Evacuation to surgical capability
Surgery: internal fixation- IM nail/ plate
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Complications:
◦ Haemorrhage requiring transfusion
◦ Fat embolism – ARDS
◦ Increased risk of open fracture
◦ Nerve injury
◦ Infection
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Supracondylar: above condyles
Condylar, Inter-condylar= intra-articular
involvement
Mechanism: high energy force, axial
load
Pain, hemarthrosis, non WB, ER,
shortened
Immobilize, IV, analgesia
Evacuation for surgical fixation
Complication: femoral artery tear
A.Anterior
B.Posterior
***Orthopaedic Emergency
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Mechanism: blow to knee in hip
abduction
Shortened, abducted, ER limb
Neurovascular exam
Stabilize, IV, analgesia,
Urgent Evacuation for X-ray, reduction
under sedation/GA
Complications: as per posterior
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***Orthopaedic Emergency
Mechanism: high force through femur
with hip in flexion and adduction
(dashboard )
Pain, Shortened, Add and IR of hip
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Stabilize, IV, analgesia,
Urgent Evacuation for X-ray- r/o fracture,
reduction under sedation/ GA, ORIF
risk of AVN with delayed reduction (>6 hrs)
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Slow onset degenerative change often
following injury or prolonged exposure to
impact, poor biomechanics, congenital hip
disorder
Pain into groin and medial thigh
worse with activity, intermittent flares with
acute pain and swelling
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O/E: trendelenberg gait, decreased ROM, strength
deficit, ligament laxity
X-ray: decreased joint space, osteophyte
formation, sclerosis of femoral head, subchondral
cysts
Treatment: NSAIDS for acute flare, Tylenol/NSAID
for long-term analgesia
Physiotherapy: ROM, strengthening, gait aids
Partial/Total hip replacement
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Etiology: Loss of vascular supply to femoral
head
Primarily distal to proximal intra-osseous
blood supply
Predisposing factors: systemic steroid,
dislocation of femur, fracture of femoral
neck, chronic alcohol use, sickle cell, septic
arthritis, “the Bends”
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Symptoms: Pain in groin, worse with WB
O/E: abnormal range of motion if collapse of
cartilage on femoral head
Normal strength on manual muscle testing
Pain on compression testing
X-ray may show crescent sign
Treatment: Non WB until new bone formation
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Etiology: trauma to hip, abnormal gait mechanics,
muscle tightness, over-training
Rule out cellulitis or infection
Pain at lateral aspect of hip, worse with weight
bearing/ walking/ direct pressure
O/E: pain on palpation over greater trochanter, +/tight ilio-tibial band, muscle imbalance, pain on
single leg stance
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Treatment: Rest, Ice, NSAIDS
Physiotherapy for stretching, muscle
imbalance
Consider corticosteroid injection for
refractive conditions
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Abnormal contact between the acetabulum
and femoral head-neck junction
Primarily an impingement issue
Groin pain with activity or extreme ROM
Usually younger active people
Can lead to labral tears
A. Rectus femoris
B. Vastus lateralis
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Adductors: groin pull
Hip flexors: Rectus femoris strain
Snapping hip: iliopsoas
Piriformis syndrome
Iliotibial band syndrome
Gluteal strain
Let’s take a break.